What is GERD and how does it affect the digestive system. What are the common symptoms of acid reflux. How is GERD diagnosed and treated by medical professionals. Can lifestyle changes help manage GERD symptoms. What medications are available for treating acid reflux. When should you see a doctor for persistent heartburn.

Understanding Gastroesophageal Reflux Disease (GERD)

Gastroesophageal reflux disease, commonly known as GERD, is a chronic condition that affects the digestive system. It occurs when the lower esophageal sphincter (LES), a ring of muscle at the bottom of the esophagus, fails to close properly. This malfunction allows stomach contents to flow back (reflux) into the esophagus, causing discomfort and potential damage to the esophageal lining.

GERD can affect anyone, including infants, children, and pregnant women. While occasional heartburn is common, experiencing symptoms more than twice a week may indicate GERD, which can lead to more serious health complications if left untreated.

How does GERD differ from occasional heartburn?

Occasional heartburn is a normal occurrence that many people experience after consuming certain foods or large meals. GERD, on the other hand, is a chronic condition characterized by frequent and persistent symptoms that can significantly impact quality of life. The key distinction lies in the frequency and severity of symptoms, as well as the potential for long-term complications associated with GERD.

Recognizing the Symptoms of GERD

Identifying GERD symptoms is crucial for early diagnosis and treatment. While heartburn and acid regurgitation are the most common manifestations, GERD can present with a variety of symptoms:

• Persistent heartburn (burning sensation in the chest)
• Acid regurgitation (sour or bitter taste in the mouth)
• Chest pain
• Difficulty swallowing (dysphagia)
• Sore throat
• Hoarseness, especially in the morning
• Sensation of a lump in the throat
• Dry cough
• Bad breath

It’s important to note that some individuals may experience GERD without the typical heartburn sensation. Instead, they may primarily experience chest pain, throat discomfort, or respiratory symptoms.

Can GERD symptoms vary from person to person?

Yes, GERD symptoms can indeed vary significantly among individuals. While some people may experience classic heartburn, others might predominantly suffer from respiratory symptoms or throat discomfort. This variability in symptom presentation can sometimes make diagnosis challenging, highlighting the importance of consulting with a healthcare professional for proper evaluation.

Factors Contributing to GERD Development

The exact cause of GERD remains unknown, but several factors can contribute to its development or exacerbate symptoms:

1. Hiatal hernia: A condition where part of the stomach protrudes through the diaphragm, making it easier for acid to reflux into the esophagus.
2. Lifestyle factors:
   • Alcohol consumption
   • Excess body weight
   • Pregnancy
   • Smoking
3. Dietary triggers:
   • Citrus fruits
   • Chocolate
   • Caffeinated beverages
   • Fatty and fried foods
   • Garlic and onions
   • Mint flavorings
   • Spicy foods
   • Tomato-based products

How does a hiatal hernia contribute to GERD?

A hiatal hernia can contribute to GERD by altering the normal anatomy of the lower esophageal sphincter (LES). When part of the stomach protrudes through the diaphragm, it can weaken the LES and reduce its ability to act as a barrier against acid reflux. This anatomical change makes it easier for stomach contents to flow back into the esophagus, increasing the likelihood of GERD symptoms.

Diagnosing GERD: When to See a Doctor

If you experience persistent heartburn or any other GERD symptoms for an extended period, it’s crucial to seek medical attention. A general practitioner can initially assess your symptoms, but you may be referred to a specialist for further evaluation and treatment.

Which specialists treat GERD?

Two types of specialists commonly treat GERD:

• Internists: Doctors specializing in internal medicine who can manage a wide range of digestive disorders.
• Gastroenterologists: Specialists focused on diseases of the stomach and intestines, including GERD and other digestive tract disorders.

These specialists can perform diagnostic tests, recommend appropriate treatments, and monitor your condition over time to prevent complications.

Comprehensive Treatment Approaches for GERD

GERD treatment typically involves a combination of lifestyle modifications, medications, and in some cases, surgical interventions. The severity of your symptoms and the presence of complications will determine the most appropriate treatment plan.

Lifestyle Modifications

Making certain lifestyle changes can significantly reduce GERD symptoms and improve overall digestive health:

• Quit smoking
• Limit or avoid alcohol consumption
• Maintain a healthy weight
• Eat smaller, more frequent meals
• Eliminate trigger foods from your diet
• Wear loose-fitting clothing
• Avoid lying down for 3 hours after meals
• Elevate the head of your bed by 6 to 8 inches

How effective are lifestyle changes in managing GERD?

Lifestyle modifications can be highly effective in managing GERD symptoms for many individuals. By identifying and avoiding personal triggers, maintaining a healthy weight, and adopting proper eating habits, some people may experience significant symptom relief without the need for medications. However, the effectiveness of lifestyle changes can vary, and more severe cases may require additional treatment approaches.

Medications for GERD Management

Various medications are available to treat GERD, ranging from over-the-counter options to prescription-strength drugs. The choice of medication depends on the severity of symptoms and individual patient factors.

Over-the-Counter Medications

• Antacids: These provide quick relief by neutralizing stomach acid. Examples include Maalox, Mylanta, Rolaids, and Tums.
• H2 blockers: These reduce acid production and provide longer-lasting relief. Over-the-counter options include famotidine (Pepcid AC) and ranitidine (Zantac 75).
• Proton pump inhibitors (PPIs): Available in lower strengths over the counter, PPIs like omeprazole (Prilosec OTC) offer more potent acid suppression.

