Reducing GERD (Gastroesophageal Reflux Disease)

with Andrew Brooks, M.D., Surgeon, Advanced Healthcare

Posted: July 1, 2005

Heartburn is so common that it’s almost easier to find someone who has experienced it than someone who hasn’t. Gastroesophageal reflux disease, or GERD, is what can happen when heartburn becomes a daily occurrence.

Dr. Andrew Brooks, a surgeon with Advanced Healthcare, said GERD can occur in people of all ages, and can range from mild to severe.

In order to understand GERD, it helps to have a grasp of basic anatomy. The stomach, an organ responsible for digestion, produces acid in order to break down what we eat.

Andrew Brooks, M.D., Surgeon, Advanced Healthcare "The lining of the stomach is specialized and able to handle an acidic environment. The esophagus, the tube which swallows the food down from the mouth to the stomach, is not built to handle acid from the stomach. GERD is caused by excessive exposure of the esophagus to the stomach acid."

“The lining of the stomach is specialized and able to handle an acidic environment,” Dr. Brooks said. “The esophagus, the tube which swallows the food down from the mouth to the stomach, is not built to handle acid from the stomach. GERD is caused by excessive exposure of the esophagus to the stomach acid.”

It’s important, said Dr. Brooks, to note that some amount of acid exposure in the esophagus is normal. Treatment is only required when it causes frequent or severe symptoms, or damage to the esophageal lining.

What are the symptoms?
Typical symptoms include heartburn, regurgitation and, in some cases, chest pain. Dr. Brooks said the pain can sometimes be difficult to tell from that associated with heart problems.

“Occasionally patients will have chest pains and no indication of a cardiac problem. Some of these patients will turn out to have reflux upon further evaluation,” he said. “It’s rare, but it can happen.”

More severe symptoms or complications of GERD can be dysphagia (the feeling of food sticking in the throat or esophagus or difficulty swallowing), odynophagia (pain with swallowing) or less typical symptoms, such as sore throat, hoarseness or certain types of asthma.

One cause of dysphagia is a stricture, or scar on the lower esophagus, which makes it difficult for food to pass through. Esophagitis is an inflammation or irritation of the lining of the lower part of the esophagus; Barrett’s Esophagus occurs when the cells lining the lower part of the esophagus change type in response to prolonged acid exposure. Patients with Barrett’s Esophagus need to be monitored, because this finding is associated with higher risk of developing esophageal cancer.

After assessing the patient’s situation and the severity of his or her symptoms, Dr. Brooks recommends an initial course of treatment. For some people, that may mean lifestyle changes, for others over-the-counter or prescription drugs and/or surgery may be the answer.

Diagnosis
In certain cases, a doctor may recommend an EGD or esophagogastroduadenoscopy, a visual examination of the swallowing tube. The procedure can reveal changes in the lining of the esophagus, and also allows a physician to biopsy the area.

“Sometimes you can see changes in the lining of the esophagus, and a biopsy reveals changes under the microscope that are consistent with reflux,” Dr. Brooks said.

Another test, a Ph study, measures the level of acid exposure to the lower esophagus, its frequency and severity. Patients are instructed to keep a log of symptoms during the test so the results can be correlated with test findings and give a more accurate assessment of the level of disease.

The final test, an upper GI, or gastrointestinal series, requires that a patient drinks a fluid that provides internal contrast. The area is then X-rayed.

Treatment
Mild GERD can be treated with lifestyle modifications. Quitting smoking can moderate GERD, as nicotine is an irritant. Maintaining a normal weight is another. Avoiding or cutting down on consumption of chocolate, peppermint, fats, onions, garlic, alcohol and caffeine can also help.

Dr. Brooks also recommended not eating for two or three hours prior to bedtime, as allowing the stomach to empty prior to lying down can decrease acid reflux.

In terms of medication, over-the-counter remedies to decrease or neutralize the acid produced by the stomach are plentiful and well-known. Common brand names include Maalox, Mylanta and Tums. Others reduce the amount of acid produced by the stomach. Generic names of these drugs are omeprazole, rantidine and famotidine.

Prescription drugs for GERD are the same as their non-prescription counterparts, in different formulations and in higher concentrations.

Surgery
For patients who are not responding to medication, or don’t want to spend their lives taking over-the-counter or prescription medication, surgery may be the answer. Complications of GERD and GERD associated with certain type of hiatal hernia also require surgery to repair.

The procedure, known as fundoplication, involves freeing the upper part of the stomach and wrapping it around the lower part of the esophagus. In 90 percent of cases, the procedure is effective in controlling the disease long-term.

“Basically, fundoplication recreates or reinforces the high-pressure zone around the lower esophagus,” Dr. Brooks said.

There are several varieties of the wrap, the most common is known as the Nissen wrap, first performed in the 1950s. While still done in the traditional, open format, it’s more commonly done laparascopically.

“We have a camera that attaches to a small scope and allows the surgeon to look into the abdomen. The procedure is performed using five small incisions,” Dr. Brooks said.

After the initial incisions, surgeons repair any hernias if necessary, then free up the upper part of the stomach and perform the wrapping procedure. Patients spend the night in the hospital, and can resume normal activity anywhere from a few days to a few weeks, depending on their occupation and lifestyle.

“A patient who lifts heavy weight on the job may have to avoid some activities for six weeks, but someone with a desk job can normally be back at work in three or four days,” Dr. Brooks said.

Andrew Brooks, M.D., Surgery
Advanced Healthcare – East Mequon Clinic
12203 N. Corporate Pkwy.
Mequon, WI 53092
262-387-8200

Advanced Healthcare – Cedar Creek Clinic
215 West Washington St.
Grafton, WI 53024
262-375-3700

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