Gastroesophageal Reflux

What is Reflux?

Gastroesophageal reflux or GERD occurs when contents from the stomach move into the esophagus. This can be acidic or non-acidic.  Many patients take medication to relieve the acid and burning that can occur, but that does not necessarily stop GERD

 

Proton Pump Inhibitors has been linked to acute and chronic kidney disease, low magnesium levels, colon infections and pathologic fractures.  

GERD can progress to Barrett's Esophagus where the acid transforms the lining of the esophagus that can be come malignant.  

What are the Symptoms of GERD?

Some of the symptoms patients experience are:

    Burning in the chest after eating

    Chest pain

    Difficulty swallowing

    Regurgitation of food

    Chronic cough

    Laryngitis

    New or worsening asthma

    Frequent belching

    Excessive saliva

    Tooth Erosion

    Bad Breath

    Hoarseness

Evaluation of GERD

Before treatment can be recommended confirmation of GERD is required to rule out other disorders. 

Depending on the circumstances the following tests may be needed to confirm the diagnosis and make the best treatment recommendation:

  • Upper GI x-ray to evaluate the stomach and esophagus

  • Endoscopy to visualize the stomach and esophagus

  • pH probe study to evaluate the acid exposure in the esophagus

  • Manometry to assess the contractions of the esophagus

  • Gastric emptying study to evaluate the stomach's function

Treatment of GERD

Surgical treatment of GERD involves repairing any hiatal defect that exists as well as establishing and anti-reflux "wrap" of the esophagus to create an anatomic barrier to reflux.  Traditionally this was done by wrapping the top portion of the stomach around the esophagus.  This is called a nissen fundoplication.  For some patients this may still be the best option.  While a well established and effective treatment for GERD the nissen fundoplication has been associated with difficulty swallowing, bloating, the inability to vomit or burp.  

A newer approach that does not have these longer term problems is the transoral incisionless fundoplication or TIF procedure.  This can be done with an endoscopy and depending on the status of any hiatal hernia can be done without acutal incisions!

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