Prescription Medications

• Stronger H2 blockers
• Higher-dose PPIs
• Prokinetics: Medications that help strengthen the lower esophageal sphincter and promote faster stomach emptying

Are there any risks associated with long-term use of GERD medications?

While GERD medications are generally safe and effective, long-term use of certain drugs, particularly proton pump inhibitors (PPIs), may be associated with potential risks. These can include an increased risk of certain infections, nutrient deficiencies, and bone fractures. It’s essential to use these medications under medical supervision and discuss any concerns about long-term use with your healthcare provider.

Surgical Interventions for Severe GERD

In cases where lifestyle changes and medications fail to adequately control GERD symptoms, or when complications arise, surgical intervention may be considered. The most common surgical procedure for GERD is fundoplication, which involves wrapping the upper part of the stomach around the lower esophagus to reinforce the lower esophageal sphincter.

Types of GERD Surgery

• Nissen fundoplication: The most common type, involving a 360-degree wrap of the stomach around the esophagus.
• Partial fundoplication: A less extensive wrap that may be suitable for some patients.
• Minimally invasive approaches: Laparoscopic and robotic-assisted techniques that offer faster recovery times and fewer complications.

When is surgery considered for GERD treatment?

Surgery for GERD is typically considered in the following situations:

• Persistent symptoms despite maximal medical therapy
• Intolerance to long-term medication use
• Presence of severe complications, such as Barrett’s esophagus or strictures
• Large hiatal hernias contributing to GERD symptoms
• Patient preference for a long-term solution

The decision to undergo surgery should be made in consultation with a gastroenterologist and a qualified surgeon, taking into account the individual patient’s circumstances and potential risks and benefits of the procedure.

Preventing GERD Complications

While GERD is a chronic condition, proper management can help prevent serious complications. Long-term, untreated GERD can lead to various health issues affecting the esophagus and beyond.

Potential Complications of Untreated GERD

• Esophagitis: Inflammation and irritation of the esophageal lining
• Strictures: Narrowing of the esophagus due to scar tissue formation
• Barrett’s esophagus: Changes in the esophageal lining that increase the risk of esophageal cancer
• Respiratory problems: Chronic cough, asthma exacerbation, or recurrent pneumonia
• Dental erosion: Damage to tooth enamel from repeated acid exposure

How can GERD complications be prevented?

Preventing GERD complications involves a multifaceted approach:

1. Adhere to prescribed treatment plans, including medications and lifestyle modifications
2. Attend regular follow-up appointments with your healthcare provider
3. Undergo recommended screening procedures, such as endoscopies, to monitor for complications
4. Promptly report any new or worsening symptoms to your doctor
5. Maintain a healthy lifestyle, including a balanced diet and regular exercise
6. Avoid known GERD triggers and adopt habits that minimize reflux episodes

By taking a proactive approach to GERD management and working closely with healthcare professionals, patients can significantly reduce their risk of developing serious complications and maintain a better quality of life.

Gastroesophageal Reflux Disease – Wake Gastroenterology

Gastroesophageal reflux disease, or GERD, occurs when the lower esophageal sphincter (LES) does not close properly and stomach contents leak back, or reflux, into the esophagus. The LES is a ring of muscle at the bottom of the esophagus that acts like a valve between the esophagus and stomach. The esophagus carries food from the mouth to the stomach

When refluxed stomach acid touches the lining of the esophagus, it causes a burning sensation in the chest or throat called heartburn.The fluid may even be tasted in the back of the mouth, and this is called acid indigestion.

Occasional heartburn is common but does not necessarily mean one has GERD. Heartburn that occurs more than twice a week may be considered GERD, and it can eventually lead to more serious health problems.

Anyone, including infants, children, and pregnant women, can have GERD.

What are the symptoms of GERD?

The main symptoms are persistent heartburn and acid regurgitation. Some people have GERD without heartburn. Instead, they experience pain in the chest, sore throat, hoarseness in the morning, or trouble swallowing. You may feel like you have food stuck in your throat or like you are choking or your throat is tight. GERD can also cause a dry cough and bad breath.

What causes GERD?

No one knows why people get GERD. A hiatal hernia may contribute. A hiatal hernia occurs when the upper part of the stomach is above the diaphragm, the muscle wall that separates the stomach from the chest. The diaphragm helps the LES keep acid from coming up into the esophagus. When a hiatal hernia is present, it is easier for the acid to come up. In this way, a hiatal hernia can predispose to reflux.

Other factors that may contribute to GERD include:

• alcohol use
• excess weight
• pregnancy
• smoking

Also, certain foods can be associated with reflux events, including:

• citrus fruits
• chocolate
• drinks with caffeine
• fatty and fried foods
• garlic and onions
• mint flavorings
• spicy foods
• tomato-based foods, like spaghetti sauce, chili, and pizza

Modifying your diet to reduce or eliminate these items can greatly reduce GERD symptoms.

How is GERD treated?

If you have had heartburn or any of the other symptoms for a while, you should see your doctor. You may want to visit an internist (a doctor who specializes in internal medicine) or a gastroenterologist (a doctor who treats diseases of the stomach and intestines). Depending on how severe your GERD is, treatment may involve one or more of the following lifestyle changes and medications or surgery.

