Gastroesophageal Reflux Disease (G.E.R.D., also known as heartburn or reflux) is a common ailment for many people. Its peak incidences occur in early infancy (less than 1 year old) and adulthood. Around 20% of adults report weekly episodes of heartburn and 7-10% experience daily symptoms. Up to 70% of asthmatics experience reflux. Many patients may have “silent G.E.R.D.” which means they are not aware they are experiencing symptoms.
The most likely explanation of reflux includes loosening of the lower esophageal sphincter which results in acidic juices regurgitated from the stomach up into the esophagus and pharynx. This can cause heartburn, regurgitation, upset stomach, nausea, vomiting, sore throat, post nasal drip, hoarseness, cough, and chest pain.
Reflux can also complicate asthma, as well as sinusitis in certain patients and may lead to esophagitis (erosions in the esophagus), ulcers, hiatal hernias or certain types of gastrointestinal cancers. Reflux is more common in people who are overweight, have certain collagen vascular diseases or patients who take certain medications including NSAIDS (non-steroidal anti-inflammatory agents) and theophylline products.
After an appropriate history or suspicion of reflux disease, there are many ways of detecting reflux. A Scintiscan (or scintigraphy) is commonly used in infants, where a radionuclide-labeled meal is given in a formula and imaging is done for up to 3 hours after the meal.
An Upper GI series is a series of x-tays taken after a person drinks a barium contrast media (a positive study is helpful, whereas a negative study does not rule out G.E.R.D.). An Esophageal 24 pH monitoring probe is much more diagnostic, but considerably more invasive. Endoscopy with a biopsy may need to be performed by a GI specialist.
Treatment for gastroesophageal reflux may include weight loss for those patients that have increased abdominal girth, since this increases pressure on the lower esophageal sphincter which promotes reflux. Avoiding certain trigger foods may be very beneficial. These include alcohol, spicey/fried foods, caffeine products (chocolate, colas, teas, coffee), citrus, carbonated drinks and mints. Cigarette smoking also promotes reflux. Eating smaller meals and not lying down for several hours after eating may be helpful. Medical management may include the use of H2 blockers:
If this is not helpful enough, acid Proton Pump Inhibitors (PPI’s) may be needed. These include:
- Acidphex (rabeprazole)
- Nexium (esomeprazole)
- Prevacid (lansoprazole)
- Prilosec (omeprazole)
- Protonix (pantoprazole)
PPI’s are most effective when given about 30 minutes before breakfast. Pro-motility agents Reglan (metoclopramide) and Propulsid (cisapride) have also been used but may cause significant side effects.
Weight loss, dietary avoidance and appropriate medications can be very effective in reducing or eliminating reflux. This can further prevent asthma, sinusitis, as well as Barrett’s Esophagitis and potential for esophageal malignancies in those patients with significant complicated disease. Patients with severe G.E.R.D. despite appropriate treatment may be candidates for surgical repair called a Nissen Fundoplication.
If you or your child are experiencing any of the symptoms of G.E.R.D. you should contact your doctor to discuss your treatment options.