An Explanation of GERD

What is GERD? Dr. Daniel C. DeMarco: Heartburn is very common. 40 million Americans have heartburn on a daily or weekly basis and 40 million Americans don't need to go see their doctor about it. But what a person or what should prompt a person to come see their doctor is if they are having symptoms that are really interfering with their lifestyle, keeping them awake all nights, they can't work during the day or if they have a new onset or change in their symptoms, if some must has been have an heartburn all their life is probably not a big problem or big concern. There's probably nothing new going on in their esophagus, but if someone in their 40 to 50 or 60 age range they has the sudden onset of heartburn whereas last week they didn't have it or if they are having trouble swallowing or if they are losing weight, then they should to see their doctor and get their esophagus checked out to make sure that there is not any thing wrong with their esophagus as far as growing abnormal tissue or tumor or anything like that. Rajeev Jain: GERD is Gastroesophageal Reflux Disease and it comprises two major symptoms and that one is heartburn or that burning acid sensation in the chest and the other symptom is regurgitation where you feel as if food is coming up into your chest. Daniel C. DeMarco: You feel like acid or burning fluid coming up from your stomach in to your esophagus and causing you discomfort in your chest, frequently by those people at night, frequently it's associated with excessive eating and overweight society. Also people occasionally have problems with it, coming up in the back of the throat at night and even I've heard patients say, reflux is up into their ears, which is hard to believe but it's a burning sensation in one's chest associate with acid reflux. Now reflux is simply acid coming up into the esophagus from the stomach due to a transient relaxation of a lower esophageal sphincter. When you swallow, food and secretion of saliva are propel it down through peristalsis and then the lower esophageal sphincter relaxes briefly and blood flew from the esophagus into the stomach where a digestion continues with stomach acid. What happens with reflux is there is a transient relaxation of that lower esophageal sphincter or some people think of it is a valve, but it's really just an area of increased pressure in the musculature of the lower esophagus and when it relaxes acid comes up into this esophagus. Rajeev Jain: Other symptoms also that can be attributed to heartburn include narrowing of the esophagus or peptic stricture where there's irritation subside, the esophageal lining becomes narrow. So phthisis trouble swallowing could often have complications of heartburn as well. Daniel C. DeMarco: Now there's other things that cause chest pain which we need to eliminate such as cardiac disease or other problems with the chest but GERD is primarily a diagnoses based on your symptoms. Test that we can do to look at someone to see if, it truly is acid reflux causing that disease is to measure the acid in the esophagus over the course of 24 or 48 hours, and the newest way to do this is using a technique called the Bravo technique, which involves endoscopy to look in the esophagus most of the times and then to place a little probe, a little radio telemetry capsule in the esophagus and that measures a pH over 48 hours and it's kind of clip to the inside of the esophagus and after 48 hours surely it passes out through the digestive system but during that 48 hours, it constantly transmits the esophageal pH or acid content to a recorder that the patient wears. Two days later the patients brings the recorder back and we download the information after that. We can tell, how much acid has come up over 24 hours and we can even give them a grade or a score based on that and also we correlate with their symptoms because some people can be having heartburn and not have any heartburn symptoms and not have acid coming up and to be truly Gastroesophageal Refluxes, you should have acid in your esophagus when you're having the symptoms. Rajeev Jain: There are common triggers to heartburn those include food, specifically, foods that are high in fat content, foods that sometimes are acidic for example, some of the juices, tomato based products, alcohol, smoking. There are certain lifestyle thing such as wearing tight clothes, things that increase pressure in the abdomen such as woman who are pregnant, as they prolong in their pregnancy to their second and third term, have a very high incidence of heartburn type symptoms. Also bending over to pick something up or just even lying down going from the upright position to supine, those are all things that can worsen or trigger heartburn. Daniel C. DeMarco: Acid belongs in the stomach doesn't belong in the esophagus or the back of the throat and that's was causes their burning sensation their symptoms. Now the symptoms that can get from reflux include heartburn, but also include other symptom such as chronic cough or sneeze, laryngitis, trouble swallowing sometimes or even asthma attacks. Rajeev Jain: The stomach has many protective mechanisms to keep you from being injured, nevertheless we still get gastric ulcers and other problems. The esophagus is not meant to handle that kind of acid load and so when it does come up, it injures the lining of the esophagus and that change can sometimes cause narrowing the esophagus or what we call a peptic stricture but more ominous is when it causes microscopic changes in the lining of esophagus or the normal columnar epithelium, or lining of the esophagus changes to an intestinal type that we see further down in the bowels and that change in lining called Barrett's esophagus is a precursor to esophageal cancer. Daniel C. DeMarco: There is thought to be as high as 1% per year or 10% overall incidences of cancer arise in patient who have Barrett's esophagus. Rajeev Jain: In one study for example patients who had acid reflux weekly or 8 times more likely than patients who had no acid reflux at all to develop esophageal cancer in their life time, and in fact if they have severe acid reflux for over 20 years, the increase was forty-fold compared to the average person. So it's an important risk factor for esophageal cancer. We are fortunate that esophageal cancer compare to other cancers in this country is rare but over the last 10 years it is the fastest growing solid tumor.