Gastroesophageal reflux disease (GERD) is a condition in which the contents of the stomach escape backwards from the stomach into the esophagus (the tube from the mouth to the stomach).
The most common cause of GERD is when the valve between the stomach and the esophagus, called the lower esophageal sphincter, becomes weak. This allows contents of the stomach to enter (reflux) into the esophagus. The acidic contents of the stomach can cause damage and discomfort which we sense as heartburn. GERD is a very common complaint with as much as 44 percent of Americans experiencing monthly symptoms.
GERD can be broken down into classic and atypical symptoms. The most common classic symptoms are heartburn and regurgitation of fluid from the stomach into the esophagus. Less common, or atypical symptoms, can include the following:
Symptoms may get worse when you bend over or lie down, or when you eat. Symptoms may also be worse at night.
The risk factors for reflux and GERD include:
Symptoms can also be caused by certain medicines, such as:
You may not need any tests if your symptoms are mild. If your symptoms are severe or they come back after you have been treated, your doctor may perform a test called an upper endoscopy (EGD).
You may also need one or more of the following tests:
You may use over-the-counter antacids after meals and at bedtime. Common side effects of antacids include diarrhea or constipation. Other over-the-counter and prescription drugs can treat GERD. They work more slowly than antacids, but give you longer relief. Your pharmacist, doctor, or nurse can tell you how to take these drugs.
It is important to note that medications only address the acid level of the fluid that is refluxing from the stomach into the esophagus. In other words, the fluid may be less acidic, but it will still continue to move backwards from the stomach into esophagus. For some, this change in pH is adequate for symptom resolution. For others, their symptoms will persist despite maximum medical treatment.
Anti-reflux surgery may be an option for patients whose symptoms do not go away with lifestyle changes and medication.
At the University of Iowa, we use two types of surgery to address GERD.
Also known as laparoscopic fundoplication, nissen fundoplication is a surgical procedure to treat GERD and hiatal hernias. Introduced in 1955, the procedure consists of wrapping the upper part of the stomach around the lower part of the esophagus, and reinforcing the lower esophageal sphincter to stop inappropriate GERD.
This is a relatively new surgical option in which a flexible ring of small magnets is placed around the lower esophageal sphincter during a minimally invasive procedure. Similar to the Nissen fundoplication, Linx stops pathologic reflux through the reinforcement of the lower esophageal sphincter. It differs from the Nissen in that it has a mildly improved side effect profile.
For an explanation of the LINX procedure, watch this whiteboard video.