Medical Minute – GERD

By: Dr. James Lee

Gastroesophageal reflux disease is a common disease worldwide.  Although incidence varies depending on the region, in the US the incidence is as high as 25-30% and seems to be increasing.  This is despite the powerful antisecretory antacid medications available now. 

Symptoms of GERD including burning type pain in the upper abdomen and chest, nausea, difficulty swallowing, bad breath, regurgitation of food or liquid.  Rare symptoms of GERD can include pulmonary symptoms, especially with nighttime reflux and include chronic cough, worsening asthma, laryngitis, and disrupted sleep.  Pain can be so severe in the chest that it can be mistaken for a heart attack.  Although pain in the upper abdomen and chest is commonly called heartburn, it has nothing to do with your heart.

Complications of Gastroesophageal reflux include scarring in the esophagus that produces a narrowing called a stricture that causes food to get stuck.  Lung damage with pneumonia and fibrosis (scarring) can also occur in chronic cases.  Long term exposure of the esophagus to acid can result in Barrett’s Esophagus.  This is a condition where the cells in the distal esophagus change to become more like the cells in the stomach and intestine.  These cells are potentially unstable and can become abnormal and increase the risk of esophageal cancer.

Diagnosis of GERD is generally accomplished by upper endoscopy.  This is done under anesthesia and allows visualization of the upper GI tract and biopsies to be taken to confirm abnormalities.  Other studies include barium swallow, monitoring of the pH inside the esophagus, and studying the pressure exerted by the esophagus when swallowing (manometry). 

Treatment of GERD include lifestyle changes, medications, and if persistent symptoms, surgery.  Lifestyle changes include avoiding things that cause the lower esophageal sphincter, the muscle between the stomach and esophagus, to relax, avoiding medications that break down the protective lining of the stomach, weight loss, and acidic foods.

Lower esophageal sphincter relaxers include caffeine, nicotine, alcohol, peppermint, and chocolate.  Medications like BC powder, ibuprofen (Advil), naproxen (Aleve), prescription non-steroidal anti-inflammatories, and steroids all interfere with the stomachs ability to produce a protective barrier.  Obesity puts more pressure on the stomach and therefore can lead to increased reflux, especially when lying down.  Lying down within 4 hours of eating can also promote reflux.  Finally certain foods like vinegar-based, tomato-based, citrus fruit, spicy foods, and carbonated beverages all have acidity and can worsen symptoms.

Medications are used either to neutralize the acidity or decrease the amount of acid that is secreted by the stomach.  The medicines that neutralize acid include drugs like Tums, Mylanta, and Pepto Bismol.  Two types of medications that revolutionized dyspepsia treatment were H2 blockers and proton pump inhibitors.  H2 blockers include drugs like Zantac, Pepcid, and Tagamet.  These drugs blocked one of three receptors that stimulated the acid pump in the stomach to release acid, decreasing the amount of acid released.  Proton pump inhibitors shut down the acid pump in the stomach all together.  The goal of therapy in uncomplicated GERD is to relieve symptoms with as little medication as possible.

With the availability of these medicines over the counter, it is important to discuss your symptoms and treatment with your physician.  Long-standing reflux, even treated with relief of symptoms, should be checked regularly.  Likewise worsening symptoms on proper treatment may indicate a change that needs to be investigated further.

Dr. James Lee serves as the Coroner of Winn Parish. He is a General Surgeon and Surgical Oncologist who has been practicing in Winnfield for over ten years. Dr. Lee attended the University of Colorado for his medical degree. He completed his residency in Surgery at the University of Oklahoma before completing a fellowship in Surgical Oncology and Endoscopy at Roswell Park Cancer Institute in Buffalo, NY. Dr. Lee and his wife Scarlett live in Winnfield with their son and are active in the community.