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Gastroenterology & Hepatology (Digestive Care)
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Gastroesophageal reflux disease (GERD) occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of your esophagus.
Many people experience mild acid reflux from time to time. They can usually manage with lifestyle changes and over-the-counter medications. But some people with more frequent acid reflux (occurring several times a week) may need stronger medications or surgery to ease symptoms.
Common signs and symptoms of GERD include:
- A burning sensation in your chest (heartburn), usually after eating, which might be worse at night
- Chest pain
- Difficulty swallowing
- Regurgitation of food or sour liquid
GERD is caused by frequent acid reflux.
When you swallow, a circular band of muscle around the bottom of your esophagus (lower esophageal sphincter) relaxes to allow food and liquid to flow into your stomach. Then the sphincter closes again.
If the sphincter relaxes abnormally or weakens, stomach acid can flow back up into your esophagus. This constant backwash of acid irritates the lining of your esophagus, often causing it to become inflamed.
Conditions that can increase your risk of GERD include:
- Bulging of the top of the stomach up into the diaphragm (hiatal hernia)
- Connective tissue disorders, such as scleroderma
- Delayed stomach emptying
- Factors that can aggravate acid reflux include:
- Eating large meals or eating late at night
- Eating certain foods (triggers) such as fatty or fried foods
- Drinking certain beverages, such as alcohol or coffee
Your doctor is likely to recommend that you first try lifestyle modifications and over-the-counter medications. If you don't experience relief within a few weeks, your doctor might recommend prescription medication or surgery.
Medications typically prescribed reduce stomach acid production. They are very effective and safe, even with long term use. They are usually taken once or twice a day.
Surgery and other procedures
GERD can usually be controlled with medication. But if medications don't help or you wish to avoid long-term medication use, your doctor might recommend:
- Fundoplication. The surgeon wraps the top of your stomach around the lower esophageal sphincter, to tighten the muscle and prevent reflux. Fundoplication is usually done with a minimally invasive (laparoscopic) procedure. The wrapping of the top part of the stomach can be partial or complete.
- LINX device. A ring of tiny magnetic beads is wrapped around the junction of the stomach and esophagus. The magnetic attraction between the beads is strong enough to keep the junction closed to refluxing acid, but weak enough to allow food to pass through. The LINX device can be implanted using minimally invasive surgery.
- Transoral incisionless fundoplication (TIF). This new procedure involves tightening the lower esophageal sphincter by creating a partial wrap around the lower esophagus using polypropylene fasteners. TIF is performed through the mouth with a device called an endoscope and requires no surgical incision. Its advantages include quick recovery time and high tolerance.