Gastroesophageal Reflux Disease or GERD
Acid reflux occurs when highly acidic gastric juices from the stomach push up into the esophagus, irritating its sensitive lining. Gastroesophageal reflux disease or GERD is the medical term for chronic acid reflux – reflux that occurs several times per week over the course of several weeks or months. GERD is estimated to affect upwards of 20 million Americans with millions more suffering from less frequent, but still significant, acid reflux symptoms.
Symptoms of GERD
The most common symptoms of GERD include:
- Pain, or a burning sensation in the chest
- Difficulty swallowing
- In severe cases, difficulty breathing due to the narrowing of the esophagus
- Bad breath
- Yellowing teeth
Symptoms commonly get worse after a meal consisting of acidic, spicy, fatty, carbonated or caffeinated food and drinks. Symptoms may also worsen when the patient lies down, especially shortly after eating.
Causes of GERD
The most common cause of GERD is dysfunction of the lower esophageal sphincter or LES – a one-way valve between the esophagus and the stomach. If this sphincter does not close completely, it may allow acid to push back up in the esophagus. Common LES disorders stem from excess abdominal pressure including obesity, pregnancy and more. The problem may also be congenital – meaning that it has existed from the patient’s childhood.
Consequences of Untreated GERD
As the acidic contents of the stomach wash on to the sensitive lining of the esophagus, the cellular composition of the esophagus may change. This is known as Barrett’s Esophagus, which is diagnosed via biopsy. Rarely, Barrett’s Esophagus may lead to esophageal cancer. We believe that the increase in esophageal cancer in the United States today is, at least in part, due to the obesity epidemic that has caused an increased in gastric reflux disorders.
Treatment Options for GERD
There are several treatments for GERD but almost all patients will be encouraged to change their lifestyle by losing weight, eliminating reflux triggers from their diet, and exercising more. Lifestyle changes often improve the symptoms of GERD significantly, but many patients are not able to maintain these changes.
The next course of action is medication in the form of antacids that neutralize stomach acid, or PPIs – Proton Pump Inhibitors – that block the production of stomach acid. Most patients find significant relief from medication, but a significant number may find that a) the medication does not offer sufficient relief or b) the side effects of the medication impair their lifestyle and are unacceptable.
For those whom lifestyle change and medication has not offered significant relief, we offer two surgical options for the treatment of GERD:
- The first is the Nissen (total) or partial fundoplication, which involves wrapping the upper portion of the stomach around lower part of the esophagus to increase pressure on the lower esophageal sphincter. This is also the definitive treatment for a paraesophageal hiatal hernia.
- The second surgical option involves the LINX Reflux Management device. This is a small “bracelet” made of titanium beads and a magnetic clasp that is placed over the LES in a short outpatient procedure. The device addresses many of the common considerations of a fundoplication while also being very effective.