By: G. Over the past several years, healthcare professionals have become increasingly interested in gastroesophageal reflux disease GERD because of its prevalence and impact on the community. This heightened focus can be attributed to several factors — GERD is a common problem in our communities that can potentially lead to serious medical complications, and the medical expense involved in the diagnosis, treatment, and management of the disease is significant.
One of the biggest challenges in determining the prevalence of GERD is identifying which patients actually have the disease.
Many patients with GERD-related symptoms do not consult a primary care physician PCP and patients that do seek treatment from PCPs are generally referred to a gastroenterologist only when symptoms become resistant to treatment refractory.
The two most frequently reported symptoms of GERD are heartburn, which can be described as a burning discomfort that begins behind the breastbone and radiates to the neck and throat, and acid regurgitation, which is characterized as a bitter, sour tasting fluid. One out of five people experience heartburn or acid regurgitation on a weekly basis and two out of five people experience heartburn or acid regurgitation at least once a month.
However, some patients may present with atypical symptoms such as a cough, asthma, laryngitis, or chest pain, and other patients with GERD experience no symptoms at all. The costs to exclude heart attacks and other heart-related problems alone are extremely high. Since GERD is a chronic disease instead of an acute illness, it causes significant economic impact due to the expense of the long-term management of the disease.
Perhaps the most significant expenses associated with a chronic condition such as GERD are the indirect costs of the disease. Indirect costs include decreased work productivity and time off work as well as a decrease in the quality of life of patients with GERD. In fact, the quality of life of patients with GERD is similar to patients with depression and heart failure. Even though there is no simple definition of GERD, it is clear that it has a profound financial impact on our community and our healthcare system as well as an emotional impact for patients suffering from the disease.
Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota. Gastroenterology ; Andersen LI, Jensen G. Prevalence of benign oesophageal disease in the Danish population with special reference to pulmonary disease. Journal of Internal Medicine ; GERD can result in serious complications including severe chest pain that can mimic a heart attack, esophageal stricture a narrowing or obstruction of the esophagus , bleeding, or a pre-cancerous change in the lining of the esophagus called Barrett's esophagus.
When symptoms of heartburn are not controlled with lifestyle modifications or over-the-counter medicines are needed two or more times a week, you should see your doctor. Treatment should be designed to eliminate symptoms, heal irritation of the esophagus and prevent the long-term complications of GERD. In most patients outside of significant lifestyle changes such as weight loss, GERD is a chronic disease. As such, long-term maintenance treatment to control symptoms and prevent complications may be necessary.
Maintenance therapy will vary in individuals ranging from mere lifestyle modifications to prescription medication as treatment. The medicines are treatments and not cures. All treatments are based on attempts to decrease the amount of acid that refluxes from the stomach back into the esophagus or make the refluxed material less irritating to the lining of the esophagus.
In order to decrease the amount of gastric contents that reach the esophagus, certain simple guidelines should be followed:. GERD can be improved with lifestyle changes but often requires medicines for complete management.
If you are using over-the-counter medications two or more times a week, or are still having symptoms despite taking daily medicines, you need to see your doctor. These medicines reduce the amount of acid produced in the stomach.
Since the mid 's, acid suppression agents, known as H2 receptor antagonists or H2 blockers, have been used to treat GERD. H2 blockers improve the symptoms of heartburn and regurgitation. H2 blockers are generally less expensive than proton pump inhibitors and can provide adequate initial treatment or serve as a maintenance agent in GERD patients with mild symptoms. Current treatment guidelines also recognize the appropriateness and in some cases desirability of using proton pump inhibitors as first-line therapy for some patients, particularly those with more severe symptoms or esophagitis on endoscopy.
Surgical management of GERD can be considered in patients who do not completely respond to medical management, patients who are unable to tolerate the medicines due to adverse reactions or in patients who do not want to take a chronic medicine. Surgical management prevents gastric reflux by strengthening the barrier between the stomach and the esophagus. There are a number of different surgical approaches to GERD. Consultation with both a gastroenterologist and a surgeon is recommended prior to such a decision.
Additional testing is usually required. A gastroenterologist is a physician who specializes in the diagnosis and management of disorders and conditions of the gastrointestinal tract.
After completing medical school, they first complete a 3-year training residency in internal medicine. This is followed by a year training fellowship specifically focused on conditions of the gastrointestinal tract.
Your doctor or gastroenterologist may wish to evaluate your symptoms with additional tests when it is unclear whether your symptoms are caused by acid reflux, or if you suffer from complications of GERD such as dysphagia difficulty in swallowing , bleeding, choking, or if your symptoms fail to improve with prescription medications. Your doctor may decide to conduct one or more of the following tests. For the upper GI series, you will be asked to swallow a liquid barium mixture.
The radiologist then takes a series of pictures and videos to watch the barium as it travels down your esophagus and into the stomach. You will be asked to move into various positions on the X-ray table while the radiologist watches the GI tract. Permanent pictures X-ray films will be made as needed.
