Identifying the Symptoms and Fighting Back Against GERD, Part One

Gastroesophageal Reflux Disease, known in shortened form as GERD and sometimes as acid reflux, is a condition in which the esophagus opens or fails to close, allowing stomach acids and contents to rise into the esophagus. It's a chronic and more serious form of Gastroesophageal Reflux (GER), a common condition in millions of adults and especially common in young children under the age of twelve.

GER and GERD often take the shape of a variety of painful symptoms, ranging from heartburn to trouble sleeping and chronic chest pain and even difficulty swallowing. Patients diagnosed with GERD often struggle with symptoms or outbreaks at various times for the rest of their lives. While a new generation of drug treatments has shown success, other means of prevention - including modifications to diet and exercise - might yet provide a more comfortable means of managing symptoms.

What causes Gastroesophageal Reflux?

GER occurs when a valve in the top of the stomach fails to close or opens spontaneously. This valve, known as the Lower Esophageal Sphincter (LES), allows mucosal fluids to rise into the esophagus, which connects the throat to the stomach. The contents of the stomach, including stomach acids, rise into the mouth and throat with painful results.

While there is no one single cause of GERD, some research points to otherwise benign physical abnormalities such as a hiatal hernia, in which the lower esophageal sphincter and the upper part of the stomach move above the diaphragm, the muscle wall separating the stomach from the chest. GER can also happen when the LES fails to close tightly after absorbing food.

The condition is considered Gastroesophageal Reflux Disease when symptoms occur more than twice a week. The symptoms are usually more severe and last longer, as well.

The symptoms of GERD

The most common result of this backflow is a pain or pressure, for example heartburn, behind the breastbone or the mid-abdomen region.

A wide range of discomfiting symptoms also linked with GERD includes chronic earache, a hoarse of rasping voice, frequent nausea, and inflammation of some sinus tissues. Pain may continue off and on for days or weeks, depending on the severity of the attack.

Making the diagnosis

Doctors are able to diagnose GERD by asking questions about diet and the patient's discomfort. They will then evaluate the patient's diet and lifestyle patterns that may foster susceptibility for GERD.

For more severe cases, doctors will sometimes examine the patient's esophagus with a small camera extended via tube into the throat, in a procedure known as endoscopy. In other cases doctors may order that a set of X-rays be taken of the esophagus, stomach, and the part of the small intestine known as the duodenum. This Upper Gastrointestinal Series test (made famous as an "upper GI series" on countless television hospital dramas) will determine if other problems in the digestive system are contributing to GERD conditions.

Several different medications, procedures for GERD treatment

Many doctors arrive at a diagnosis simply by prescribing H2 blockers (sold commercially as Pepcid) or proton pump inhibitor drugs (such as Prilosec) that work to block stomach acids. If heartburn conditions disappear after the drugs are taken, doctors may diagnose GERD.

In many cases, mild to moderate symptoms can be treated with over the counter medicines such as antacid tablets and digestive aids. Doctors may also prefer to schedule fundoplication surgery to repair the lower esophageal sphincter in cases where no other option seems promising. In fundoplication, the stomach is actually wrapped around the LES, strengthening it and preventing acid reflux. The surgery is often performed with a minimum of invasion into the body.

Two recent surgeries approved by the FDA work to treat symptoms by managing the operation of the LES. The first, known as Endocinch, puts pleats into the muscle to help strengthen its workings and operationl. Another procedure, called the Stretta Procedure, uses radio frequency energy to treat the LES. The lasting benefits of both procedures are still being determined.

Other medications include foaming agents, for example Gaviscon, that cover the stomach contents with foam, rendering them less acidic.

The drugs known collectively as prokinetics help strengthen the Lower Esophageal Sphincter and help the stomach to faster empty its contents through the digestive system.

In Part Two of this series we discuss how to manage and prevent GERD symptoms and also how the disease behaves and affects children as well as pregnant women.

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