What is Gastroesophageal Reflux Disease (GERD)?
GERD occurs when acid that is normally produced in the stomach refluxes into the “swallowing tube” (esophagus). This happens because a valve called the lower esophageal sphincter (LES) located at the junction of the stomach and esophagus stops working. The stomach's function is to produce acid; however, this acid is supposed to be confined to the stomach and should not reflux into the esophagus. The lining of the esophagus is fragile and poorly withstands this refluxed acid. It therefore becomes irritated causing pain and the typical “heartburn” symptom.
Acid production is part of normal stomach function and excess production is not the cause of GERD. GERD is caused by malfunction of the LES.
GERD affects approximately 30% of the population. It is a disease of the western world, primarily the United States and Europe. Although it is not confined to any sex or age group, the stereotypic patient is the affluent, middle-aged male. GERD is a lifetime, chronic, progressive disease that usually worsens over the years.
GERD typically causes heartburn, chest pain and regurgitation. Other less typical symptoms are trouble swallowing, cough, worsening asthma and hoarseness. GERD has been linked to decreased work productivity and difficulty sleeping. GERD cannot be reliably diagnosed solely by patient symptoms. Specific testing is required.
GERD and Esophageal Cancer
In addition to symptoms, GERD causes esophageal cancer. GERD-induced esophageal cancer is the fastest growing malignancy in terms of incidence and has increased 600% in the United States since 1975. 24,000 cases will be diagnosed this year and these numbers continue to rise. Some refer to this as an epidemic and assessment of cancer risk is an essential part of a comprehensive GERD evaluation. Identification of a cancer “precursor” that raises the risk of getting this deadly malignancy is called Barrett's esophagus. It is present in 10-15% of patients with GERD and should be identified.
Specific studies have evolved over the last 5 years to diagnose GERD, assess GERD induced esophageal cancer risk and measure the function of the esophagus. Endoscopy is a test that provides a visual inspection of the esophagus, pH testing measures the amount of acid refluxing into the esophagus, and esophageal manometry assesses the integrity of the valve between the stomach and esophagus (LES) as well as whether the function of the esophagus has been damaged by reflux. Special small samples of the lower esophagus called biopsies provide a cancer risk assessment. These tests together represent a thorough and comprehensive evaluation.
Proven, effective treatments for GERD are medications that function to decrease stomach acid and minimally invasive laparoscopic surgery. Many acid reducing medications are available over the counter. The most common medications prescribed are called proton pump inhibitors (PPIs). Examples of these are Prilosec, Prevacid, Protonix, Aciphex and Zegerid. Suppressing stomach acid decreases the “irritating ingredient” from the refluxing material resulting in a decrease or elimination of symptoms in most patients. The reflux however, continues. All of these acid suppressive medications should be used for only a limited time prior to a complete GERD evaluation. Minimally invasive laparoscopic surgery reconstructs the malfunctioning valve, restoring the “barrier" necessary to prevent reflux. This is effective in both resolving GERD symptoms as well as stopping the reflux. In addition, new therapies are being investigated and developed on an ongoing basis. Patients must be educated regarding all therapeutic alternatives as well as the application of each depending on the results of their complete GERD evaluation.