GERD (Acid Reflux)

Gastroesophageal reflux disease, which is often referred to as GERD, is a condition in which acid from the stomach backs up into the esophagus. The esophagus is the tube that connects your throat to your stomach. You may think of it as being inside your chest. A ring of muscle at the bottom of the esophagus, called the lower esophageal sphincter (LES), should contract to keep stomach acid from “refluxing,” or coming back up into the esophagus. When you have GERD, the LES does not close properly. This allows your stomach contents to reflux.

Have you ever squirted lemon juice in your eye? The tissue lining your esophagus is very sensitive. When stomach acid touches this tissue, it causes a reflux referred to as “heartburn.”

Occasional heartburn is normal. However, if you experience heartburn more than twice a week, you may have GERD.

Are You More Likely to Experience Acid Reflux?

Anyone can fall victim to GERD. If you are overweight or pregnant, you are particularly vulnerable to experiencing acid reflux because of the extra pressure on your stomach.

Physical causes of acid reflux GERD can include a malfunctioning or abnormal lower esophageal sphincter muscle, hiatal hernia, abnormal esophageal contractions and slow emptying of the stomach.

Additionally, recent studies indicate that GERD may often be overlooked in infants and children. Symptoms in infants and children may include repeated vomiting, coughing, sore throats, ear infections or other ear, nose and throat disorders. Most infants grow out of GERD by the time they are a year old.

How You Can Avoid Symptoms

Although anyone may experience acid reflux, there are simple steps you can take to reduce and possibly eliminate symptoms. These steps include:

• Avoid alcohol.
• If you are overweight, lose weight.
• Avoid smoking.
• Limit consumption of caffeine, carbonated drinks, chocolate, peppermint, tomatoes, citrus, and fatty or fried foods.
• Wear loose clothing.
• Eat small meals, and eat slowly.

What Are the Symptoms of Acid Reflux?

You probably already associate GERD with persistent heartburn, acid regurgitation and nausea. However, not all patients with acid reflux experience heartburn. Less common symptoms of GERD include chest pain that can be severe enough to mimic the pain of a heart attack, hoarseness in the morning dry cough, trouble swallowing, and bad breath. Others may feel like they have food stuck in their throat, or as if they’re choking.

Should You See a Doctor?

If GERD is left untreated, it can lead to other medical problems, including ulcers and strictures of the esophagus (also called esophagitis), cough, asthma, throat and laryngeal inflammation, inflammation and infection of the lungs, and collection of fluid in the sinuses and middle ear. GERD can also cause a change in the esophageal lining called Barrett’s esophagus, a serious complication that can lead to cancer.

If you experience heartburn more than twice a week, frequent chest pains after eating, trouble swallowing, persistent nausea, and cough or sore throat unrelated to illness, you may have GERD. For proper diagnosis and treatment, you should be evaluated by a physician.

Otolaryngologists (ear, nose and throat doctors) have extensive experience with the tools that diagnose GERD. They are specialists in treating the complications associated with GERD, including sinus and ear infections, throat and laryngeal inflammation, Barrett's esophagus and ulcerations of the esophagus.

Diagnosing GERD

GERD can be diagnosed or evaluated by clinical observation and the patient’s response to a recommended course of treatment. In some cases, other tests may be recommended, such as an endoscopic examination (in which a long tube with a camera is inserted into the esophagus), biopsy, x-ray, examination of the throat and larynx, 24-hour esophageal acid testing, esophageal motility testing (also called manometry), emptying studies of the stomach or esophageal acid perfusion (also called a Bernstein test). Many of these procedures may be performed as an outpatient in a hospital setting. Light sedation may be used for endoscopic examinations.

How Acid Reflux is Treated and Managed

Fortunately, most people with GERD see significant improvement with a combination of lifestyle changes and medication. Occasionally, surgery is recommended.

Your doctor may prescribe pro-motility drugs like Reglan or foam barriers such as Gaviscon. Certain over-the-counter products may also be recommended, including antacids such as Tums or Rolaids; proton pump inhibitors such as Prilosec, Prevacid, Aciphex, Protonix, and Nexium; or histamine antagonists, also known as H2 blockers, such as Tagamet.

Difficulty swallowing may be helped by direct swallowing therapy with a speech pathologist. Direct swallowing therapy uses special exercises to coordinate the swallowing muscles or re-stimulate the nerves that trigger the swallow reflex. You may also be taught ways to place food in your mouth or position your body and head to reduce symptoms.

Some patients with swallowing disorders have difficulty feeding themselves. An occupational therapist can recommend feeding techniques. These techniques can help you become as independent as possible. A dietitian or nutrition expert can help determine the amount of food or liquid needed and whether supplements are recommended.

For some patients, surgery is recommended. If a narrowing or stricture exists, the area may need to be stretched or dilated. If a muscle is too tight, it may need to be dilated or even released surgically. This procedure is called a myotomy and is performed by an otolaryngologist, otherwise known as an ear nose and throat specialist. Surgical treatments commonly recommended include fundoplication, a procedure in which a part of the stomach is wrapped around the lower esophagus to tighten the LES, and endoscopy, in which hand stitches or a laser are used to make the LES tighter.

Many factors may contribute to swallowing disorders, and recommended treatment options will depend on your unique medical history. If you have a persistent problem with symptoms of GERD, see an otolaryngologist. Our ENT specialists are happy to discuss your symptoms and provide a personalized treatment plan to lead you toward a path of recovery. To speak with one of our ear, nose and throat specialists, call us at 404.257.1589 (Atlanta) or 770.777.1100 (Alpharetta) today, or book an appointment online now.

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