The stomach produces acid for the digestion of food. The esophagus carries food from the mouth to the stomach. A muscular valve located at the top of the stomach separates the esophagus and stomach. This valve is commonly referred to as the lower esophageal sphincter (LES). When operating properly, this valve between the esophagus and stomach opens to allow food to pass after swallowing. When not operating properly, the valve allows acid and bile to escape from the stomach, leak back into the esophagus (reflux) and travel all of the way back into the throat. GERD (gastroesophageal reflux disease) is caused by stomach and bile acid that passes into the esophagus, producing symptoms of heartburn and regurgitation. If the acid is inhaled damage to the lining of the esophagus may occur, as well as damage to the lungs, vocal cords, mouth and teeth.
Along with malfunction of the valve, other problems may contribute to reflux such as the presence of a hiatus hernia, which is an abnormal sliding of the upper stomach into the chest. Patients may also have abnormal esophageal muscle function, delayed emptying of the stomach, or overproduction of stomach acid.
The most common symptoms of GERD are heartburn and acid regurgitation. However, it is possible to have GERD without those symptoms. Other symptoms include, problems swallowing, chest pain, hoarseness, a sensation of food being stuck in the throat, choking, throat tightness, dry cough and bad breath. Many people occasionally suffer from reflux with one or several of these symptoms. When the GERD symptoms are no longer occasional, and are constant, then medical advice is advised. Self-diagnosis for GERD can lead to severe problems. It is highly recommended that you seek professional diagnosis for proper treatment. Once you have GERD, it usually does remains with you forever unless you seek medical intervention. Diagnosis of GERD is made either by your primary care physician or a gastroenterologist.
HOW IS GERD DIAGNOSED?
Several tests may be performed to prove that a defective valve is causing your symptoms. These include: endoscopy, or looking into the esophagus with an endoscope 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.
Manometry 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, alternative procedures may be performed.
The Bravo Procedure is a small device, the size of a clip which is placed by an upper endoscopy that determines the acid level in the esophagus to diagnose GERD.
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 intestinal 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.