Gastroesophageal Reflux Disease and Heartburn (GERD)

What is GERD/ Heartburn?

Symptoms
Everyone has heartburn and acid reflux occasionally. Heartburn is extremely common; approximately 10% of the population experience it daily. Heartburn occurs when stomach acid flows upward (regurgitates) into the esophagus. Heartburn usually feels like a burning sensation or pain in the pit of the stomach or in the chest, behind the breastbone. Regurgitation of bitter tasting stomach acid can sometimes accompany heartburn. Heartburn usually occurs after a large meal containing fatty, fried foods or very acidic foods. Thankfully heartburn is rarely serious; it can however significantly impact your quality of life.

What Causes Heartburn
Heartburn is a symptom of gastroesophageal reflux disease (G.E.R.D.). Chronic acid reflux can be caused by a malfunction of a small valve at the base of the esophagus called the lower esophageal sphincter (L.E.S.). The L.E.S. muscle should only open when food or liquid is being swallowed and passing through to the stomach. Sometimes the L.E.S. is too weak to stay completely closed, and stomach acid can reflux back up into the esophagus. Your stomach produces a strong acid to help you digest your food; the stomach has a lining to protect itself from the effects of the acid. Unfortunately, your esophagus does not have this protective lining and can be easily irritated by the reflux of acid, causing painful symptoms. If the reflux is frequent and/or prolonged you may develop G.E.R.D., which refers to having severe damage, not just simple heartburn. The lining of the esophagus may become inflamed (esophagitis), which can cause significant pain, especially while swallowing. Ulcers may develop in the esophagus and, if not treated, they may cause significant bleeding.

Continuous inflammation over many years may cause scar tissue to develop, which may narrow the esophagus and make swallowing difficult. Some people complain of food getting stuck in their esophagus. Your doctor may need to dilate or “stretch open” your esophagus if it is difficult for you to swallow solid foods.

Chronic acid reflux over a long period of time can also lead to a condition called Barrett’s Esophagus. The risk of developing cancer of the esophagus is higher in people with Barrett’s. If you have Barrett’s Esophagus you will need to be screened regularly by your doctor.

Diagnosis
There are several ways to evaluate heartburn and reflux disease.

Treatment
Treatment for acid reflux may be as simple as making some minor lifestyle changes such as changing your eating habits. Some general guidelines for treating heartburn and acid reflux are:

In mild cases of G.E.R.D. making the above modifications and taking occasional antacids (Tums, Mylanta, Maalox, Rolaids, etc.) may be sufficient. In more severe cases of reflux, stronger medication (Zantac, Tagamet, Prilosec, Prevacid, Aciphex, Nexium, Protonix) may be prescribed by your doctor to effectively reduce the secretion of stomach acid, thereby reducing acid reflux. Short-term use of these medications is very safe; the effects of long term use are not yet known.

Surgery is reserved for those patients with symptoms that cannot be handled with medications. Surgery for reflux disease can now be accomplished laparoscopically, which greatly reduces hospital stay and recovery times, making surgery a more viable option for many.