GASTROESOPHAGEAL REFLUX DISEASE (GERD)

GERD or Heartburn is a condition in which the acidified liquid content of the stomach backs up into the esophagus. GERD occurs when stomach acid or, occasionally, stomach content, flows back into your food pipe (esophagus). The backwash (reflux) irritates the lining of your esophagus and causes GERD.

This may damage the lining of the esophagus and cause inflammation or esophagitis.  Severe complications for esophagitis is the development of cancer.

When these signs and symptoms occur at least twice each week or interfere with your daily life, or when your doctor can see damage to your esophagus, you may be diagnosed with GERD.

Most people can manage the discomfort of GERD with lifestyle changes and over-the-counter medications. But some people with GERD may need stronger medications, or even surgery, to reduce symptoms.

GERD signs and symptoms include:

  • A burning sensation in your chest (heartburn), sometimes spreading to your throat, along with a sour taste in your mouth
  • Chest pain
  • Difficulty swallowing (dysphagia)
  • Dry cough
  • Hoarseness or sore throat
  • Regurgitation of food or sour liquid (acid reflux)
  • Sensation of a lump in your throat

DIAGNOSIS

Diagnosis of GERD is based on:

  • Your symptoms. Your doctor may be able to diagnose GERD based on frequent heartburn and other symptoms.
  • A test to monitor the amount of acid in your esophagus. Ambulatory acid (pH) probe tests use a device to measure acid for 24 hours. The device identifies when, and for how long, stomach acid regurgitates into your esophagus.

If you have GERD and you’re a candidate for surgery, you may also have other tests, such as:

  • An X-ray of your upper digestive system. Sometimes called a barium swallow or upper GI series, this allows your doctor to see a silhouette of your esophagus, stomach and upper intestine (duodenum).
  • A flexible tube to look inside your esophagus. Endoscopy is a way to visually examine the inside of your esophagus and stomach. Your doctor may also use endoscopy to collect a sample of tissue (biopsy) for further testing. Endoscopy is useful in looking for complications of reflux, such as Barrett’s esophagus.
  • A test to measure the movement of the esophagus. Esophageal motility testing (manometry) measures movement and pressure in the esophagus. The test involves placing a catheter through your nose and into your esophagus.

 

RECOMMENDED MEDICATIONS

Initial treatments to control heartburn

Over-the-counter treatments that may help control heartburn include:

  • Antacids that neutralize stomach acid. Antacids, such as Maalox, Mylanta, Gelusil, Gaviscon, Rolaids and Tums, may provide quick relief. But antacids alone won’t heal an inflamed esophagus damaged by stomach acid.
  • Medications to reduce acid production. Called H-2-receptor blockers, these medications include cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR) or ranitidine (Zantac). H-2-receptor blockers don’t act as quickly as antacids do, but they provide longer relief and may decrease acid production from the stomach for up to 12 hours.
  • Medications that block acid production and heal the esophagus. Proton pump inhibitors are stronger blockers of acid production than are H-2-receptor blockers and allow time for damaged esophageal tissue to heal. Over-the-counter proton pump inhibitors include lansoprazole (Prevacid 24 HR) and omeprazole (Prilosec, Zegerid OTC).

Prescription-strength medications

If heartburn persists despite initial approaches, your doctor may recommend prescription-strength medications, such as:

  • Prescription-strength H-2-receptor blockers. These include prescription-strength cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid) and ranitidine (Zantac).
  • Prescription-strength proton pump inhibitors. Prescription-strength proton pump inhibitors include esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec, Zegerid), pantoprazole (Protonix), rabeprazole (Aciphex) and dexlansoprazole (Dexilant).
These medications are generally well-tolerated, but long-term use may be associated with a slight increase in risk of bone fracture and vitamin B-12 deficiency.
  • Medications to strengthen the lower esophageal sphincter. Baclofen may decrease the frequency of relaxations of the lower esophageal sphincter and therefore decrease gastroesophageal reflux. It has less of an effect than do proton pump inhibitors, but it might be used in severe reflux disease. Baclofen can be associated with significant side effects, most commonly fatigue or confusion.

GERD medications are sometimes combined to increase effectiveness.

Surgery and other procedures used if medications don’t help

Most GERD can be controlled through medications. In situations where medications aren’t helpful or you wish to avoid long-term medication use, your doctor may recommend more-invasive procedures.

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