Gastroesophageal Reflux Disease (GERD)

Overview

Gastroesophageal Reflux Disease (GERD) is a digestive disorder in which stomach acid frequently flows back into your esophagus, the long, muscular tube that connects the mouth and stomach. Over time, this acid can irritate the lining of your esophagus, causing pain, discomfort and other symptoms.

Usually, GERD is caused by a weakened lower esophageal sphincter (LES), which is the ring of muscle at the bottom of the esophagus that normally relaxes when you swallow, allowing food to enter the stomach. In those with GERD, this ring of muscle is weakened or doesn’t relax as it should, allowing stomach acid or partially-digested food to flow back into the esophagus.

GERD is considered a long-term, frequently-recurring type of gastroesophageal reflux (GER). GER is commonly known as acid indigestion, acid reflux or “heartburn.” Most people experience GER every once in a while, but if you regurgitate stomach acid frequently, you may have GERD.

If left untreated long-term, GERD can sometimes cause serious and even life-threatening complications in rare cases. GERD has been connected to a slightly higher risk of esophageal cancer, especially in those who experience symptoms frequently. GERD can also cause a related condition called Barrett’s esophagus, which can increase your risk of developing esophageal cancer even more.

Why Hoag for GERD Evaluation and Treatment?

Because long-term GERD can increase your risk for both esophageal cancer and a related condition called Barrett’s esophagus — which can increase your cancer risk even more — getting your frequent heartburn in check shouldn’t be an afterthought. It should be a priority.

Need treatment for GERD in Orange County? Trust the Hoag Digestive Health Institute to help you heal. Hoag’s comprehensive, fully-integrated Foregut Program is the best in the business when it comes to treating serious or recurring conditions of the esophagus, stomach and lower esophageal sphincter. Our program offers a patient-centered approach, drawing on the latest advancements in techniques and technology to help patients find lasting, life-changing treatments.

Your recurring heartburn may be a sign of more than your love of hot wings. Get it checked out, and get the answers you can trust, at Hoag.

Symptoms and Causes of GERD

The symptoms of GERD are different for every patient. However, the most common symptom is frequently-recurring acid reflux (AKA “heartburn”), which is a painful, burning sensation in the center of your chest, usually after eating. This sensation, which is caused by stomach acid and partially-digested stomach contents being regurgitated into the esophagus, may become worse after you lie down.

Though rare, GERD has been linked to a slightly-increased risk of esophageal cancer. If left untreated long-term, GERD can sometimes also lead to the development of a condition called Barrett’s Esophagus, in which the lining of the esophagus becomes thickened and red due to repeated exposure to stomach acid. Having Barrett’s esophagus boosts the risk of developing esophageal cancer even more.

Other common symptoms of GERD may include:

• Chest pain
• Recurring nausea
• Trouble swallowing, or pain when swallowing
• Chronic or recurring cough
• Having a hoarse speaking voice
• Feeling like there’s a “lump in your throat”
• New or more frequent asthma attacks

Risk Factors

• Being overweight or obese
• Being pregnant
• Having a hiatal hernia, which is a condition in which the upper part of the stomach can move up into the chest
• Smoking
• Taking certain medicines, including:
  • Benzodiazepines
  • Tricyclic antidepressants
  • Certain asthma medicines
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Calcium channel blockers, which are used to treat high blood pressure

Diagnosis and Tests for GERD

If you visit a doctor with symptoms that suggest you may have gastroesophageal reflux disease (GERD), the doctor will likely talk to you about your symptoms and medical history, followed by a thorough physical examination.

In most cases, physicians can diagnose GERD based on a review of symptoms and medical history alone and move straight to treatment.

However, if you have symptoms that suggest a serious complication of GERD, such as Barrett’s esophagus, or if your symptoms suggest you may have a health issue that may be mimicking the symptoms of GERD, your doctor may recommend more tests to confirm his or her diagnosis.

These diagnostic tests may include:

• Upper gastrointestinal (GI) endoscopy, in which a specialist puts a long, flexible tube with a light and a camera on the tip into your mouth and down the esophagus to check for issues related to GERD and collect tissue samples for examination in a lab
• Esophageal pH monitoring (AKA an ambulatory acid probe test), which checks for the presence of stomach acid in the esophagus. During this test, you’ll be asked to wear an electronic monitor that collects information about your symptoms, sleep and diet. This information is generally collected in one of two ways:
  • Catheter monitoring, in which a small tube is passed through your nose and down your throat to monitor the esophagus for acid reflux
  • Capsule monitoring, in which a specialist uses an endoscope to place a wireless capsule in the lining of your esophagus.
• Esophageal manometry, which measures the force of the muscle contractions in your esophagus during swallowing
• A barium-swallow X-ray, in which X-rays are taken of the stomach and esophagus after the patient has swallowed a chalky liquid called barium, which makes the esophagus and stomach show up more clearly in imaging

Explore Hoag’s Orange County endoscopy centers located near you

Orange County’s Most Advanced Diagnosis of Conditions of the Esophagus and Stomach

As Orange County’s recognized leader in the accurate diagnosis and treatment of conditions involving the stomach and esophagus, the Hoag Digestive Health Institute is here for those facing serious conditions involving these crucial digestive organs, including GERD, Barrett’s esophagus and esophageal cancer.