Lifestyle Changes

• If you smoke, stop.
• Do not drink alcohol.
• Lose weight if needed.
• Eat small meals.
• Change your diet to eliminate those foods and beverages which aggravate GERD.
• Wear loose-fitting clothes.
• Avoid lying down for 3 hours after a meal.
• Raise the head of your bed 6 to 8 inches by putting blocks of wood under the bedposts Ð just using extra pillows will not help.

Medications

Your doctor may recommend over-the-counter antacids, which you can buy without a prescription, or medications that stop acid production, or others which help the muscles that empty your stomach.

Antacids, such as Maalox, Mylanta, Pepto-Bismol, Rolaids, and Riopan, are usually the first drugs recommended to relieve heartburn and other mild GERD symptoms. Many brands on the market use different combinations of three basic salts magnesium, calcium, and aluminum – with hydroxide or bicarbonate ions to neutralize the acid in your stomach. Antacids, however, have side effects. Magnesium salt can lead to diarrhea, and aluminum salts can cause constipation. Aluminum and magnesium salts are often combined in a single product to balance these effects.

Calcium carbonate antacids, such as Tums, Titralac, and Alka-2, can also be a supplemental source of calcium. They can cause constipation as well.

Foaming agents, such as Gaviscon, work by covering your stomach contents with foam to prevent reflux. These drugs may help those who have no damage to the esophagus.  They can also minimize excess belching.

h3 blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75), impede acid production. They are available in prescription strength and over the counter. These drugs provide short-term relief, but over-the-counter h3 blockers should not be used for more than a few weeks at a time without physician supervision. They are effective for about half of those who have GERD symptoms.  We strongly recommend that you consult with a physician before using these on a long-term basis.

• Proton pump inhibitors include omeprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole (Nexium), which are all available by prescription and many are generic. Prilosec OTC and Prevacid is now available over-the-counter. Proton pump inhibitors are more effective than h3 blockers and can relieve symptoms in almost everyone who has GERD.  Both these medications are taken 30-60 minutes before eating.  Again, since persistent heartburn symptoms can indicate a number of more serious conditions, we strongly recommend discussing this medication with your physician before choosing to take it for an extended period of time.

Another group of drugs, prokinetics, helps strengthen the sphincter and makes the stomach empty faster. This group includes bethanechol (Urecholine) and metoclopramide (Reglan). Metoclopramide also improves muscle action in the digestive tract, but these drugs have frequent side effects that limit their usefulness.

Because drugs work in different ways, combinations of drugs may help control symptoms.  Your doctor is the best source of information on how to use medications for GERD.

What if symptoms persist?

If your heartburn does not improve with lifestyle changes or drugs, you may need additional tests.

• A barium swallow radiograph uses x-rays to help spot abnormalities such as a hiatal hernia and severe inflammation of the esophagus. With this test, you drink a solution and then x-rays are taken. Mild irritation will not appear on this test, although narrowing of the esophagus called stricture – ulcers, hiatal hernia, and other problems will.  This test is rarely used these days.
• Upper endoscopy is more accurate than a barium swallow radiograph and may be performed in a hospital or a doctor’s office. The doctor will spray your throat to numb it and slide down a thin, flexible plastic tube called an endoscope. A tiny camera in the endoscope allows the doctor to see the surface of the esophagus and to search for abnormalities. If you have had moderate to severe symptoms and this procedure reveals injury to the esophagus, usually no other tests are needed to confirm GERD.
  The doctor may use tiny tweezers (forceps) in the endoscope to remove a small piece of tissue for biopsy. A biopsy viewed under a microscope can reveal damage caused by acid reflux and rule out other problems if no infecting organisms or abnormal growths are found.
• In an ambulatory pH monitoring examination, the doctor puts a tiny tube into the esophagus that will stay there for 24 hours. While you go about your normal activities, it measures when and how much acid comes up into your esophagus. This test is useful in people with GERD symptoms but no esophageal damage. The procedure is also helpful in detecting whether respiratory symptoms, including wheezing and coughing, are triggered by reflux.  A wireless version of this test is also available to detect acid reflux over a 48 hour period (Bravo testing).

SurgeryGastroesophageal reflux disease, or GERD, occurs when the lower esophageal sphincter (LES) does not close properly and stomach contents leak back, or reflux, into the esophagus. The LES is a ring of muscle at the bottom of the esophagus that acts like a valve between the esophagus and stomach. The esophagus carries food from the mouth to the stomach

When refluxed stomach acid touches the lining of the esophagus, it causes a burning sensation in the chest or throat called heartburn.The fluid may even be tasted in the back of the mouth, and this is called acid indigestion.

Occasional heartburn is common but does not necessarily mean one has GERD. Heartburn that occurs more than twice a week may be considered GERD, and it can eventually lead to more serious health problems.

Anyone, including infants, children, and pregnant women, can have GERD.

What are the symptoms of GERD?

The main symptoms are persistent heartburn and acid regurgitation. Some people have GERD without heartburn. Instead, they experience pain in the chest, sore throat, hoarseness in the morning, or trouble swallowing. You may feel like you have food stuck in your throat or like you are choking or your throat is tight. GERD can also cause a dry cough and bad breath.

What causes GERD?

