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Gastroesophageal reflux disease (GERD) is when stomach contents (acid, bile, and digestive enzymes) reflux into the esophagus, leading patients to experience heartburn or acid reflux.
There are three key aspects to treating GERD: diet and lifestyle changes, medications, and surgery.
Some of the most well-known esophageal surgeons and gastroenterologists in the world work at Providence Health hospitals. They can help you find the solution that’s right for you.
If you’ve ever felt a burning sensation in your chest or esophagus after eating or lying down, then you may have experienced acid reflux. Many people have acid reflux from time to time. But if you consistently have these problems more than twice a week for several weeks or find yourself avoiding certain foods or beverages to avoid this sensation, then you may have chronic gastroesophageal reflux disease (GERD) and should see a doctor.
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) estimates that GERD affects about 20 percent of people in the United States. Anyone can develop this disease and without treatment, it can lead to serious health complications such as:
- Esophagitis (inflammation and erosions in the esophagus)
- Abnormal narrowing or scarring of the esophagus that causes problems with swallowing
- A change in the lining of the esophagus called Barrett’s esophagus, which could progress to esophageal cancer over time.
Many people don’t even consider talking to their primary care physician about the acid reflux symptoms they are experiencing, they just consider it a normal part of life. But it is not normal to have to constantly think about the foods you are eating so you don’t have painful acid reflux.
What causes GERD?
GERD occurs when the reflux barrier at the junction between the esophagus and stomach is weakened, allowing gastric acid, digestive enzymes, and food to move from the stomach into the esophagus. Typically, this occurs from chronic gastric distension and over-eating, often in combination with a hiatal hernia. Often GERD symptoms are exacerbated by the types of foods a person eats or by eating a large meal late in the evening. Common triggers for GERD include:
- Citrus fruits
- Eating late at night, prior to lying down
People who are obese, smokers, or pregnant are at a higher risk for developing GERD than others.
GERD has many possible symptoms, but the most common are:
- Heartburn – This is a warmth or burning sensation behind the breastbone or centered in the upper abdomen.
- Regurgitation – This is the effortless movement of food or sour-tasting fluid from the stomach toward the mouth. It is distinct from vomiting, which is an active process; regurgitation happens without effort.
- Chest pain – Patients often describe this as a spasm, sharp and knife-like.
Other symptoms can include frequent throat clearing, sore throat, hoarseness/voice changes, asthma-like symptoms, the sensation of food sticking in the esophagus, and shortness of breath.
The challenge with all these symptoms is that they overlap with many other esophageal diseases. It may take several visits — first to a primary care doctor and later to a specialist for testing — to determine if GERD is the disease-causing your symptoms.
Treatments for GERD
While you might think of over-the-counter medications as your first defense against GERD, there are many different steps you should take to avoid this painful disease and halt its progression to something more serious.
- Diet and Lifestyle changes: The first place to start for most patients with GERD is to modify diet and lifestyle, including losing weight if your body mass index (BMI) is elevated. Smaller, less fatty, and rich meals can also help, along with elevating the head of the bed if nighttime regurgitation is occurring.
Instead of eating one or two big meals each day, try eating four or five smaller meals throughout the day. Avoid “trigger foods,” such as caffeine, chocolate, acidic foods like tomatoes, and alcohol, and build more exercise into your routine. If you are overweight, consider meeting with a dietitian or weight loss professional. Elevating the head of your bed while sleeping may also provide some relief.
- Medications: The most common treatments for chronic acid reflux are medications that either neutralize or suppress stomach acid. Tums and other antacids neutralize the stomach acid and provide short-term relief from heartburn. More sustained relief can sometimes be obtained with histamine blockers such as Pepcid.
However, the most powerful acid suppression medications are called proton pump inhibitors (PPIs). You can find these medications — including Prevacid, Prilosec, and Nexium — at your local drug store, but talk with your doctor if you start taking them to discuss all of your treatment options and to confirm that your symptoms are actually from GERD and not some other condition.
Your doctor can talk to you about the risks and benefits of long-term PPIs and refer you to an expert in GERD — such as an esophageal surgeon or gastroenterology specialist — for a consultation.
- Surgery: There are four different surgical options — each with its own pros and cons. The current American College of Gastroenterology GERD Guidelines recommends that patients find an experienced surgeon to discuss each option, and the goal of Providence GERD specialists is to find the procedure that will work best in each individual situation.
- Nissen fundoplication – The surgeon wraps a part of the stomach around the lower esophagus to create a new valve that stops reflux of gastric juice into the esophagus.
- Partial fundoplication (Toupet, Dor, or Hill gastropexy) – These options are similar to the Nissen fundoplication, except the surgeon only folds the stomach part of the way around the lower esophagus. This is typically done when there has been damage to the function of the esophageal body, or in patients with less severe GERD.
- Magnetic sphincter augmentation (LINX) – The surgeon implants a small bracelet of magnetic beads, called LINX, around the lower esophagus to minimize acid reflux by reinforcing the leaking valve and prevent reflux of gastric juice into the esophagus
- Transoral incisionless fundoplication (TIF) – This is an advanced endoscopy procedure that allows the doctor to augment the defective valve by bringing stomach tissue partially around the esophagus
Expert care at Providence
At Providence, we have a group of leading reflux experts within the Digestive Health Institute — including gastroenterologists and esophageal surgeons — across the seven states we serve. Some of the most well-known GERD experts in the world work at the Providence hospitals. These doctors work with the Digestive Health Institute to drive research across the nation and have influenced GERD management and driven the adoption of new surgical techniques.
The providers at Providence take a patient-centered approach, recommending treatment based on your individual circumstances and goals. They are experienced at all the different types of medical and surgical therapies, which means they can adapt when the situation requires something different. Providence GERD specialists can find the right treatment for the right person while keeping them as close to home as possible during their specialty care.
When to seek help
So, how do you know when it’s time to seek care from a GERD specialist? While your primary care doctor can help you manage your GERD, you eventually will need care from a specialist, especially when the medications are not controlling your symptoms. Even if PPIs control your symptoms, it may be helpful to see a specialist so you can discuss your risk for developing Barrett’s esophagus. Barrett’s esophagus is a pre-cancerous condition caused by GERD that can cause you to develop esophageal cancer.
You don’t have to “just live with” acid reflux. Seek help from a Providence Digestive Health Institute doctor today.
Find a doctor
If you are looking for a GERD specialist or surgeon, you can find one at the Providence Digestive Health Institute or search for one who’s right for you in our provider directory.
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This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.
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