At Hoag, advanced procedures used to diagnose or treat conditions involving the stomach and esophagus include:

• Abdominal Ultrasound
• Barium Swallow X-ray
• Capsule Studies
• Esophageal Bravo pH Monitoring
• Esophagogastroduodenoscopy (EGD)
• Endoscopic Ultrasound (EUS)
• Esophageal Manometry (EM)
• Gastric Emptying Test (GET)
• Video Esophagram

Management and Treatment of GERD

Unless you have symptoms that suggest a serious complication like Barrett’s esophagus or esophageal cancer, your doctor will likely begin treatment following a GERD diagnosis by recommending lifestyle changes and medications to help reduce the amount of acid in your stomach.

Lifestyle Changes

Commonly-suggested lifestyle changes to help treat GERD include:

• Lose weight if you are overweight or obese
• Quit smoking
• Elevate your head 6-8 inches while sleeping by using a foam wedge or extra pillows, or by placing blocks or risers under the feet of the headboard of your bed
• Wait at least three hours after meals before lying down
• Avoid foods that you know are a heartburn/acid reflux trigger for you

Medications

Over the counter medications that are often initially recommended to help treat GERD include:

• Antacids with calcium carbonate, which are generally recommended for mild symptoms. However, antacids can’t heal damage to the esophagus, and may cause constipation or diarrhea
• H2 blockers, which decrease how much acid your stomach produces. H2 blockers can help heal the esophagus, and are available either over the counter or by prescription
• Proton Pump Inhibitors (PPI), which also lower the amount of acid your stomach makes. In general, PPIs are considered better at treating GERD symptoms than H2 blockers. They are also available either over-the-counter or by prescription.

Surgery (Rare)

In very rare cases in which GERD doesn’t improve following medication or lifestyle changes, your doctor may recommend a surgical procedure. These may include:

• Fundoplication, in which a surgeon joins the top of the stomach around the end of the esophagus to reinforce the lower esophageal sphincter (LES) and prevent acid reflux.
• Bariatric surgery, which can help obese patients lose weight, which can reduce the symptoms of GERD. Learn more about bariatric surgery at Hoag.

Advanced Treatment Options for GERD at Hoag

We’re committed to finding and using the latest and most advanced treatment options for conditions involving the esophagus and stomach. At Hoag, options for the treatment of GERD include:

• LINX Reflux Management System, which is an implantable, FDA-approved device that treats GERD symptoms and stops reflux. Hoag is one of only a handful of centers in California to offer this life-changing technology. Watch a short video about the LINX Reflux Management System.
• Nissen Fundoplication, which is a surgery to reinforce and strengthen the lower esophageal sphincter
  Toupet Fundoplication: Anti-Reflux Surgery, which a type of anti-reflux surgery that is most often used in cases where the patient has difficulty swallowing in addition to traditional reflux symptoms.
• Transoral Incisionless Fundoplication (TIF), which is a minimally invasive, non-surgical procedure that corrects a weakened esophageal sphincter, which causes chronic gastroesophageal reflux disease (GERD). The TIF procedure is performed entirely within the stomach, using an endoscope passed down the throat, and requires no incisions.

Prevention of GERD

There’s no known way to definitely prevent yourself from developing GERD. However, there are certain steps you can take to reduce your risk of developing the condition. These may include:

• Eat a balanced, healthy diet
• Maintain a healthy weight
• Don’t smoke
• If you experience acid reflux at night, elevate your head 6-8 inches with extra pillows or a foam wedge, or by placing blocks or risers under the feet of your headboard
• Sleep on your left side, which may make it less likely you’ll experience reflux
• Get screened for hiatal hernia, which is a condition in which the upper part of the stomach can move up into the chest
• Tell your doctor if you begin experiencing acid reflux or GERD symptoms while taking certain medicines, including:
  • Benzodiazepines
  • Tricyclic antidepressants
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Calcium channel blockers, which are used to treat high blood pressure