No one knows why people get GERD. A hiatal hernia may contribute. A hiatal hernia occurs when the upper part of the stomach is above the diaphragm, the muscle wall that separates the stomach from the chest. The diaphragm helps the LES keep acid from coming up into the esophagus. When a hiatal hernia is present, it is easier for the acid to come up. In this way, a hiatal hernia can predispose to reflux.

Other factors that may contribute to GERD include:

• alcohol use
• excess weight
• pregnancy
• smoking

Also, certain foods can be associated with reflux events, including:

• citrus fruits
• chocolate
• drinks with caffeine
• fatty and fried foods
• garlic and onions
• mint flavorings
• spicy foods
• tomato-based foods, like spaghetti sauce, chili, and pizza

Modifying your diet to reduce or eliminate these items can greatly reduce GERD symptoms.

How is GERD treated?

If you have had heartburn or any of the other symptoms for a while, you should see your doctor. You may want to visit an internist (a doctor who specializes in internal medicine) or a gastroenterologist (a doctor who treats diseases of the stomach and intestines). Depending on how severe your GERD is, treatment may involve one or more of the following lifestyle changes and medications or surgery.

Lifestyle Changes

• If you smoke, stop.
• Do not drink alcohol.
• Lose weight if needed.
• Eat small meals.
• Change your diet to eliminate those foods and beverages which aggravate GERD.
• Wear loose-fitting clothes.
• Avoid lying down for 3 hours after a meal.
• Raise the head of your bed 6 to 8 inches by putting blocks of wood under the bedposts Ð just using extra pillows will not help.

Medications

Your doctor may recommend over-the-counter antacids, which you can buy without a prescription, or medications that stop acid production, or others which help the muscles that empty your stomach.

Antacids, such as Maalox, Mylanta, Pepto-Bismol, Rolaids, and Riopan, are usually the first drugs recommended to relieve heartburn and other mild GERD symptoms. Many brands on the market use different combinations of three basic salts magnesium, calcium, and aluminum – with hydroxide or bicarbonate ions to neutralize the acid in your stomach. Antacids, however, have side effects. Magnesium salt can lead to diarrhea, and aluminum salts can cause constipation. Aluminum and magnesium salts are often combined in a single product to balance these effects.

Calcium carbonate antacids, such as Tums, Titralac, and Alka-2, can also be a supplemental source of calcium. They can cause constipation as well.

Foaming agents, such as Gaviscon, work by covering your stomach contents with foam to prevent reflux. These drugs may help those who have no damage to the esophagus.  They can also minimize excess belching.

h3 blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75), impede acid production. They are available in prescription strength and over the counter. These drugs provide short-term relief, but over-the-counter h3 blockers should not be used for more than a few weeks at a time without physician supervision. They are effective for about half of those who have GERD symptoms.  We strongly recommend that you consult with a physician before using these on a long-term basis.

• Proton pump inhibitors include omeprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole (Nexium), which are all available by prescription and many are generic. Prilosec OTC and Prevacid is now available over-the-counter. Proton pump inhibitors are more effective than h3 blockers and can relieve symptoms in almost everyone who has GERD.  Both these medications are taken 30-60 minutes before eating.  Again, since persistent heartburn symptoms can indicate a number of more serious conditions, we strongly recommend discussing this medication with your physician before choosing to take it for an extended period of time.

Another group of drugs, prokinetics, helps strengthen the sphincter and makes the stomach empty faster. This group includes bethanechol (Urecholine) and metoclopramide (Reglan). Metoclopramide also improves muscle action in the digestive tract, but these drugs have frequent side effects that limit their usefulness.

Because drugs work in different ways, combinations of drugs may help control symptoms.  Your doctor is the best source of information on how to use medications for GERD.

What if symptoms persist?

If your heartburn does not improve with lifestyle changes or drugs, you may need additional tests.

• A barium swallow radiograph uses x-rays to help spot abnormalities such as a hiatal hernia and severe inflammation of the esophagus. With this test, you drink a solution and then x-rays are taken. Mild irritation will not appear on this test, although narrowing of the esophagus called stricture – ulcers, hiatal hernia, and other problems will.  This test is rarely used these days.
• Upper endoscopy is more accurate than a barium swallow radiograph and may be performed in a hospital or a doctor’s office. The doctor will spray your throat to numb it and slide down a thin, flexible plastic tube called an endoscope. A tiny camera in the endoscope allows the doctor to see the surface of the esophagus and to search for abnormalities. If you have had moderate to severe symptoms and this procedure reveals injury to the esophagus, usually no other tests are needed to confirm GERD.
  The doctor may use tiny tweezers (forceps) in the endoscope to remove a small piece of tissue for biopsy. A biopsy viewed under a microscope can reveal damage caused by acid reflux and rule out other problems if no infecting organisms or abnormal growths are found.
• In an ambulatory pH monitoring examination, the doctor puts a tiny tube into the esophagus that will stay there for 24 hours. While you go about your normal activities, it measures when and how much acid comes up into your esophagus. This test is useful in people with GERD symptoms but no esophageal damage. The procedure is also helpful in detecting whether respiratory symptoms, including wheezing and coughing, are triggered by reflux.  A wireless version of this test is also available to detect acid reflux over a 48 hour period (Bravo testing).

