Acid Reflux Management at AGMG
Learn about Acid Reflux Management from the doctors of Associated Gastroenterology
GERD is one of the most common GI complaints seen at AGMG. It is estimated that up to 20% of the US population suffers from GERD. The primary medications used to treat GERD are in the top 10 prescription drugs yearly. At AGMG, our doctors focus on a diagnostic and treatment pathway to make sure our patients are effectively treated and monitored for side effects.
What is GERD?
Gastroesophageal Reflux Disease (GERD) is a chronic medical condition caused by the flow of stomach contents into the esophagus resulting in symptoms. The two typical symptoms of GERD are heartburn (burning sensation behind the chest) and volume regurgitation (feeling of food or liquids coming back up from the stomach to the mouth).
The stomach produces acid (hydrochloric acid) to help breakdown food and liquids for digestion. The stomach is used to handling this acidic fluid while symptoms can develop if the acid fluid flows (refluxes) back up into the esophagus. The body has multiple barriers to prevent this happening but certain food items, lifestyle habits and anatomic issues can weaken these barriers. For most this reflux of fluid can cause symptoms but in some patients acid reflux can result in damage to the esophagus such as ulcers, narrowing or even cancer.
What are the complications of GERD?
- Ulcers in the esophagus
- Narrowing of the esophagus
- Barrett’s esophagus
- Esophageal cancer
How is GERD diagnosed?
For many patients, the typical symptoms of GERD such as heartburn and regurgitation are enough to make the diagnosis of GERD. However, for others the picture may be less clear. For example, a patient with chronic cough or chest pain. For these patients, direct measurement of the acid in the esophagus is useful. This is called a pH test. Using either a catheter or a transponder directly inserted into the esophagus Bravo, doctors can get an objective measure of acid exposure and correlate it to your symptoms.
Does EGD (Upper endoscopy) diagnose GERD?
This is a common misconception. Endoscopy is not used to diagnose GERD. Patients can have frequent intense symptoms of heartburn but will have a normal EGD. This is called “non-erosive GERD”. The role of EGD is to evaluate for complications of GERD such as Barrett’s esophagus or erosive changes.
How is GERD managed?
Treatment of GERD is a combination of lifestyle changes, medicines and even sometimes surgical procedures. The treatment options are personalized and need to be carefully discussed with an expert in GERD.
- Weight loss if appropriate
- Raising the head of your bed by 6-8 inches (wedge, wood blocks or inclined mattress)
- Avoiding certain foods (coffee, chocolate, alcohol, spicy foods, fatty foods)
- Limit alcohol
- Stop smoking
- Avoid lying down for at least 3 hours after you eat
- Antacids – effective for rare or mild symptoms. Short acting
- Histamine blockers – effective for rare or mild symptoms. Short acting
- Proton pump inhibitors – the most effective class of medications for GERD. Work by reducing acid production in the stomach. Strongly indicated for patients who have had damage to the esophagus from acid reflux.
- Device implantation – there are medical devices that can be inserted to strengthen the barrier at the bottom of the esophagus helping to prevent acid reflux
- Fundoplication – the top of the stomach is wrapped around the bottom of the esophagus to strengthen the barrier and prevent acid reflux
Frequently Asked Questions
This is a common and difficult situation. The first step is determining if you actually have GERD. Not everyone with heartburn has GERD. There are other diseases such as allergic conditions and muscle disorders that present with heartburn but will not improve with acid medicines. This is why it is important that you seek consultation with an expert in GERD.
Once the diagnosis is GERD, there are occasions where PPI therapy is not effective or enough. In this cases there are complementary medicines, endoscopic procedures or surgical procedures that can provide relief.