Reflux and GERD

Millions of people suffer from what they describe as heartburn. Actually, heartburn is a symptom of acid reflux and gastroesophageal reflux disease (GERD).

Most patients experience heartburn after they eat. This is because at the end of the esophagus there is a small ring of muscle called the lower esophageal sphincter (LES). The LES allows food to pass into the stomach. When it functions properly, the LES closes after swallowing to keep stomach acids from backing up into the esophagus.

When it is malfunctioning, this acid "refluxes" and burns the lower esophagus. Over time, this area becomes inflamed, irritated and even damaged. While some people naturally have a weakened sphincter; others develop GERD when the muscle loosens. Symptoms can often become more pronounced after eating high-fat and spicy foods or consuming excessive alcohol.

Reflux

Reflux is a chronic digestive disease where the liquid content of the stomach pushes back up into the esophagus.

Symptoms of Reflux

• Heartburn
• Bitter taste in the mouth

The most common symptom is heartburn. Heartburn is a burning feeling that occurs in the chest or throat, which usually occurs two to three hours after meals or at night.

Triggers for Reflux

Certain foods may trigger reflux. These foods include:

• Spicy foods
• Fried foods
• Citrus and tomato products
• Chocolate
• Carbonated and caffeinated beverages
• Alcohol, certain medications and pregnancy can also trigger reflux.

Diagnosing Reflux

Indigestion — which can also cause pain and discomfort in the stomach — is different than reflux. It’s often tied to eating too quickly or too much or feeling stressed or anxious.

Our physicians start by taking a detailed patient history and a review of symptoms. Usually, this is enough to diagnose reflux. Sometimes, we may perform an endoscopy to look at the inside of the esophagus.

Chronic reflux, or reflux that occurs more than two times a week, may be a sign of gastroesophageal reflux disease (GERD). WakeMed’s dedicated gastroenterologists provide exceptional care to patients with reflux and are experts at determining whether it may be GERD.

If you’re having severe chest pain, especially if combined with difficulty breathing, seek immediate medical help. Chest pain can be a sign of a heart attack.

Treating Reflux

Medication

Reflux can often be treated with both over-the-counter medications, such as antacids (which neutralize stomach acid) and acid reducers (that reduce the acid production itself).

Lifestyle Changes

Lifestyle changes can also be helpful, including:

• Eating small meals
• Avoiding foods that seem to trigger symptoms
• Waiting a few hours after eating before lying down
• Maintaining a healthy weight
• Wearing loose clothing

If over-the-counter medication and lifestyle changes don’t work, our physicians may recommend prescription medication.

They may also do additional screening for GERD and it’s complications, including Barrett’s esophagus.

GERD

GERD is a common condition where contents from the stomach — including food, acid and bile — come back into the esophagus, causing a burning feeling and other painful symptoms. While the most common symptom is heartburn, you can also have GERD without heartburn.

WakeMed’s dedicated gastroenterologists are experts at diagnosing and treating GERD, through lifestyle modifications, medications and surgery.

Symptoms of GERD

GERD causes chronic reflux (occurring twice a week or more), and symptoms are more common after eating and at night.

Common Symptoms of GERD:

• Chest pain
• Difficulty swallowing (dysphagia)
• Persistent dry cough
• Sore throat or hoarseness/loss of voice after waking up
• Regurgitation of food or sour liquid when bending over or lying down
• Sensation of a lump in your throat
• Sour taste in the mouth
• Chest pain that can mimic a heart attack
• Choking sensation
• Nausea

Less common symptoms of GERD:

• Frequent throat clearing
• Chronic cough
• Recurrent pneumonia
• Chronic sinus infection
• Night-time asthma

Risk Factors for GERD

GERD is more common in people who are obese and in those who have a hiatal hernia, a condition where a portion of the stomach is within the chest. In this situation, the lower sphincter of the esophagus does not close completely.

Complications of GERD

Very rarely, esophageal cancer can occur as a complication of chronic long-standing GERD.

Listen to a one-minute overview of GERD by one of our physicians.

Diagnosing GERD

If symptoms are affecting your quality of life, or if you find it difficult to swallow, have chest pain, are losing weight, are throwing up blood or coffee grounds, or are having red or black stools, you should see a gastroenterologist to determine if you have GERD.

Our physicians start by taking a detailed patient history and a review of symptoms. Usually, this is enough to diagnose GERD. Sometimes, we may perform an endoscopy to look at the inside of the esophagus.

Treating GERD

Mild GERD Treatment

Mild forms of GERD can often be treated with diet and lifestyle changes, which include:

• Eating small meals
• Avoiding foods that seem to trigger symptoms (including alcohol, fatty foods, chocolate, excessive caffeine, peppermint and tomatoes)
• Waiting a few hours after eating before laying down
• Maintaining a healthy weight
• Wearing loose clothing
• Avoiding late night snacks
• Quitting smoking
• Elevating the head of the bed to 30 degrees. This can help prevent stomach contents from backing up into the esophagus.

Over-the-counter medications, such as Zantac, Pepcid and Tagamet can also help mild GERD.

Moderate and Severe GERD Treatment

Moderate and severe GERD may require long-term treatment with proton pump inhibitors (PPI), which block the enzyme in the wall of the stomach that produces acid. PPIs include Nexium, Prilosec, Prevacid, and Protonix. These medications are available over-the-counter for short-term use but should be prescribed by a doctor when needed for more than 2 weeks.

Surgical Treatment for Severe GERD

Occasionally, ifâ€&hibar;GERD symptoms do not improve with medications and/or lifestyle change, surgery may be necessary. This is most common if there is a large hiatal hernia that prevents the lower esophageal sphincter from completely closing. The experienced surgeons at WakeMed may recommend a procedure known as fundoplication to correct the weakness in the esophageal sphincter.

The transoral incisionless fundoplication (TIF) procedure repairs or recreates the anti-reflux valve that keeps the stomach acids from flowing back into the esophagus. The TIF procedure requires no abdominal incisions and has fewer complications.

Hiatal Hernia Repair

While some patients can control GERDs with lifestyle changes, such as dietary and exercise modifications, others need surgical repair to ensure that the esophagus is not damaged. Laparoscopic anti-reflux surgery repairs and reinforces the "valve" between the stomach and esophagus.

The surgeon, literally wraps a part of the stomach around the lower esophagus. Using a small camera the surgeon can see images on a screen to guide this wrapping process to ensure that the esophagus has strong support

Most patients get complete or greatly improved relief from the uncomfortable symptoms of GERD after surgery.

Learn What to Expect from Hernia Repair Surgery

Make an Appointment 

If you or someone you care for is experiencing worrisome symptoms, we encourage you to make an appointment with one of our pediatric gastroenterologists, adult gastroenterologists or colorectal surgeons.

WakeMed has board-certified general surgeons on staff who perform minimally invasive, corrective procedures. Find the WakeMed general surgeon by visiting our Find a Doctor module.