Dr. Arif Ahmad is the Director of the Acid Reflux and Hiatal Hernia Centers of Distinction at St. Charles and St. Catherine of Siena Hospital.
What is GERD?
Gastroesophageal reflux disease (GERD) is a condition where the stomach acid leaks into your food pipe (esophagus) causing a burning sensation in your chest and other associated symptoms.
Everyone experiences acid reflux once in a while after a heavy meal or when lying down. However, people with GERD experience acid reflux on a regular basis, often more than twice a week, and it could lead to serious health concerns and negatively impact quality of life.
What Causes GERD?
GERD occurs as a result of the weakening of the lower esophageal sphincter (LES) which is a muscular ring that connects the lower part of the esophagus to the stomach. The function of the LES is to prevent the backing up of food and stomach acids into the esophagus, but when the sphincter is weak, it fails to close tightly enough resulting in acid reflux. The other common way it occurs is due to the LES opening too frequently.
Risk Factors for GERD
Factors that may contribute to the development of GERD include:
- Hiatal hernia
- Loose LES
- Natural weakness of the lower esophageal sphincter
- Consuming too much oily and spicy foods
- Certain types of medications
- Drinking alcohol
- Lying down after a heavy meal
What are the Symptoms of GERD?
You may experience the following symptoms:
- A harsh, burning sensation in your chest rising from your stomach
- Regurgitation of partially digested food
- Sour taste in the mouth
- Nausea and vomiting
- Chronic coughing or wheezing
- Difficulty swallowing
- Hoarseness of voice
- Sore throat
- Bad breath
What if GERD is Left Untreated?
If left untreated, GERD can cause bleeding, perforation, ulcer, scarring, or precancerous changes in the mucosal lining of the esophagus.
Diagnosis of GERD
To diagnose your condition, your doctor will discuss the frequency of your symptoms as well as the aggravating and relieving factors and perform a physical examination. The following diagnostic tests may be ordered:
Endoscopy: A fiberoptic camera is introduced through your mouth allowing visualization of the esophagus to look for signs of GERD. This is a day procedure.
Radiology: CT scan, X-rays.
Esophageal Manometry: It is a method of testing the strength and efficiency of oesophageal contraction. A thin tube is passed through your nose down your throat and into the esophagus. The pressure on the tube is measured as you eat different types of food.
pH Study: It is performed to check the acid levels in your esophagus
Impedance Testing: It is performed to check for non-acid reflux in your esophagus
Treatment of GERD
The three progressive stages of treatment of GERD are:
The first line of treatment would be lifestyle changes such as:
- Avoid foods that aggravate GERD symptoms
- Eat smaller meals
- Do not lie down for at least 3 hours after a meal
- Maintain a healthy body-mass index
- Elevate the head of your bed while lying down
- Stop smoking
- Reduce alcohol consumption
If lifestyle changes do not resolve symptoms, you may have to use medications such as:
- Antacids - These are medications that neutralize the effect of stomach acids.
- Acid-suppression medications – These medications suppress the production of stomach acids. These include H2 Antagonists and PPIs
If medications and lifestyle treatments fail to resolve your GERD symptoms, or you are having side effects from medications, or you do not want to remain on lifelong medication, surgery should be considered. Our practice offers the latest surgical treatments such as robotic surgery and laparoscopic anti-reflux surgery to ensure positive outcomes and quick return to activities of daily living. This is usually done through keyhole incisions and you have a short hospital stay, usually just overnight. You can return to work after one week and will have a modified diet for 4 weeks post-op. We also offer the latest antireflux surgery with the use of LINX procedure (Magnetic Sphincter Augmentation).