Surgery

Surgery is an option when medicine and lifestyle changes do not work. Surgery may also be a reasonable alternative to a lifetime of drugs and discomfort.

Fundoplication, usually a specific variation called Nissen fundoplication, is the standard surgical treatment for GERD. The upper part of the stomach is wrapped around the LES to strengthen the sphincter and prevent acid reflux and to repair a hiatal hernia.

This fundoplication procedure may be done using a laparoscope and requires only tiny incisions in the abdomen. To perform the fundoplication, surgeons use small instruments that hold a tiny camera. Laparoscopic fundoplication has been used safely and effectively in people of all ages, even babies. When performed by experienced surgeons, the procedure is reported to be as good as standard fundoplication. Furthermore, people can leave the hospital in 1 to 3 days and return to work in 2 to 3 weeks.

Endoscopic devices, The U.S. Food and Drug Administration (FDA) has approved several endoscopic devices to treat chronic heartburn. The Bard EndoCinch system puts stitches in the LES to create little pleats that help strengthen the muscle. The Stretta system uses electrodes to create tiny cuts on the LES. When the cuts heal, the scar tissue helps toughen the muscle. The long-term effects of these two procedures are unknown.  Endoscopic devices are rarely used in the management of GERD.

What are the long-term complications of GERD?

Sometimes GERD can cause serious complications. Inflammation of the esophagus from stomach acid causes bleeding or ulcers. In addition, scars from tissue damage can narrow the esophagus and make swallowing difficult. Some people develop Barrett’s esophagus, where cells in the esophageal lining take on an abnormal shape and color, and which over time can lead to cancer.

Also, studies have shown that asthma, chronic cough, and pulmonary fibrosis may be aggravated or even caused by GERD.

Points to Remember

• Heartburn / acid indigestion, is the most common symptom of GERD. Anyone experiencing heartburn twice a week or more may have GERD.
• You can have GERD without having heartburn. Your symptoms could be excessive clearing of the throat, problems swallowing, the feeling that food is stuck in your throat, burning in the mouth, or pain in the chest.
• If you have been using antacids for more than 2 weeks, it is time to see a doctor. Most doctors can treat GERD. Or you may want to visit an internist–a doctor who specializes in internal medicine–or a gastroenterologist–a doctor who treats diseases of the stomach and intestines.
• Doctors usually recommend lifestyle and dietary changes to relieve heartburn. Many people with GERD also need medication. Surgery may be an option.

Surgery is an option when medicine and lifestyle changes do not work. Surgery may also be a reasonable alternative to a lifetime of drugs and discomfort.

Fundoplication, usually a specific variation called Nissen fundoplication, is the standard surgical treatment for GERD. The upper part of the stomach is wrapped around the LES to strengthen the sphincter and prevent acid reflux and to repair a hiatal hernia.

This fundoplication procedure may be done using a laparoscope and requires only tiny incisions in the abdomen. To perform the fundoplication, surgeons use small instruments that hold a tiny camera. Laparoscopic fundoplication has been used safely and effectively in people of all ages, even babies. When performed by experienced surgeons, the procedure is reported to be as good as standard fundoplication. Furthermore, people can leave the hospital in 1 to 3 days and return to work in 2 to 3 weeks.

Endoscopic devices, The U.S. Food and Drug Administration (FDA) has approved several endoscopic devices to treat chronic heartburn. The Bard EndoCinch system puts stitches in the LES to create little pleats that help strengthen the muscle. The Stretta system uses electrodes to create tiny cuts on the LES. When the cuts heal, the scar tissue helps toughen the muscle. The long-term effects of these two procedures are unknown.  Endoscopic devices are rarely used in the management of GERD.

For More Information

To learn more about this topic, visit:

American College of Gastroenterology (ACG)
American Gastroenterological Association (AGA)

Types of Specialists & When to See Them

Gastroesophageal reflux disease (GERD) is a common condition that causes acid reflux (heartburn) at least several times a week. GERD symptoms can get in the way of daily activities or getting a good night’s sleep.

If heartburn is a daily or almost-daily part of your life, it may be time to see a GERD doctor.

In this article, we’ll go over the types of specialists who treat GERD. We’ll also clarify the symptoms that might indicate you need a specialist.

When you eat or drink, food is transported from your mouth to your stomach through a tube called the esophagus. GERD symptoms occur when stomach contents flow back up through the esophagus into the chest. This causes the burning sensation most associated with GERD.

Anyone can get an occasional bout of heartburn. GERD differs from ordinary heartburn in frequency and, in some instances, severity.

These common symptoms of GERD may require consultation with a specialist:

• heartburn that occurs more than twice weekly
• heartburn that doesn’t get better with antacid use
• acid reflux that wakes you up at night
• regurgitation of sour liquid or food particles from the stomach into the throat and mouth
• chest pain
• sore throat
• difficulty swallowing
• feeling like you have a lump in your throat
• hoarseness
• bad breath

Lifestyle changes that may help GERD symptoms

GERD symptoms may lessen with lifestyle changes, such as:

• maintaining a moderate weight
• trying to quit smoking, if you smoke
• eliminating or reducing consumption of coffee, alcohol, and carbonated beverages
• eating smaller meals, especially at night
• not eating late at night
• not lying down for at least 3 hours after eating
• eliminating spicy, fatty, and acidic foods from your diet

If lifestyle changes don’t eliminate these symptoms, seeing a GERD specialist may help. A GERD doctor can do medical testing that uncovers the underlying cause of your symptoms. They can also provide advice on how to handle GERD.

