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Do I Have Gastro-esophageal Reflux Disease (GERD) by Jonathan Steinke

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Gastro-esophageal Reflux Disease (GERD), more commonly known as acid reflux, is a digestive system disease in which stomach acid flows back into the esophagus through the lower esophageal sphincter.  This can result in an inflammatory or burning sensation in the throat.

The function of the lower esophageal sphincter (LES) is to close as soon as food passes through it toward the stomach.  But if it does not entirely close—or it alternates between opening and closing—the stomach acid can retract through the LES when open and cause heartburn sensations or complete blockage of the esophagus (which can lead to asphyxiation).  A condition known as hiatal hernia can also exacerbate GERD.  In a hiatal hernia, one of the upper stomach’s flap valves and the LES are pushed up through the diaphragm together.  The diaphragm acts to store food in our stomach until its acid breaks it down.  However, a hiatal hernia causes the combined stomach acid and food to re-enter the esophagus because of the proximity of the diaphragm to the esophagus resulting from the hernia.

However avoidable risk factors also contribute to GERD, most arising out of an individual’s deleterious health choices.  Such factors include lying down or bending at the waist after eating copious amounts of food, consuming excessively rich or spicy foods, obesity, eating even a small amount of food before bedtime, smoking, or consuming very acidic food or drink.  Symptoms include heartburn (ranging in severity from mild to serious), a sour taste in one’s mouth from acid being forced into the throat, hiccoughing or belching for long periods, possible asphyxiation from trapped acid in the esophagus, and dysphagia (esophageal narrowing, giving a false sensation of food being lodged in the throat).

GERD can be treated with any of the four procedures.  An esophagram is the swallowing of a solution to expose the esophagus and parts of the throat for easier viewing.  A treatment focusing on a closer examination of the esophageal and LES functions is known as esophageal manometryEsophageal PH monitoring involves the insertion of a tube with an attached monitor orally or nasally into the stomach; the tube is then pulled back into the esophagus.  The monitor measures the level of acids traveling from the stomach to the esophagus.  Similarly, a flexible tube with a light source is inserted into a patient’s throat to study more complex stomach and esophageal problems after a throat anesthetic and sedative are given.  This is called an endoscopy.  A biopsy, usually performed in conjunction with an endoscopy, involves the examination of tissue samples under a microscope for possible infections.  If any of these procedures fail, one may need a fundoplication.  In a fundoplication, a portion of the upper stomach is wrapped around the lower esophagus to keep it stationary so further reflux is prevented.  This surgical procedure should only be performed as a last resort.

Lifestyle changes one can make to prevent further symptoms include consuming smaller meals, exercising at a mild to strenuous rate, raising or lowering one’s bed further off the ground so the esophagus is either vertically positioned or at least positioned at an incline, and avoiding food consumption just before bedtime.  Medications that can be used to treat GERD include antacids containing both magnesium hydroxide and aluminum hydroxide to most effectively counteract side effects.  If these do not work one may consider a pump inhibitor, such as Prilosec, that lessens the amount of acid.  One may also take a prokinetic, a medication that helps the LES build resistance and strength so the stomach can be emptied more rapidly.

If GERD is left untreated, one can suffer long-term complications such as esophageal scarring or open sores from acid overexposure, or even esophageal cancer.  Cancer occurring because of GERD will be detected through color changes in the esophageal tissue lining.  One should seek immediate medical attention if one reports severe chest pain along with difficulty in breathing, as this could signal a heart attack.


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