Definition:

Also known as chronic heartburn and reflux esophagitis, GERD often occurs after eating a meal.  It is when the food/liquid moves against the normal flow, from the stomach into the esophagus.  Since the stomach contains lots of acid to break down, this backflow irritates the esophagus.  Causes include incomplete closure of the lower esophageal sphincter (the valve between the esophagus and stomach), hiatal hernia, obesity, esophageal surgery, and pregnancy.

Symptoms:

• Burping/belching
• Nausea/vomiting
• Sore throat
• Difficulty swallowing (dysphagia)
• Hoarseness/wheezing/cough
• Heartburn - relieved by milk, frequent at night, increased by movement

Diagnosis:

• Stool test - to see if there is blood in the stool
• Esophageal pH monitoring - to see if the esophagus contains stomach acid
• Endoscopy - visualization of inflammation of esophagus
• Esophageal manometry - to test lower esophageal sphincter pressure
• Barium swallow - contrast visualization of backflow
• Bernstein test - a test to see if gastric acid reflux occurs

Treatment:

• Lifestyle
  • Lose weight
  • Not lying down after a meal
  • Medication/water
  • Avoid fatty foods, chocolate, caffeine, spicy foods, mints
• Medication
  • Antacids (Maalox, Mylanta, etc.)- to compensate acid in the esophagus
  • Histamine H2 receptor blockers (Zantec, Pepcid AC, Tagamet, etc.) - to reduce acid production
  • Proton pump inhibitors (Prilosec) - blocks acid production
  • Promotility drugs (Reglan) - to increase movement of food through the GI tract
• Surgery
  • Endoscopic intervention - tightening the lower esophageal sphincter using sutures/stitches
  • Fundoplication - using the stomach to wrap around the lower esophageal sphincter to strengthen the sphincter and/or close a hiatal hernia