Babies, children, and adults can have GERD. Talking with your general healthcare practitioner (GP) or with your child’s pediatrician is a good first step for GERD treatment. They may prescribe medications that reduce symptoms, plus they can provide insight about next steps.

In many instances, your regular physician will recommend seeing a gastroenterologist or other type of specialist for testing and treatment.

Gastroenterologist

Gastroenterologists are board certified physicians who receive specialized training to treat conditions of the gastrointestinal tract and liver. Gastroenterologists are the type of specialists usually seen for diagnosis and treatment of GERD.

Otolaryngologist

Based on your symptoms, your GP may instead recommend you see an otolaryngologist. They are also known as an ENT, or ear, nose, and throat specialist. If you have stomach acid that spills into your throat or voice box, you may have laryngopharyngeal reflux (LPR) instead of, or in addition to, GERD. Otolaryngologists have experience diagnosing and treating both conditions.

Nutritionist or dietitian

Coaching from a nutritionist or registered dietitian may also be beneficial for helping you maintain a moderate weight. Nutritional specialists can also recommend lists of foods to eat or avoid for GERD management. These types of specialists don’t take the place of gastroenterologists or ENTs. They can, however, help with lifestyle choices and symptom management.

GERD doctors, such as gastroenterologists, receive extensive training to perform endoscopic procedures and interpret their results. GERD specialists are equipped to do diagnostic tests that uncover underlying causes and conditions that mimic GERD.

Conditions that may seem like GERD include:

• gastritis
• Helicobacter pylori (H. pylori)
• gallstones
• stomach ulcers
• esophagitis
• esophageal cancer
• hiatal hernia
• angina

Diagnostic tests that a GERD specialist may do include:

• Upper endoscopy. This procedure is done under light anesthesia. A flexible tube fitted with a small camera is placed into the esophagus to examine it. Your doctor may remove a tiny piece of esophageal tissue for biopsy during an upper endoscopy.
• Esophageal pH monitoring. For this test, a small monitor is placed into your esophagus to analyze how your gastrointestinal system manages and regulates the flow of stomach acid over the course of several days.
• Esophageal manometry. During this test, a tube is placed into the esophagus through the nose to measure the strength of the esophageal muscles.
• Esophogram. For this test, you will first drink a barium solution and then have an X-ray of your upper digestive tract.
• Ambulatory 24-hour pH probe. During this test, a tube is placed into the esophagus through your nose and left in place for 24 hours. A pH sensor in the tube measures acid levels in the esophagus.

After testing and diagnosis, you may be placed on medication and monitored. In some instances, a specialist will recommend that you continue to see them for monitoring and treatment. In other cases, they may instead recommend you see your GP regularly for monitoring.

If your symptoms don’t improve, a GERD specialist may recommend other treatments, such as surgery or a Transoral Incisionless Fundoplication (TIF). Though not as widely used as surgery, a TIF procedure is starting to be used more often in clinical practices. This minimally invasive, nonsurgical procedure repairs the anti-reflux barrier inside the stomach.

In some instances, diagnostic testing may show that a hiatal hernia is causing GERD symptoms. Hiatal hernias are often treated with an outpatient laparoscopy procedure, such as a Nissen fundoplication.

Surgery for GERD and its underlying causes can only be done by a GERD specialist.

Your GP may be able to recommend a GERD specialist to you. If you have health insurance, your insurer may also be able to provide a list of specialists practicing in your area. You may also wish to research patient recommendations online.

GERD specialists

GERD specialists can also be found here:

• You can find a gastroenterologist through the American College of Gastroenterology.
• You can find an otolaryngologist through the American Academy of Otolaryngology — Head and Neck Surgery.
• You can find a nutrition expert through the Academy of Nutrition and Dietetics.

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What to consider when choosing a specialist

When choosing a specialist, take these considerations into account:

• How many years have they been practicing their specialty?
• How experienced are they in treating your condition?
• Have any complaints been logged against them in the Federation of State Medical Boards’ DocInfo database?
• If surgery is required, how many times a week do they perform the procedure you need?
• Do they accept your insurance?
• How comfortable do they make you feel?
• Are they patient enough to answer all your questions without rushing you through the appointment?
• Does their office follow local COVID-19 safety guidelines?

Gastroesophageal reflux disease (GERD) involves excessive or extreme bouts of heartburn.

A GERD doctor such as a gastroenterologist is usually the best choice for diagnosing and treating this condition. In some instances, an ENT specialist may also be used to diagnose and treat GERD.

At the doctor’s appointment. Gastroesophageal reflux

GERD appointment

In order for a doctor’s appointment to be productive, it is necessary to prepare for it in advance.

Preparing for your GERD appointment

— Write down all the symptoms that occur, even those that you think are not related to the reason you went to the doctor.

— Make a list of all medications, vitamins, and supplements you take. Specify the dosage and frequency of administration.

— If possible, bring a family member or friend with you. During the appointment, you will learn a lot of new things, and it will be difficult to remember all the information received.

– Bring a notebook or notebook with you. Write down all important information during the appointment.

— Write down the questions you want to ask the doctor. Place the most important questions at the top of the list.

