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Some cases of GERD have few symptoms, and won't require any testing or treatment. However, severe and recurrent symptoms do require the attention of a doctor, and the patient in this case will benefit from a diagnostic test.
The first order of business in diagnosing GERD is an esophagogastroduodenoscopy (EGD), in which the physician examines the esophagus by inserting a tube fitted with a camera into the patient's mouth and pushes it slowly down. As the doctor manipulates the tube, the camera takes pictures of the esophagus, stomach and intestine. Photographs of these organs will help to identify signs of damage.
Other forms of diagnosis include the following:
- Barium swallow, in which the patient drinks a solution containing a metallic compound named Barium sulfate that shows up in x-rays. As the chemical travels through the digestive system, the doctor uses an x-ray machine to detect any abnormalities in the stomach, the esophagus, or the intestine.
- Esophageal manometry, in which a physician inserts a catheter in the patient to measure (a) the pressure inside the esophagus, which will be abnormal if there is acid backup, and (b) the frequency and length of esophageal contractions, which may slow down or speed up if the patient has GERD.
- Stool test, in which a practitioner examines fecal matter for signs of bleeding from the irritated esophagus,
Another article in this series has explored some home remedies that can prevent heartburn. To summarize them quickly here, GERD patients should AVOID all the following:
- Any food, drinks or medicines that irritate the esophagus and cause an outburst of heartburn or other symptoms. Among the no-nos are alcohol, any type of mint, caffeine, chocolate, carbonated drinks, juices made from citrus fruits, and any foods containing tomatoes, spices or fat -- including dairy products. These aren't the only ones, because everybody is different and may get heartburn from different food.
- Body movements such as bending or exercising, but only right after a meal. Exercising on an empty or half-full stomach is highly encouraged, however, because losing weight can prevent GERD.
- Tight-fitting clothes or belts that constrict the waist and might inadvertently close off the valve separating the stomach and the esophagus, Avoid garments or belts that fit tightly around your waist
- Sleeping when the stomach is full. GERD patients should wait 2 to 3 hours after eating before going to bed. . For example, avoid eating within 2 -3 hours of bedtime.
- Large meals that overload the digestive system.
- Stress, which complicates digestion.
- Smoking, which also damages the esophagus and may worsen the effects of GERD.
- Sleeping on a flat bed. If GERD patients sleep with their heads raised a few inches above the rest of their bodies, they make it easier for acids to stay down in the stomach instead of flowing up into the esophagus.
There are medications, both over-the-counter and by prescription, that can help with GERD symptoms. Any antacid medication will limit symptoms for a short time, and can be taken before going to sleep and after eating. Antacids can make patients constipated or give them diarrhea. Some prescription medicines treat GERD symptoms by blocking the production of stomach acids. These include proton pump inhibitors -- Prilosec, Nexium, Prevacid, AcipHex, or Protonix -- H2 antagonists -- Pepsid, Tagamet, Zantac or Axid-- and promotility agents like Reglan.
GERD can also be treated surgically if its symptoms continue after patients have changed their lifestyles and taken drugs, but it remains a chronic disease nonetheless. Patients who continue to regurgitate their food in large amounts may benefit from a procedure called laparoscopic Nissen's Fundoplication, in which the surgeon wraps the stomach around the esophagus. Surgery cannot be the end of the story, however. According to a 2001 study published in JAMA (the Journal of the American Medical Association), 62% of patients who had surgery to reduce acid reflux still need to take anti-reflux medications.
Since 2001, physicians have experimented with endoscopic therapy, a fourth treatment strategy for GERD in addition to lifestyle changes, medication and traditional surgery. They have used upper gastrointestinal endoscopes to insert small instruments known as "perendoscopic anti-reflux devices" into the esophagus. In clinical trials, this newest form of treatment has been shown to reduce symptoms and allow patients to go off their proton pump inhibitors. There is no evidence, however, that endoscopic therapy prevents GERD itself -- the spread of acid into the esophagus and the resulting inflammation, or esophagitis. Of the five procedures developed before 2006, only three received FDA approval, and the scientific consensus about the three that remain is that they are significantly more effective than older treatments.
The majority of patients can live with the disease by changing their lifestyles and taking medication, but GERD is chronic, so the drugs must be a lifelong commitment. They are better than the alternative. Some of the side effects of untreated GERD include problems with the teeth as a result of corrosion from acid, a chronic cough, an esophageal ulcer, inflammation, stricture -- narrowing of the esophagus -- as a result of the development of scar tissue in response to the inflammation, and finally, "Barrett's Esophagus,” a condition that makes the esophageal lining more susceptible to cancer. One way or another, GERD must be treated.
* This article is based on the information at http://www.mayoclinic.com/health/gerd/, http://www.nlm.nih.gov/medlineplus/ency/article/000265.htm, http://www.webmd.com/heartburn-gerd/tc/gastroesophageal-reflux-disease-gerd-symptoms, http://www.gerd.com/, ttp://www.medicinenet.com/gastroesophageal_reflux_disease_gerd/article.htm
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