How common is Gastroesophageal reflux disease (GERD)?

GERD is a common problem in the United States. More than 44% of all adults, 61 million people, experience heartburn at least once a month. Twenty percent of the population has heartburn at least once a week and nine percent have heartburn each day. Five percent of the population will at some point require physician directed medical or surgical therapy involving the creation of a Nissen or Toupet fundoplication.

What are the symptoms of GERD?

Althought the most common symptom of GERD is heartburn, many people will complain of regurgitation of sour tasting fluid or food in the back of their mouth. Less commonly people may have difficulty or pain upon swallowing. This may be secondary to a narrowing in the esophagus as a result of acid reflux. Other patients complain of abdominal pain, nausea, vomiting, early satiety, difficulty sleeping, belching, flatulence and diarrhea. Rarely patients may have blleding in their esophagus from severe inflamation.

What are the atypical symptoms of GERD?

Patients may not be able to sense the burning in the chest so as the GERD becomes more severe they develop symptoms related to acid moving into the breathing tubes and the lungs. They will have coughing, choking, difficulty breathing, hoarseness, sore throat, asthma and wheezing and may develop pneumonia. Patients with recurrent episodes of pneumonia should be evaluated because reflux may be the cause of these symptoms. Acid may also erode dental enamel.

What Causes GERD?

The esophagus normally has a neutral pH, which means that it is neither acidic nor alkaline. The stomach produces acid for the digestion of food. A muscular valve separates the esophagus and stomach. Gastroesophageal reflux occurs when the valve allows stomach acid to pass into the esophagus, producing symptoms of heartburn and acid regurgitation. Damage to the lining of the esophagus may occur, as well as damage to the lungs if the acid is inhaled.

Along with malfunction of the valve, other problems may contribute to reflux such as a hiatus hernia, which is an abnormal sliding of the upper stomach into the chest, obstruction of the stomach outlet, overproduction of acid in the stomach or impaired function of the muscles of the esophagus.

What tests are performed to diagnose GERD?

Several may be performed to prove that a defective valve is causing your symptoms. These include: endoscopy, or looking into the esophagus with a telescope to see if there is damage to the wall of the esophagus, contrast x-ray to see the anatomy of the esophagus and 24-hour esophageal pH monitoring to demonstrate abnormal acid in the esophagus. In some patients a gastric emptying study may be performed.

The most important test is manometry. This examines the "squeeze" pressure of the valve by placing a tube into the nose and into the esophagus. If the valve pressure is low and the 24-hour pH test indicates significant reflux of acid into the esophagus, surgery is indicated. If the esophageal muscles are weak, a Toupet or partial fundopliaction should be performed instead of a Nissen fundoplication.

Are these tests uncomfortable?

Although these tests are not pleasant, the initial placement of the tubes is the worst part. The manometry test will last only one hour. The 24-hour pH test is one day long but this tube is soft and very thin. It will exit the nose and be attached to the back of the ear. No sedatives are given during tube placement, but a numbing jelly may be used.

What are the complications of GERD?

Patients that suffer from chronic GERD may develop severe esophagitis, ulcers or Barrett's esophagus which is the transformation of the esophagus cells into stomach cells. Barrett's may be a precursor to cancer of the esophagus. Other patients may develop scarring or strictures in their esophagus which block the passage of food.