Gastroesophageal reflux is usually diagnosed based on the patient’s symptoms. Most likely, the doctor will first ask a few questions.

To answer the following questions, describe how often symptoms occur: never, rarely, once or twice a week, often, more than once a day.

Do you get heartburn?

— Does heartburn interfere with your daily life, does it disturb your sleep?

— Does heartburn cause severe pain that prevents you from doing your normal activities?

– Did you have difficulty swallowing? Painful sensations?

— Did you have a persistent cough?

Have you experienced hoarseness or a feeling of itching in your throat?

— Did you have difficulty breathing or shortness of breath?

— Did you have chest pain?

— How often do you take antacids or over-the-counter drugs to relieve symptoms?

Then the doctor performs a physical examination, including assessing the condition of the mouth, teeth and throat, checking for signs of inflammation.

Top questions to ask your doctor about GERD

Can any medications I take make my symptoms worse?

Do I need to have any tests, such as X-rays of the upper gastrointestinal tract, endoscopy or esophageal manometry?

Do you specialize in the treatment of diseases of the gastrointestinal tract?

Can my symptoms indicate angina or a heart attack? How to distinguish them from each other?

Could my symptoms be related to another condition?

What foods should I avoid?

Should I avoid any activities?

What are the signs that I should be re-examined?

How can I tell if my symptoms are due to a more serious condition, such as Barrett’s esophagus or esophageal cancer?

If you are prescribed medication:

Which medication is best for me?

When should I take the medicine?

Are there any side effects from taking the drug?

If I am pregnant, which drugs are safe?

How long do I have to take medication?

Will my medicine be expensive? Are there any alternative drugs or discounts?

Make sure you understand everything the doctor says. Feel free to ask for information to be repeated and ask questions if something is not clear.

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Gastroenteritis

Reflux esophagitis (GERD) – treatment, symptoms and diagnostics of reflux esophagitis (GERD) in “SM-Clinic”

This disease is treated by Gastroenterologist

• What is reflux esophagitis (GERD)?
• Symptoms of gastroesophageal reflux disease
• Causes and course of GERD
• Diagnosis of gastroesophageal reflux disease (GERD)
• Treatment of gastroesophageal reflux disease (GERD)
• Surgical treatment of gastroesophageal reflux disease (GERD)
• Doctors

Symptoms of gastroesophageal reflux disease

Characteristic symptoms of gastroesophageal reflux disease are heartburn, pain in the sternum, sour eructation, regurgitation, nausea, painful and difficult passage of food, discomfort after eating, flatulence. Errors in the diet (fatty, carbonated drinks, alcohol), smoking, physical activity, wearing clothes with a tight belt can provoke an increase in symptoms.

Gastroesophageal reflux disease (GERD, reflux esophagitis) is one of the most common diseases of the esophagus, episodically its symptoms, primarily heartburn, occur in half of the adult population of the country, men and women get sick equally often, usually between the ages of 20 and 45 years.

GERD is an insidious disease, without proper treatment it can lead to serious complications, including cancer of the esophagus. The danger is aggravated by the fact that despite the mass of unpleasant symptoms that spoil their lives, many people are in no hurry to see a doctor, preferring to muffle the symptoms with heartburn pills.

Causes and course of GERD

Factors contributing to the development of GERD are hiatal hernia (esophageal hernia), stress, obesity, pregnancy, smoking, taking certain medications (calcium antagonists, anticholinergics, beta-blockers, etc. ).

The immediate cause of gastroesophageal reflux disease is prolonged contact of gastric contents with the mucosa of the esophagus. Dysmotility leads to the fact that the acidic gastric environment not only enters the esophagus, but also stays there for a long time.

Incorrect work (weakness) of the lower esophageal sphincter, which should prevent the reverse movement of masses, causes the entry of gastric contents into the esophagus, and insufficient peristalsis of the esophagus and a decrease in esophageal clearance cause slow emptying of the stomach and the withdrawal of this aggressive environment. This imbalance of protective functions leads to the development of reflux esophagitis.

Prolonged exposure of acid and bile to the mucosa of the esophagus leads to its chronic inflammation and erosive and ulcerative changes, foci of altered mucosa of the lower esophagus often serve as a source of growth of a cancerous tumor.

At the initial stages of the disease, separate areas of erosion of the distal esophagus are noted, at the second stage, individual foci of inflammation merge into a common area, then at the third stage, the inflammatory process covers the entire surface of the mucosa, ulcers appear. The fourth stage is a chronic esophageal ulcer, stenosis, cylindrical metaplasia of the esophageal mucosa (Barrett’s esophagus).

Patients with reflux disease are at increased risk of acquiring various diseases of the paranasal sinuses, diseases of the trachea, larynx and lungs (ischemic heart disease with angina pectoris and / or heart rhythm disturbances, reflux laryngitis and pharyngitis, recurrent pneumonia, bronchial asthma, dental erosion, etc. ).

Get advice

If you experience these symptoms, we recommend that you make an appointment with your doctor. Timely consultation will prevent negative consequences for your health.

You can find out more about the disease, prices for treatment and sign up for a consultation with a specialist by phone:

+7 (495) 292-39-72

Request a call back
Book online

Why SM-Clinic?

