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Gastroesophageal Reflux Disease

Disease Summary:

Gastroesophageal reflux disease or GERD occurs when acid from the stomach backs up or refluxes into the esophagus.  The lining of the esophagus is not acid resistant, and the reflux of acid into the esophagus causes heartburn.  GERD is when a person has chronic recurrent symptoms.   Other symptoms that may be associated with GERD include a chronic cough, hoarseness, and difficulty swallowing.  The prolonged contact of stomach acid may injure the lining of the esophagus.  Individuals who have chronic GERD are at risk for the development of Barrett's esophagus, which is a condition that can lead to esophageal cancer.  Fortunately, the risk of cancer is low; however, your doctor will recommend periodic endoscopy exams to assess for any signs of progression to cancer if an individual has Barrett's esophagus.  


There are lifestyle modifications that are helpful in treating GERD.  Avoiding foods and beverages that contribute to heartburn such as chocolate, coffee, caffeine, greasy or spicy foods, tomato products, and alcoholic beverages.  Individuals should also stop smoking.  Tobacco inhibits saliva production, which is the major buffer to stomach acid in the esophagus.  If one is overweight, losing weight is beneficial.  Also, avoid tight-fitting clothes.  Do not eat within two to three hours of bedtime.  Eating smaller meals and not lying down after eating will also be beneficial.  One may also elevate the head of your bed to reduce reflux events.(sleeping on extra pillows will not work).


Some individuals will have relief of their heartburn with lifestyle changes.  Others may continue to have symptoms and require medication such as H2 blockers or proton pump inhibitors (PPIs).  Additional testing may be required in individuals that do not respond to medical therapy or have complications from GERD such as difficulty swallowing, choking, or bleeding.  Evaluation of GERD may require several tests including upper GI series, upper endoscopy, esophageal manometry, or PH testing. An upper GI series is performed with x-ray after an individual drinks barium, which coats and fills the inside of the esophagus, stomach, and first portion of the small intestine (duodenum).  Upper endoscopy involves passing a flexible lighted tube (endoscope) through the mouth into the esophagus, stomach, and duodenum to exam for any abnormalities.  This is usually done with sedation.  It is the best test to identify and look for Barrett's esophagus. 


Tissue samples (biopsies) can be taken.  Esophageal manometry and esophageal pH testing may also be performed to assess the function of the esophagus and the amount of acid in the esophagus.

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