GERD

alt

GERD (Gastro Esophageal Reflux Disease)

Overview

GERD is an acronym for a very common condition called "Gastroesophageal Reflux Disease." It is a disease that is suffered by millions of Americans. Patients with GERD experience a reflux of acid into their esophageal tract. The most common symptom of GERD is heartburn, a burning sensation just below the heart, which occurs right after a big meal; however, in some cases GERD is caused by physiological irregularities which are very serious and can be quite painful if left untreated.

Your gastrointestinal tract includes a number of organs that aid in the process of digestion. The esophagus is a long tube, which begins at the pharynx and ends at the diaphragm. It's actions are controlled through a combination of muscle and nerve activity. The primary function of the esophagus is to move food toward the stomach by swallowing (peristalsis). Once the food has passed into the stomach the esophagus also prevents food and stomach acid from regurgitating by using the Lower-Esophageal Sphincter (LES). The LES is an area of thickness located at the end of the esophageal tract, right before the entry into the stomach. After peristalsis, the LES tightens preventing the reflux of food and acid. The dominant cause of GERD is due to improper LES function.

Should any material be regurgitated back into the esophageal tract, it will be cleared through a process of secondary peristalsis. In some patients suffering from GERD, stomach acid can remain in the esophageal tract for several hours because of ineffective secondary peristalsis.

In addition to improper LES function, there are certain physiological and lifestyle factors that can also increase the incidence of GERD. Two physiological factors include:

	Decreased salivation: your saliva contains bicarbonate, a substance that neutralizes stomach acid. If you are not producing enough saliva to properly coat your food, stomach acid will remain potent and caused prolonged acid exposure to the esophageal tract.
	Impaired tissue resistance: the lining of your esophageal tract is designed to protect itself from stomach acid. It also produces bicarbonate to neutralize the acid. In some patients, this built-in protection system operates ineffectively, thereby causing GERD. This factor is more common in patients over the age of 40.

There are several lifestyle risk factors that can increase the incidence of GERD:

	Smoking
	Large meals
	Fatty foods
	Caffeine
	Pregnancy
	Obesity
	Body position
	Hormones

Symptoms

GERD can have multiple effects on various parts of the body. Symptoms can be pulmonary, digestive or oral depending on the severity and duration of the case. Here are some of the most of the symptoms associated with GERD:

	Heartburn: this is the most common symptom of GERD. This symptoms is associated with a burning sensation just below the heart and is caused by a reflux of extremely potent acid into the esophageal tract.
	Regurgitation: caused by the reflux of acid and gastric contents into the esophageal tract.
	Dysfunctional Swallowing: dysphagia (difficulty swallowing) and odynophagia (pain swallowing) are both symptoms of GERD. Dysphagia is caused by either inflammation, abnormal peristalsis, or stricture. Dysphagia can also be a symptom of esophageal cancer. Odynophagia is caused by erosive esophagitis which can be caused either by bacterial infection or medication.
	Chest Pain: the pain can radiate throughout the chest, neck and arms with varying intensity.

Pulmonary symptoms which occur in a smaller percentage of people with GERD are caused by acid reflux past the upper esophageal sphincter. This type of symptom includes:

	asthma
	chronic coughing
	wheezing
	bronchitis
	interstitial fibrosis
	aspiration pneumonia

Oral symptoms include:

	waterbrash: spontaneous appearance of saliva in the mouth
	gingivitis
	tooth decay

Diagnosis

If you or your physician suspects that you are suffering from GERD, then endoscopy will be used to determine the damage to your esophageal tract. There are several types of abnormalities associated with GERD all of which can be classified, generally, as a subset of a condition called esophagitis. Using endoscopy your physician will inspect your esophageal tract in order to determine the severity of your condition. Here are the different classifications associated with esophageal damage associated with GERD:

	erythema: redness of the esophageal lining.
	isolated erosions
	confluent erosions
	circumferential erosions
	stricture
	Barrett's Esophagus: replacement of normal "squamous" lining of esophagus with columnar lining.

Treatment

GERD can usually be treated by making lifestyle or diet modifications. If you are suffering from GERD or heartburn you should consult a physician. In addition to your consultation try the following tips to reduce the incidence of reflux:

	Avoid lying down right after eating and within two to three hours of bedtime.
	Elevate the head of the bed four to six inches.
	Lose weight if overweight.
	Stop smoking.
	Avoid eating large meals. Instead, eat smaller, more frequent meals.
	Avoid: Chocolate Coffee and alcohol Fried and fatty foods Mint products (i.e., peppermint, spearmint) Carbonated beverages, and citrus fruits or juices Tomato sauce, ketchup, mustard and vinegar Aspirin and most pain medicines (other than acetaminophen).

If diet and lifestyle changes are not enough to control GERD, then medications can be prescribed. Most medications treating GERD fall into two categories: H₂Blockers or the more potent Proton Pump Inhibitors (PPIs).

H2 Blockers

Most H2 Blockers work by decreasing the flow of stomach acid and are available without a prescription. H2 Blockers should be used to treat mild cases of heartburn. Consult your physician if over-the-counter H2 Blockers have not been effective.

Proton Pump Inhibitors

PPIs work by helping the esophagus heal faster (within 6 to 8 weeks), thereby decreasing the duration of pain associated with reflux. This type of medication is more potent than H2 Blockers and may require a prescription.

The following is a list of medications used to treat GERD:

	Aciphex (PPI): requires a prescription. Other similar drugs are Prevacid, Prilosec, Nexium and Protonix.
	Carafate: prescription required.
	Pepcid (H2 Blocker): available with or without a prescription
	Propulsid: prescription required. Note: The FDA has issued a warning that Propulsid may cause cardiac arrhythmia.
	Reglan: available without a prescription
	Tagamet (H2 Blocker): available with or without a prescription.

