Gastroesophageal Reflux Disease

With GERD, It is common for many patients to experience symptoms of reflux and most are controlled with lifestyle modification, dietary change and medication alone.

Many patients with reflux also have a small hiatal hernia. Having a hiatal hernia is not typically a situation when you can feel a “bulge” or protrusion of the hernia in the abdominal wall.

Smaller hernias can lead to gastroesophageal reflux and large hernias can cause the blockage of food passing from the esophagus to the stomach. (Please reference paraesophageal hiatal hernia.)

Symptoms

GERD symptoms may include:

• Burning in the throat or chest occasionally associated with eating
• Waking up at night with a cough or the regurgitation of stomach acid
• Chest pain or abdominal pain particularly after eating
• A sour taste in the back of the throat
• Worsening asthma type symptoms or shortness of breath

Risk Factors

Risk factors for GERD include:

• Advancing age
• Obesity
• A poorly functioning lower esophageal valve

Types

There are several types and forms of GERD:

• Hiatal hernias are graded by size on a scale of 1 through 4
• 1 is the smallest and is the most common associated with symptoms of heartburn or gastroesophageal reflux
• Types 2 through 4 are when larger portions of the stomach protrude through the diaphragm causing a variable number of symptoms. (Please reference paraesophageal hiatal hernia.)

Diagnosis

GERD diagnosis can involve:

• An endoscopy (EGD/scope) of the esophagus, which can demonstrate a hypertensive or overly compliant lower valve
• A barium swallow which is a test where contrast material is swallowed and x-rays are taken which can clearly outline a tapering of the distal esophagus
• Most critical in making the diagnosis is functional esophageal testing called esophageal manometry which will measure pressures throughout the esophagus

Causes

GERD may be caused by:

• Small hiatal hernias
• Obesity
• Persistent pressure on the stomach and esophagus/diaphragm with coughing, weight lifting, aggressive exercise, straining with bowel movements which disrupt the valve between the stomach and esophagus

Treatment

For most, surgical treatment is not necessary to manage gastroesophageal reflux disease. Treatment options may include:

• Weight loss, which is important particularly if your BMI is greater than 30
• Dietary modification including avoiding products such as tomato, citrus, chocolate and caffeine (which tend to worsen symptoms)
• Elevation of the head of your bed particularly with choking or gagging at night
• Smaller meals and avoiding meals late in the evening
• Often your doctor may recommend medication to help control reflux symptoms
  • The options include antacids which neutralize stomach acid such as Mylanta or Tums; medications to reduce acid production known as H2 receptor blockers such as famotidine or Pepcid; medications that block acid production and heal the esophagus known as proton pump inhibitors such as omeprazole or Prilosec
• Surgery can play a role in the management of gastroesophageal reflux disease but only with significant study and testing prior to any procedure to ensure success
  • Surgical options include endoscopic approaches such as a transoral incisionless fundoplication (TIF); the placement of a LINX device which is a tiny ring of magnetic beads to augment the valve; and a fundoplication with the surgeon uses the top of the stomach to reconstruct the valve typically done in a laparoscopic or minimally invasive fashion

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