What Causes GERD?
Gastroesophageal Reflux Disease, or GERD, is a chronic, often progressive condition resulting from a weak Lower Esophageal Sphincter (LES). When left untreated, serious complications can result, including: esophagitis, stricture, Barrett's esophagus, and esophageal cancer.
Gastroesophageal Reflux Disease (GERD), also known as GORD, is a chronic, often progressive condition resulting from a weak Lower Esophageal Sphincter (LES). When left untreated, serious complications can result, including: esophagitis, stricture, Barrett's esophagus, and esophageal cancer.
The LES is a muscle at the junction of the esophagus and stomach that functions as the body's natural barrier to reflux. The LES acts like a valve, allowing food and liquid to pass through to the stomach. Normally, the LES closes immediately after swallowing, preventing reflux. (Fig. 1) However, in people with GERD, the LES is weak, allowing acid and bile to reflux from the stomach into the esophagus. (Fig. 2)
Figure 1: A competent LES prevents chronic reflux into the esophagus
Figure 2: A weak LES allows reflux into the esophagus
Symptoms of GERD
People experience symptoms of GERD in a variety of ways. The most common symptom of GERD is heartburn.
Other symptoms may include:
- Sore throat
- Chest pain
Treatment options for people who suffer from GERD vary widely depending on the severity and symptoms of their disease, however, there are currently three primary means of treating GERD: lifestyle changes, medical therapy and surgical intervention. Always consult your physician when considering treatment options.
Infrequent heartburn may be controlled by lifestyle changes such as weight loss, smoking cessation and eating modifications.
Taking the following steps may aid in reducing the frequency and severity of reflux episodes:
- Eating smaller meals
- Avoiding spicy foods, alcohol, coffee and chocolate
- Remaining upright after meals
- Eating evening meals several hours before going to bed
- Sleeping with the head of the mattress elevated
Taking steps such as these may help to reduce the symptoms associated with infrequent reflux, however, for patients who have moderate to severe GERD, lifestyle changes alone may not completely relieve symptoms.
Medications used to treat GERD fall into three categories: antacids, H2 Blockers and Proton Pump Inhibitors (PPI's). These medications are designed to control or suppress acid production in the stomach. They do not address the cause of reflux and do not prevent reflux.
It is important to note that each of these drugs require lifetime therapy; symptoms may return shortly after a patient discontinues their use.
Antacids are drugs that neutralize stomach acid. While effective for immediate, short-term relief, antacids are typically not effective in preventing chronic heartburn. Common antacids include: Maalox®, Mylanta®, Tums®, Alka-Seltzer®, and Rolaids®.
H2 (histamine) inhibitors act on the acid producing cells (parietal cells) of the stomach. H2 blockers prevent histamine from stimulating the parietal cell, reducing the amount of acid each cell produces. H2 blockers work for 8-12 hours. Taking an H2 blocker in the morning may not prevent acid production and heartburn later in the day. Common H2 blockers include: Tagamet®, Zantac®, and Pepcid®.
Proton Pump Inhibitors
Proton Pump Inhibitors (PPI's) are the most commonly prescribed medication for the treatment of heartburn and acid-related disorders. They work by blocking the site of acid production in the parietal cells of the stomach, these acid producing sites are called proton pumps.
Proton Pump Inhibitors are generally more potent at suppressing acid secretion and have a longer duration of efficacy than H2 blockers. Common PPI's include: Nexium®, Prevacid®, and Protonix®.
Anti-reflux surgery is performed through open or laparoscopic incisions in the abdominal wall. Currently, the standard of care for surgical treatment of GERD is the Nissen Fundoplication procedure. The Nissen Fundoplication procedure involves wrapping a portion of the stomach around the esophagus to reinforce the weakened Lower Esophageal Sphincter.
While typically effective, the Nissen procedure has several shortcomings that have limited its use:
- Potential complications including dysphagia, gas bloat, and an inability to belch or vomit
- Potential loss of effectiveness over time
- Recovery period lasting several days
A New Treatment Option
Torax Medical has developed a new technology for the treatment of GERD; to learn more about this technology follow the link below.