GERD Overview

Gerd video

HOST ON CAMERA:
Hello, and welcome to The Answered Patient.  I'm Jane Hanson. If you’re like most people, you probably suffer heartburn from time to time. It’s usually just a minor annoyance. But if you get heartburn daily, or even a few times a week, you may have a more serious medical condition known as gastro esophageal reflux disease, or GERD.  In this episode…

HOST NARRATION:…We’ll tell you about GERD…what causes it…and how it affects your body. We’ll also discuss when to talk to your doctor about persistent heartburn…

HOST on camERA: And the best ways to treat GERD, from over-the-counter medication, to surgery.

HOST NARRATION: Millions of Americans experience heartburn every day.  According to one survey, 60 million Americans suffer from it at least once a month. Despite the name, heartburn actually has nothing to do with the heart. The term refers to the distinctive, painful sensation that can sometimes be felt in the chest, neck , and throat  after a large meal, or eating just before going to bed. Heartburn is caused by acid reflux. Reflux occurs when gastric juice, the fluid used to break down food in the stomach, escapes and “refluxes,” or flows back, into the esophagus.

DR. GOLDMAN: In the gastric juice is acid, of course, is hydrochloric acid, and it’s relatively dilute, but it doesn’t belong in the esophagus.  So then when it backs up into the esophagus, it can injure the esophagus and cause pain.

HOST NARRATION: If you experience heartburn, you probably take an over-the-counter antacid to relieve the pain, and think little of it. 

MICHAEL D. BROWN: If your heartburn is very infrequent, you know once or twice a month, and then I think you can treat that very successfully over-the-counter.

HOST ON CAMERA:
If you suffer from heartburn once a week or more, however, you may have gastro esophageal reflux disease, or GERD. The primary cause of GERD is a dysfunction of the lower esophageal sphincter – or L.E.S.  This is the muscle that squeezes the bottom of the esophagus closed, preventing, and dangerous stomach fluid from flowing into it.

HOST NARRATION:
When it’s functioning properly, the L.E.S. forms a tight seal, opening only when we swallow.  But in people with GERD, the L.E.S. is abnormally weak …or relaxes unexpectedly for minutes at a time. 

MICHAEL D. BROWN: 
That valve at the bottom of your esophagus should stay nice and tight and when it opens inappropriately, something we call a transient lower esophageal sphincter relaxation , acid comes up into the esophagus and can damage it . 

DR. SRI KOMANDURI: Do you get any discomfort in the abdomen or lower in the stomach?

PATIENT: Lower in the stomach.

HOST NARRATION:
Over time, this damage to the esophagus can become severe. That’s why it’s important to see your doctor immediately if you think you might have GERD.

HOST ON CAMERA:
To make a diagnosis, your doctor will ask you for a full history of the frequency and severity of your heartburn. Usually, this is all a doctor needs to diagnose GERD.

MICHAEL D. BROWN:
Reflux is a pretty easy diagnosis to make.  You don’t need a gastroenterologist.  Any decent clinician can make this diagnosis based on symptoms because heartburn is present in 95 percent or so of patients who have this and it’s a very classic complaint.  Heartburn does not occur in a lot of other conditions. 

HOST NARRATION: Your doctor might also recommend an endoscopy.

MICHAEL D. BROWN: This test takes anywhere from 5-8 minutes depending on whether if we have to do any biopsies down there or anything. So this won’t be a long one.

HOST NARRATION: This procedure uses a flexible tube outfitted with a camera to look for damage in the esophagus caused by acid reflux.  

MICHAEL D. BROWN: So here’s her esophagus…this looks normal. Nice and healthy here.

HOST ON CAMERA :Once you’ve been diagnosed with GERD, the first line of treatment doctors usually recommend is medication. The most popular and effective class of drugs is proton pump inhibitors-- or PPIs. PPIs block the production of acid in the stomach.

MICHAEL D. BROWN:
PPIs are the gold standard of treatment in reflux disease.  They’re an absolutely amazing class of drugs.  They’re extremely safe.  They’re extremely well tolerated.  They never wear out their welcome.  In other words, if they work on day one, they’re going to work on day 365. 

HOST NARRATION:
Your doctors might also suggest lifestyle changes to help reduce the frequency and severity of your acid reflux. Watch your weight.  Extra girth around the abdomen can put pressure on the stomach, pushing acid into the esophagus. Eat smaller meals ...  Large meals can stretch the stomach, and cause the L.E.S. to open slightly. Sleep with your head above your stomach … Acid reflux does the most damage to your esophagus when you lie down, and gravity is unable to pull fluid back into the stomach. And finally, after eating at night, give yourself at least 2 hours before going to bed.

DR. MICK:
Eating late at night is big – it’s big – some people with totally competent sphincter’s but if they eat a meal right before they go to bed – can have significant symptoms at night.

HOST NARRATION:
In more serious cases of GERD, when a patient has acute esophageal damage or other complications a doctor can perform surgery to strengthen the lower esophageal sphincter. Remember, many people get heartburn from time to time.  And it’s normal to treat an episode with one of the many antacids available. But if you suffer from heartburn a few times a week or more, you may have GERD, and you should seek professional help. Working with your doctor, you can determine the best treatment for your needs.

HOST ON CAMERA:
In the other chapters of this episode, you can learn more about diagnosing GERD…get some science on what causes it…and discover the various treatment options currently being practiced.

HANSON NARRATION: And in our “Personal Stories” chapter, you’ll meet a real patient, and his doctor, who are successfully managing the condition.