Heartburn and Gastroesophageal Reflux Disease (GERD)

Heartburn is the most common symptom of a disease called GERD, or Gastroesophageal Reflux Disease. GERD is a serious condition which can interfere with your quality of life. For many, symptoms are mild and relief can be found. For some, GERD is a daily, severe problem with lifelong implications.

GERD, or Gastroesophageal Reflux Disease, is a condition in which contents of the stomach or small intestine such as stomach acid repeatedly back up into the esophagus (the tube connecting the throat to the stomach).

Most commonly, the refluxed gastric (stomach) contents are acidic, but bile (non-acidic fluid) may also be present in the gastric juice. GERD is a common problem in the United States, where the symptom of heartburn, at least once a week, is present in 20% of the population. In addition, GERD accounts for 75% of overall esophageal diseases in the United States.

Do You Have GERD?

Over 60 million Americans experience heartburn at least once a month; 25 million Americans experience it daily. In the Houston area, it is estimated that approximately 375,000 people suffer from chronic heartburn. Are you one of these people?

If you think you have GERD, take this quick self-assessment. If you answer YES to one or more of these questions (symptoms), there is a good chance you may have GERD.

• Do I get a burning feeling in the middle of my chest?
• Do I often have a burning feeling after a meal or at night?
• Does this burning feeling gets worse when I lie down or bend over?
• Do over-the-counter medicines, such as acid reducers or antacids, help the burning go away?
• Do I frequently regurgitate (burp up) my food?
• Is there a bitter or sour taste in the back of my throat?

How Is Acid Reflux Different Than GERD?

Acid Reflux is closely related to GERD, but the terms aren't necessarily interchangeable. Acid reflux is the backward flow of stomach acid into the esophagus — the tube that connects the throat and stomach. Acid reflux is more specifically known as gastroesophageal reflux. If you have frequent, ongoing heartburn, you may have a more serious condition, such as gastroesophageal reflux disease (GERD).

Quality of Life

GERD is a serious problem and patients with severe GERD have a quality of life similar to patients with angina or heart failure. Further, complications of GERD such as Barrett’s esophagus, peptic stricture and other esophageal and gastric abnormalities, such as a paraoesophageal hernia, are commonly associated with the disease.

Severity of Complications

The severity of the complications of GERD is directly related to the presence of a mechanically defective lower esophageal sphincter (malfunctioning of the valve between the esophagus and the stomach) and presence of both acid and bile in the esophagus.

Combined reflux of gastric acid and bile into the esophagus causes severe damage to its lining. This can result in changes in the esophagus called Barrett’s esophagus, which can be transformed to dysplasia (abnormal cells in the esophagus) and esophageal adenocarcinoma (cancer).

GERD is caused by a mechanically defective lower esophageal sphincter (malfunctioning of the valve between the esophagus and the stomach). This valve controls the passage of food from the esophagus into the stomach.

When the valve does not function well (does not close properly) food, acid and bile reflux back into the esophagus causing gastroesophageal reflux disease.

• Epigastric pain (upper abdominal pain)
• Dysphagia (difficulty swallowing, or a sensation that food is hanging up or not passing down into the stomach properly)
• Regurgitation of food or liquids, particularly when bending over or laying down, associated with a bitter taste in the mouth
• Less common symptoms of GERD include:
• Chest pain
• Hoarseness
• Cough
• Pneumonia

Patients with recurring symptoms of reflux have an eightfold increase in the risk of esophageal adenocarcinoma. Therefore, we believe that GERD is a serious health problem and anyone with more than the occasional episode of heartburn or regurgitation, and in particular anyone with dysphagia (difficulty swallowing) should be evaluated with an upper endoscopy.

Below is a schematic presentation of three consecutive swallows recorded during an esophageal motility study (high-resolution manometry) in a patient with a normal esophageal body study. The arrow shows the direction of the esophageal contractions in a normal esophagus. Each color corresponds to a certain amount of pressure.

The next image is a simple schematic presentation of three consecutive swallows recorded during an esophageal motility study in a patient with a normal esophageal body study. The arrow shows the direction of the esophageal contractions in a normal esophagus.

Esophageal pH assessment

• 24-hour pH study
• 48-hour Bravo capsule wireless pH study: This study is performed to measure the acid inside the esophagus by placing a small capsule in the esophagus. Images of the capsule are shown below.
• Impedance Monitoring EsophagealpH Assessment

Bravo Capsule

Esophageal impedance study: This study is performed to measure the reflux of bile (non-acidic fluid) inside the esophagus.

Testing and Evaluation for GERD

Thorough evaluations performed at Memorial Hermann help Houston GERD sufferers understand their treatment options. We provide a visual, microscopic, physiologic and functional evaluation of GERD and the esophagus. Diagnostic tests include:

• Visual evaluation through endoscopy
• Microscopic evaluation with biopsies
• Physiologic evaluation including ambulatory pH Testing (Bravo® Receivers, endoscopic ultrasounds, etc.)
• Functional evaluation like esophageal manometry

At Memorial Hermann, we take a comprehensive approach to treating GERD since many don't find relief through standard treatments. Our treatment options are customized to each individual, and may include:

• Lifestyle Changes, like bed blocks, nutritional counseling, and weight loss
• Medications, like antacids, H2 blockers and proton pump inhibitors (PPIs)
• Surgical Treatments such as the LINX Reflux Management System.

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