Acid reflux occurs when the sphincter muscle at the lower end of the esophagus relaxes at the wrong time, allowing stomach acid to back up into the esophagus, causing heartburn and other symptoms. Gastroesophageal reflux disease (GERD) is a condition when stomach acid flows back up into the esophagus. GERD is a more severe and long-lasting condition in which acid reflux causes repeated symptoms or leads to complications over time, such as Barrett’s disease, a risk factor for esophageal cancer.
Diagnosing GERD can be challenging, as one in three individuals with ongoing GERD-like symptoms may not actually have the condition. According to Yale Medicine, GERD can occur at any age, and it is estimated that around 20% of people in the United States are affected.
If not identified or treated, frequent acid reflux can lead to esophageal ulcers, swallowing difficulties, and even cancer. Fortunately, GERD can be effectively managed through lifestyle adjustments, over-the-counter medications, and surgery.
Our dedicated team of specialists is focused on working with you to create a personalized care plan that caters to your specific needs. When surgery is necessary, our experts utilize the latest minimally invasive techniques, incorporating advanced robotic methods for precision.
Symptoms of GERD and Esophageal motility problems may include:
- Heartburn not controlled with standard medical management.
- Difficulty swallowing or a chronic lump in the throat (dysphagia/globus)
- Chronic hoarseness or loss of voice
- Adult-onset asthma with reflux issues
- Non-cardiac chest pains and spasms
- Difficulty sleeping due to regurgitation or choking.
- Medications only “taking the edge off” heartburn symptoms.
- Regurgitation and vomiting
Some people also suffer from heartburn or chest pain due to a hiatal hernia. This is an opening in the diaphragm that allows a portion of the stomach to protrude upwards into the chest. This defect can be acquired over time and is typically due to a combination of genetics, straining, pregnancy, chronic coughing, gaining weight, and other factors that extend beyond a person's control.
When the stomach is in its normal position, the diaphragm, and the lower esophageal sphincter work together to keep stomach contents and acid from rising into the esophagus. When a hiatal hernia is present, acidic and non-acidic reflux can occur more easily. However a hiatal hernia is not “required” for reflux issues to occur.
Persistent reflux or heartburn that occurs more than twice a week is considered gastroesophageal reflux disease (GERD), and it can eventually lead to more serious health problems.
How is GERD Diagnosed?
At Good Samaritan Medical Center, we offer an advanced wireless testing system to help diagnose and assess symptoms of GERD and determine the effectiveness of treatment.
The procedure, known as the Bravo Reflux Testing System, is performed by our highly skilled surgeons who specialize in bariatric metabolic surgery, anti-reflux procedures, gastric stimulator for gastroparesis, abdominal wall hernia repair, and minimally invasive acute care surgery.
The system measures the acidity level in the patient’s esophagus using a small pH-sensing wireless capsule, about the size of a gel cap, that is temporarily attached to the esophageal tissue by the surgeon during an upper endoscopy while the patient is under sedation. Data from the capsule is transmitted for up to four days to a recording device, about the size of a pager, that the patient wears on their belt or waistband. The system’s software analyzes the data to determine if, and when, stomach acid is backing up into the patient’s esophagus.
GERD is one of the most common gastrointestinal diseases, affecting up to 20% of the U.S. population, according to the American College of Gastroenterology. People who experience persistent acid reflux symptoms such as heartburn, a chronic cough or hoarseness may need to undergo an endoscopy to be tested for GERD.
The condition can be treated with prescription medications, such as proton pump inhibitors (PPIs), which reduce stomach acid production, or non-prescription medications such as antacids. Long-term or over-use of PPIs, however, can lead to serious health complications such as osteoporosis, dementia, and enteric infections. Doctors also may recommend lifestyle changes such as quitting smoking, losing weight, or making dietary changes such as avoiding fatty or spicy foods, coffee, chocolate, tomatoes, and peppermint that are known to increase stomach acid production
Esophageal Motility Problems
Some patient’s symptoms are not from reflux of gastric fluid/acid but from motility problems in the esophagus. The esophagus is a muscular tube that propels the food/fluid from the mouth to the stomach via a series of complex muscular contractions. There are numerous structural, mechanical, neuromuscular, and metabolic disorders that can affect how the esophagus and LES contract and relax. If the coordination is impaired symptoms result.
In some cases, the contractions are too strong and pain or difficulty swallowing result. The diagnosis of Esophageal Spasm, Nutcracker esophagus, Jackhammer esophagus and a Hypertensive LES are frequently made in our lab, and these can be managed successfully if correctly diagnosed.
In other cases, the contractions are so weak that patients struggle to get food to the stomach. Scleroderma can create a gradual atrophy of the smooth muscles in the esophagus resulting in weaker and weaker contractions over time. Achalasia is a well understood motility problem of the esophagus that is caused by the destruction of nerves responsible for the contraction of the esophagus and the relaxation of the LES. The consequence is severe chronic difficulty swallowing food/liquids with significant regurgitation and vomiting. It is often confused with reflux disease until proper evaluations are done.
