Question: What is gastroesophageal reflux, or acid reflux, disease?
Answer: Gastroesophageal reflux disease is a condition in which the contents of the stomach will reflux out of the stomach into the esophagus. Although most individuals will experience some occasional episodes of reflux, it is considered gastroesophageal reflux disease (GERD) when the reflux occurs on a frequent and recurring basis.
Q: How and why do people get this disease?
A: Reflux is most commonly caused by a weakened valve at the lower esophagus called the lower esophageal sphincter. Other causes may be related to abnormalities of how the esophagus moves or delayed gastric emptying. Obesity is a common cause of reflux symptoms. Other causes include caffeine and red wine, and some medications will reduce the pressure of the lower esophageal sphincter resulting in reflux.
Q: What are the symptoms of reflux?
A: Common symptoms include heartburn, regurgitation, chest pain and a bitter taste in the back of the throat. Many patients are not able to lie down without having reflux or regurgitation. Difficulty swallowing may be seen in patients that develop either a stricture or narrowing of their esophagus from reflux or those that have developed a hiatal hernia.
Q: Could the pain I'm feeling be something other than reflux?
A: Symptoms of reflux may be confused with other conditions such as heart disease, gallbladder disease and other gastrointestinal disorders.
Q: Are there ways to prevent this disease? Are there ways to control or cure the problem? Is there a risk of cancer associated with reflux?
A: Reflux can be treated by lifestyle modifications including weight loss, smoking cessation, alcohol avoidance and avoiding eating meals late in the day. Elevating the head of your bed on a couple of blocks may help nocturnal symptoms. When symptoms are not controlled with these lifestyle modifications, acid suppressing medications can be utilized. The most common medications are proton pump inhibitors such as Prilosec, Nexium and Protonix.
Anti-reflux surgery should be considered in some patients, including those who require lifelong medical therapy for reflux. It also might be needed for patients who have persistent symptoms in spite of medications or those that have developed complications from their reflux such as strictures, esophageal ulcers, and large hiatal hernias. Anti-reflux surgery has the advantage of "curing" reflux as the surgery will recreate the lower esophageal sphincter and prevent acid from leaving the stomach. The most common anti-reflux surgery is called a Nissen fundoplication. This surgery may be performed utilizing minimally invasive techniques. Postoperative pain is minimal and the procedure can be an outpatient one. Patients will have resolution of their reflux symptoms immediately following the procedure as the new valve begins to work immediately.
Dr. J. Scott Roth is chief of gastrointestinal surgery and director of minimally invasive surgery at the UK Medical Center and assistant professor of surgery in the UK College of Medicine.