1

Treatment is carried out in accordance with clinical guidelines

2

Comprehensive assessment of the nature of the disease and treatment prognosis

3

Modern diagnostic equipment and own laboratory

4

High level of service and balanced pricing policy

Diagnosis of gastroesophageal reflux disease (GERD)

Various methods are used to diagnose GERD. The main method is endoscopic – it allows you to get confirmation of the presence of reflux esophagitis, to assess its severity. Histological analysis of biopsy specimens of the esophageal mucosa provides additional information on the degree of dystrophic changes in the epithelial layer.

Contrast radiography of the esophagus allows you to identify reflux as such, that is, to fix the ingress of contrast from the stomach into the esophagus. X-ray examination of the esophagus may also indicate the presence of hiatal hernia, stricture of the esophagus, diffuse esophagospasm of the diaphragm.

Esophageal manometry (esophagomanometry) – allows you to evaluate the contractile activity of the esophagus, to study the indicators of the movement of its wall and the activity of the esophageal sphincters.

Treatment of gastroesophageal reflux disease (GERD)

After a comprehensive diagnosis, a gastroenterologist comprehensively assesses the patient’s health, analyzes the severity and nature of the disease and selects an individual treatment regimen.

The goal of treatment of gastroesophageal reflux disease is to relieve its symptoms, treat esophagitis, prevent or eliminate complications of the disease, and improve the patient’s quality of life. Treatment for GERD can be conservative or surgical.

Non-surgical treatment of gastroesophageal reflux disease (GERD)

Non-surgical treatment is indicated for mild to moderate reflux disease.

Properly selected antireflux therapy can reduce reflux, reduce the damaging properties of refluxate (gastric contents), improve esophageal clearance and protect the esophageal mucosa.

Effective antireflux treatment is based on lifestyle changes, in particular, it is necessary to normalize body weight, seriously adjust the diet, the amount and time of eating (avoid fatty, sour, gas-inducing foods, as well as chocolate, coffee, carbonated drinks) . It is very important to exclude smoking and drinking alcohol, you should refrain from taking drugs that depress the function of the lower esophageal sphincter. Patients should avoid overeating, as well as stress on the abdominal muscles.

Anti-reflux drug therapy includes regular intake of antacids and alginic acid derivatives, prokinetics and antisecretory drugs that reduce gastric acidity, protect the esophageal mucosa, activate peristalsis, increase the activity of esophageal sphincters and improve esophageal and gastric motility in general.

With complex drug therapy of moderate reflux esophagitis, most patients experience a significant reduction in symptoms and an improvement in quality of life.

The basic course of treatment should be at least one month, and then for 6-12 months the patient should receive maintenance treatment. Without supportive treatment, the likelihood of recurrence of erosive esophagitis is high – it reaches 90% within a year.

It should be borne in mind that many antacid preparations contain a large amount of aluminum in their composition, and, accordingly, their long-term, unsystematic use leads to its accumulation in the body, which in old age increases the risk of developing Alzheimer’s disease.

Surgical treatment of gastroesophageal reflux disease (GERD)

The question of surgical treatment of GERD arises when conservative therapy does not give the expected effect, despite repeated courses of drug therapy and adherence to all recommendations for normalizing lifestyle. Conservative treatment can reduce the severity of symptoms and prevent complications from developing, but does not eliminate the cause of the disease.

If, despite active medical treatment of GERD, you continue to suffer from heartburn, pain and other symptoms of reflux disease for more than a year, then it’s time to think about consulting with an experienced surgeon.

The indication for surgical treatment of reflux esophagitis is also a complicated course of the disease: bleeding, ulcerative lesions, peptic strictures of the esophagus, development of Barrett’s esophagus with high-grade epithelial dysplasia. Especially often, indications for surgery occur when GERD is combined with a hernia of the esophageal opening of the diaphragm.

SM-Clinic employs experienced surgeons who successfully perform surgical treatment of gastroesophageal reflux disease.

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Diseases referred to Gastroenterologist

Avitaminosis
Ascariasis
Atrophic gastritis
Achalasia
Balantidiasis
Crohn’s disease
Viral hepatitis
Gastritis
gastroptosis
Gastroenteritis
Gastroenterocolitis
Helminthiasis
Liver hemangioma
Hepatitis A
Hepatitis B
Hepatitis D
Hepatitis E
Hepatitis C
Hepatomegaly
hiatal hernia
Diarrhea
diarrhea during pregnancy
Traveler’s diarrhea
Intestinal diverticulosis
Dysbacteriosis
Dyspepsia
Benign neoplasms of the esophagus
Duodenitis
Jaundice
Cholelithiasis
fatty liver disease
Fatty hepatosis
Constipation
Heartburn
intestinal candidiasis
liver cyst
pancreatic cyst
intestinal colic
Colitis
Blood in stool
Flatulence
Mechanical jaundice
food poisoning
pancreatitis
Intestinal pneumatosis
Polyps of the stomach
Gallbladder polyps
Intestinal polyps
Postcholecystectomy syndrome
Gilbert’s syndrome
Spasm of the esophagus
Toxic hepatitis
Helicobacteriosis
Cholangitis
cholestasis
Cholecystitis
Chronic gastritis
Chronic cholecystitis
celiac disease
Cirrhosis of the liver
Enteritis
Enterocolitis
Erosive gastritis
Esophageal ulcer
Peptic ulcer of the stomach and duodenum
Ulcerative colitis

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