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Gastroesophageal Reflux (GERD)

A large portion of the population experiences acid reflux in the esophagus either occasionally or chronically. Those who suffer from it regularly have gastroesophogeal reflux disease (GERD),  one of the most common of GI conditions.

The stomach produces acidic digestive fluids that are not meant to be in contact in high concentrations or regularly with the esophagus. A valve of muscle at the bottom of esophagus closes to prevent these GI juices from passing up into the esophagus and back of the throat. Called the esophageal sphincter, this barrier in the form of a ring of muscular and mucosal tissue can sometimes lose some of its function, resulting in leakage of stomach contents upwards to the esophagus. The lower esophagus at the juncture of the stomach suffers from repeated contact with the caustic contents of the stomach-which typically occurs daily in patients with GERD. The result is the irritation and pain of chronic heartburn. Other symptoms include hoarseness and sore throat.

Heartburn is so common it may not seem like a disease. But patients with high acid production or abnormalities of the esophageal-stomach juncture are more prone to chronic discomfort and irritation from reflux, which can lead to more serious conditions.
Risks from Chronic Acidic Injury in the Esophagus

In this environment, the cells lining this lower portion of the esophagus become irritated and chronically inflamed—a status that gastroenterologists can identify using the esophagoscope. Eventually, these conditions cause the cells that line the esophagus to change nature, becoming scarred and more like stomach tissue. When this type of tissue injury is serious and well established, the condition brings on chronic esophagitis that can produce further tissue changes called Barrett’s esophagus. Specialists can identify this condition by examining the abnormal cells from the lining of the esophagus under a microscope, after sampling them endoscopically. In some individuals, these cells will become fully cancerous, resulting in esophageal adenocarcinoma or cancer of the esophagus.

Virtua gastroenterologists make practiced use of the esophagoscope. Introduced orally, the scope allows the specialists to examine the base of the esophagus and its juncture with the stomach to detect any irritation or ulceration that can come from reflux disease.

Thus, not only is reflux uncomfortable but it increases the risk of Barrett’s esophagus, which in turn increases the risk of esophageal cancer. For all of these reasons, identifying and treating GERD is important.

Risk factors include:

  • older age;
  • family history;
  • hiatal hernia;
  • and poor eating and dietary habits.

Stress may also play a role for some patients.

Treatment Can Help Confirm Diagnosis

Both GI specialists and primary care physicians may diagnose and treat GERD based on history and symptoms. If an anti-acid medication resolves the discomfort, this is often sound confirmation that reflux is the source of the symptoms.

Often, though, experienced gastroenterologists will want to conduct testing to determine the status of the esophagus and establish a baseline reading on its inflammation as a reference point for future monitoring. They perform an upper endoscopy, in which they use a videoscope at the end of a flexible tube to visually inspect this area-the gastro-esophageal juncture. With the scope, they can also take a small scraping of the esophageal tissue to check it for abnormal cells. For patients with established GERD, this test should be repeated on a schedule set over a course of years to make sure that inflammation or dysplasia resolves or does not become more severe.

Other tests can add information to the diagnosis. Sometimes the staff may use esophageal pH monitoring to help diagnosis GERD. A set of x-rays called an upper GI series can also help to eliminate other causes.

Choice of Meds
Highly effective medications are available to reduce the exposure of the esophagus and stomach to gastric acids. These various classes, types and brands of medications are some of the widely used medications in the U.S. They start with the most common, short-acting, over-the-counter chewable calcium carbonate tablets that immediately decrease the acidity of the environment in the stomach and esophagus through directly changing the pH of the stomach, neutralizing existing acids in the stomach. Others most commonly used by patients with GERD, and available both OTC and by prescription, fall into to two primary categories:

  • proton pump inhibitors, which decrease the production of acid by stomach cells;
  • and H2-receptor antagonists, which decrease the release of acid by stomach cells.

Medications and Change in Habits Needed

Virtua GI specialists are thoroughly experienced in detecting the signs of GERD and counseling patients on managing the disease though medications and change in habits. They are highly skilled in performing upper endoscopy, providing this procedure more often than any type of  endoscopy  other than colonoscopy. (Patients whose testing schedule coincides in this way, may sometimes undergo upper endoscopy and colonoscopy in the same the visit to the endoscopy suite.) They are also thoroughly acquainted with the different classes of anti-reflux medications and can advise patients on these choices and prescribe the one best for the patient.

Many people use these medications daily to increase their comfort and to safeguard their esophagus. Esophageal cancer, which can often require surgical removal of a portion of the esophagus, is well worth preventing with these and other efforts, which can include change in eating and dietary habits. Learning to reduce intake of acidic foods and not eating for several hours before being in a prone position can help, as can elevating the head of the bed to help minimize nighttime reflux. GERD patients are also instructed to eat smaller meals and, if they are overweight, to lose weight.

In this model of five stages of reflux esophagitis, grades A through D show progression from mild erosion to deep ulcerations due to untreated acid reflux. Virtua’ experienced GI endoscopists stage these injuries at the time of initial endoscopy.

Surgery Needed in Some Cases

The Virtua team aims its efforts always at conservative care of GERD first. Most GERD can be resolved without invasive treatment.

However, patients who have severe dysfunction of the esophageal sphincter may need surgery. In the operation used for this purpose, the general surgeon can wrap a portion of the upper stomach around the base of the esophagus to tighten the sphincter area. Most often this procedure is performed laparoscopically. It is the  same operation used to treat severe hiatal hernia. Nonsurgical endoscopic techniques to tighten the lower esophageal sphincter are also available.

In the uncommon cases in which they discover esophageal cancer, Virtua gastroenterologists work closely with oncologists, general surgeons and other cancer specialists to aggressively treat the disease, with the goal of curing it.

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