In some cases, when medications have proven to be ineffective, the patient must live on medications or if surgery is the only viable option, a physician will use a procedure called a Nissen Fundoplication to treat GERD.

"Heartburn." The American Gastroenterology Association of America. 2002.
"GERD." GERD Information Resource Center. 2002. <http://www.gerd.com> 22 Mar. 2002

BrooklynGI.com with offices in New York City Brooklyn Queens and Manhattan. Treating patients from New York, New Jersey and Connecticut. is dedicated to helping patients and physicians receive accurate and up-to-date information on the Gastrointestinal tract (GI Tract) The organs that compose the GI tract include, Esophagus, Stomach, Small Intestine, Large Intestine (Colon), Pancreas and the Liver and Gall Bladder (Hepato-Biliary Tree) Dr. Scott Tenner
Physicians include Dr. Scott Tenner Dr. Robin Baradarian Dr. Susan Ramdhaney Dr. Nison Badalov
Private Practice at 2211 Emmons Ave. Other locations include Maimonides Medical Center 1025 48th Street, Beth Israel Medical Center at KD3201 Kings Highway, Kingsbrook Jewish Medical Ctr at 585 Schenectady Ave, Brookdale Hospital at One Brookdale Plaza, and Kings Highway Hospital at 2525 Kings Highway
We treat a variety of gastrointestinal GI diseases and conditions including Achalasia
Barrett's Esophagus Chronic Hepatitis Cirrhosis of the liver Celiac disease Collagenous Colitis Colorectal cancer Colorectal polyps Constipation Crohn's disease Diverticulosis And Diverticulitis Fatty liver (Steatohepatitis) Gallstones Gas Gastritis Gastric Cancer GERD Helicobacter pylori infection Hemochromatosis Hemorrhoids Hepatitis (Viral Hepatitis A, B, C etc) Hiatus Hernia Irritable Bowel Syndrome Lactose Intolerance Liver failure and transplantation Lymphocytic Colitis Microscopic Colitis Esophageal Cancer Pancreatitis Peptic Ulcer Primary biliary cirrhosis Reflux esophagitis Ulcerative colitis
A premier site for the diagnosis, treatment and management Gastrointestinal diseases, Drs. Tenner and Baradarian provide a variety of Patient Services.
Drs. Tenner and Baradarian are Board Certified Gastroenterologists performing a variety of tests and procedures at their private offices and at Maimonides Medical Center.
We perform many tests & procedure, including: Barium Enema Barium Esophagram Capsule Endoscopy Colonoscopy Colon Cancer Screening EGD (Esophagogastroduodenoscopy) Endoscopic Ultrasound ERCP (Endoscopic Retrograde Cholangiopancreatography) Esophageal Dilation Esophageal pH Fundoplication Hemorrhoid Banding Hemorrhoidectomy Lactose Tolerance Test Liver Biopsy PEG (Percutaneous Endoscopic Gastrostomy) Sigmoidoscopy Stool Acidity Test Upper GI Series
BrooklynGI.com with offices in New York City Brooklyn Queens and Manhattan. Treating patients from New York, New Jersey and Connecticut. is dedicated to helping patients and physicians receive accurate and up-to-date information on the Gastrointestinal tract (GI Tract) The organs that compose the GI tract include, Esophagus, Stomach, Small Intestine, Large Intestine (Colon), Pancreas and the Liver and Gall Bladder (Hepato-Biliary Tree) Dr. Scott Tenner. Physicians include Dr. Scott Tenner Dr. Robin Baradarian Dr. Susan Ramdhaney Dr. Nison Badalov.
Gastrointestinal GI diseases and conditions including Achalasia Private Practice at 2211 Emmons Ave. Other locations include Maimonides Medical Center 1025 48th Street, Beth Israel Medical Center at KD3201 Kings Highway, Kingsbrook Jewish Medical Ctr at 585 Schenectady Ave, Brookdale Hospital at One Brookdale Plaza, and Kings Highway Hospital at 2525 Kings Highway
Barrett's Esophagus Chronic Hepatitis Cirrhosis of the liver Celiac disease Collagenous Colitis Colorectal cancer Colorectal polyps Constipation Crohn's disease Diverticulosis And Diverticulitis Fatty liver (Steatohepatitis) Gallstones Gas Gastritis Gastric Cancer GERD Helicobacter pylori infection Hemochromatosis Hemorrhoids Hepatitis (Viral Hepatitis A, B, C etc) Hiatus Hernia Irritable Bowel Syndrome Lactose Intolerance Liver failure and transplantation Lymphocytic Colitis Microscopic Colitis Esophageal Cancer Pancreatitis Peptic Ulcer Primary biliary cirrhosis Reflux esophagitis Ulcerative colitis
A premier site for the diagnosis, treatment and management Gastrointestinal diseases, Drs. Tenner and Baradarian provide a variety of Patient Services.
Drs. Tenner and Baradarian are Board Certified Gastroenterologists performing a variety of tests and procedures at their private offices and at Maimonides Medical Center.
We perform many tests & procedure, including: Barium Enema Barium Esophagram Capsule Endoscopy Colonoscopy Colon Cancer Screening EGD (Esophagogastroduodenoscopy) Endoscopic Ultrasound ERCP (Endoscopic Retrograde Cholangiopancreatography) Esophageal Dilation Esophageal pH Fundoplication Hemorrhoid Banding Hemorrhoidectomy Lactose Tolerance Test Liver Biopsy PEG (Percutaneous Endoscopic Gastrostomy) Sigmoidoscopy Stool Acidity Test Upper GI Series