This test involves passing a small lighted flexible tube through the mouth into the esophagus and stomach to examine for abnormalities. The test is usually performed with the aid of sedatives. It is the best test to identify inflammation of the esophagus and pre-cancerous conditions of esophagus Barrett's esophagus , or other complications of the esophagus. The diagnosis of GERD is often made based on physical and history alone.
A pH test involves either placement of a small catheter through the nose into the esophagus or a small chip directly attached to the esophagus during endoscopy which can provide objective data about the the degree of acid reflux. Besides heartburn and regurgitation, GERD can result in a number of other symptoms outside of the esophagus. Usually, they also have other symptoms like heartburn and acid regurgitation. If your doctor says your chest pain is not coming from the heart, do not forget about the esophagus.
On the other hand, if you have chest pain, you should not assume it is your esophagus until you have been evaluated for a potential heart cause by your physician. Asthma: Acid reflux may aggravate asthma. Recent studies suggest that the majority of asthmatics have acid reflux. Clues that GERD may be worsening your asthma include: 1 asthma that appears for the first time during adulthood; 2 asthma that gets worse after meals, lying down or exercise; and 3 asthma that is mainly at night.
Treatment of acid reflux may cure asthma in some patients and decrease the need for asthmatic medications in others. Ear, Nose, and Throat Problems: Acid reflux may be a cause of chronic cough, sore throat, laryngitis with hoarseness, frequent throat clearing, or growths on the vocal cords. If these problems do not get better with standard treatments, think about GERD. Peptic Stricture: This results from chronic acid injury and scarring of the lower esophagus. Patients complain of food sticking in the lower esophagus.
Heartburn symptoms may actually lessen as the esophageal opening narrows down, preventing acid reflux. Stretching of the esophagus and proton pump inhibitor medication are needed to control and prevent peptic strictures. In patients with chronic heartburn, an endoscopy will often be recommended to identify any suspicious or pre-malignant lesions, such as Barrett's esophagus. So, do not ignore your heartburn. If you are having heartburn two or more times a week, it is time to see your physician.
Increasingly, we are becoming aware that the irritation and damage to the esophagus from continual presence of acid can prompt an entire array of symptoms other than simple heartburn.
Experts recognize that often the role of acid reflux has been overlooked as a potential factor in the diagnosis and treatment of patients with chronic cough, hoarseness and asthma-like symptoms.
In some instances, patients have never reported heartburn, and in others the potential causal link between reflux and the onset of these so-called "extra-esophageal manifestations" has not been fully recognized. Physicians are increasingly becoming aware that it is good clinical practice to evaluate the possible presence of reflux in patients with chronic cough and asthma-like symptoms, as well as the importance that acid suppression and treating underlying reflux can have in potentially improving the symptoms in these patients.
Esophageal disease may be perceived in many forms, with heartburn being the most common. Since the esophageal lining is sensitive to stomach contents, persistent and prolonged exposure to these contents may cause changes such as inflammation, ulcers, bleeding and scarring with obstruction. A pre-cancerous condition called Barrett's esophagus may also occur.
Barrett's esophagus causes severe damage to the lining of the esophagus when the body attempts to protect the esophagus from acid by replacing its normal lining with cells that are similar to the intestinal lining. Research was conducted to determine whether the duration of heartburn symptoms increases the risk of having esophageal complications. The study found that inflammation in the esophagus not only increased with the duration of reflux symptoms, but that Barrett's esophagus likewise was more frequently diagnosed in these patients.
Those patients with reflux symptoms and a history of inflammation in the past were more likely to have Barrett's esophagus than those without a history of esophageal inflammation.
Persistent symptoms of heartburn and reflux should not be ignored. By seeing your doctor early, the physical cause of GERD can be treated and more serious problems avoided.
How significant is your heartburn? What are the chances that it is something more serious? If you need a yardstick, here's a simple self-test developed by a panel of experts from the American College of Gastroenterology.
Remember, if you have heartburn two or more times a week, or still have symptoms on your over-the-counter or prescription medicines, see your doctor. If you said yes to two or more of the above, you may have GERD. To know for sure, see your doctor or a gastrointestinal specialist. They can help you live pain free. Gastroesophageal reflux disease GERD is a chronic condition where fluids in the stomach reflux into the esophagus causing bothersome symptoms such as heartburn, and regurgitation.
This can also cause serious symptoms such as chest pain mimicking heart attack, hoarseness, asthma, difficulty swallowing and even esophageal cancer. Acid in the stomach is the first line of defense against the food-borne pathogens that we ingest. Scar tissue can cause the esophagus to become too narrow esophageal stricture.
This can make swallowing difficult and painful. Stomach acid entering into your lungs can cause serious harm. Lung damage can make you more likely to have chest congestion and wheezing. This puts you at increased risk for recurrent pneumonia or asthma.
Long-term inflammation of the esophagus esophagitis increases the risk of precancerous cells in the esophagus. According to the HCUP , 4. Cases of dysphagia grew by percent between and Esophageal adenocarcinoma rose by percent. Esophagitis increased by 94 percent. If you need to be hospitalized, GERD can be costly. Jen Thomas is a journalist and media strategist based in San Francisco. Jen is also a competitive Ultimate Frisbee player, a decent rock climber, a lapsed runner, and an aspiring aerial performer.
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