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Gastroesophageal Reflux Disease (GERD)

Gastroesophageal Reflux Disease (GERD)

Gastroesophageal reflux is a common condition in which the gastric contents move up into the esophagus. Reflux becomes a disease when it causes frequent or severe symptoms or injury. Reflux may damage the esophagus, pharynx or respiratory tract.

Mechanism of gastroesophageal reflux disease
Mechanism of gastroesophageal reflux disease (Click to Enlarge)

Gastroesophageal Reflux Disease (GERD) Symptoms

The main symptom of GERD is heartburn, often described as a “fiery feeling” in one's chest, and regurgitating sour or bitter liquid to the throat or mouth. The combination of heartburn and regurgitation is such a common characteristic of GERD that formal testing may be unnecessary.

Other symptoms of GERD include:

  • Non-burning chest pain, which is usually located in the middle of the chest and radiates to the back

  • Difficulty swallowing (dysphagia)

  • Atypical reflux symptoms relating to the throat, larynx or lungs:

    • Sore throat

    • Coughing

    • Increased salivation

    • Shortness of breath

GERD Diagnosis at Johns Hopkins

Gastroenterologists at Johns Hopkins are the leading experts in the nation, pioneering new diagnostic procedures and treatments for GERD and other reflux conditions. Our doctors treat a high volume of cases every year, giving them the necessary experience to diagnose and treat even the most complex case of GERD.

At Johns Hopkins, we understand that more than one specialty may be involved in obtaining an accurate diagnosis. Our multidisciplinary approach gathers doctors from many different fields to analyze each case and discuss the best approach.

GERD Diagnostic Procedures

A diagnosis of GERD starts with a thorough physical examination during which you describe your symptoms and medical history. If the typical symptoms of reflux disease are present, including heartburn and regurgitation, your doctor may begin treatment without performing specific diagnostic tests.

However, test may be performed if:

  • Your symptoms are atypical

  • The severity of the reflux raises concerns about esophageal damage

  • Symptoms do not respond to initial treatment

  • Your doctor is considering anti-reflux surgery

Diagnostic procedures for GERD include:

Upper Endoscopy

Upper endoscopy allows your doctor to examine the lining of your esophagus, stomach and first part of the small intestine. It is the best test for evaluating reflux-induced esophageal injury and diagnosing esophagitis and Barrett's esophagus. It can also help diagnose an esophageal stricture (narrowing.)

Although only 10 to 20 percent of people with reflux will have abnormal findings during an endoscopy, the procedure is necessary to evaluate the potential for complications. Your doctor also will want to rule out other, more serious conditions that mimic GERD.

During an upper endoscopy:

  1. You receive an anesthetic to help relax your gag reflex. You may also receive pain medication and a sedative.

  2. You lie on your left side, referred to as the left lateral position.

  3. Your doctor inserts the endoscope through your mouth and pharynx, into the esophagus.

  4. The endoscope transmits an image of the esophagus, stomach and duodenum to a monitor that your physician is watching.\

Reflux Testing

There are two methods for testing the severity of your reflux. Your doctor will discuss with you the benefits and risks of each one and choose the most appropriate method for you.
The two methods are:

Wireless pH Testing

Wireless pH testing allows your doctor to evaluate your reflux activity over a 48-hour period while you continue your normal activities. To perform wireless pH testing:

  1. Your doctor performs an endoscopy and places a small chip in your lower esophagus.

  2. The chip records acid at that site for 48 hours.

  3. The chip transmits your acid level to a wireless recording device that you wear around belt.

  4. The data from the recording device can gauge your reflux severity.

24-Hour pH Impedance

Your doctor may order this procedure to evaluate your reflux. This procedure monitors your pH level (level of acidity) for a prolonged period. During pH impedance:

  1. Your doctor places a thin, flexible catheter with an acid-sensitive tip through your nose into your esophagus. The catheter is placed in separate recording spots to evaluate the flow of liquid from your stomach into your esophagus.

  2. The catheter stays in your nose for a period of 24 hours.

  3. Your doctor is able to evaluate if you have GERD, the severity of your reflux, and the correlation between your reflux and the symptoms and presence of nonacid reflux. This procedure helps in the design of a course of treatment for you.

Esophageal Manometry

Esophageal manometry, or esophageal motility (movement) studies, cannot diagnose GERD, but doctors use it in order to rule out other conditions that mimic GERD. This is especially important if your doctor is considering an anti-reflux surgery.

During an esophageal manometry:

  1. Your doctor places a pressure-sensitive catheter into the esophagus. (This may be performed right before esophageal pH studies, as it determines the level of the esophagus where your doctor should place the pH probe.)

  2. The catheter evaluates the strength and coordination of your muscle contractions. It also tests the strength and relaxation function of the lower esophageal sphincter (LES).

  3. An esophageal manometry is an essential part of the assessment process prior to anti-reflux surgery.

Barium Esophagram

Barium contrast radiography, or a barium esophagram, is an X-ray study. It is one of the most common procedures to test for GERD.

During barium contrast radiography:

  1. You swallow a contrast solution called barium.

  2. The barium coats your esophagus and gastrointestinal tract, making it easier for the doctor to detect abnormalities.

  3. An X-ray is taken.

  4. During the X-ray, your doctor looks for a narrowing in the esophagus called a stricture.

A barium esophagram also evaluates the coordination of your esophageal motor function. While it does not test for the presence of reflux, it is useful for evaluating injury to your esophagus.

Barium x-ray of a reflux-induced esophageal stricture.
Barium x-ray of a reflux-induced esophageal stricture. (Click to Enlarge)
         

GERD Complications

Patients with severe reflux may suffer from further complications, including:

GERD Treatment at Johns Hopkins

There are two main approaches to treating GERD: medication and surgery. Most patients can effectively use a combination of lifestyle changes and drug therapy to treat their GERD. GERD is chronic, so most patients will have to continue some sort of treatment throughout their lives.

Surgery is an option for patients who do not respond to medical treatment. Others choose therapy as an alternative to a lifetime of taking medication. Learn more about GERD treatment at Johns Hopkins.

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