Diagnosing GERD

What is GERD?
Gastroesophageal reflux disease (GERD) occurs when the lower esophageal sphincter opens spontaneously, or does not close properly and stomach content rises up into the esophagus. GERD is also called acid reflux because the stomach content has acid mixed in with it.

When refluxed stomach acid touches the lining of the esophagus it may cause a burning sensation in the chest or throat commonly called heartburn or acid indigestion.  Occasional reflux does not necessarily indicated a serious problem.  However, reflux that occurs more than twice a week is considered GERD, which can eventually lead to more serious health problems.

What causes GERD?
In some people, the lower esophageal sphincter simply relaxes at an inappropriate time.  Often, anatomical abnormalities such as a hiatal hernia contributes to GERD.  A hiatal hernia is when the upper part of the stomach and the lower esophageal sphincter move above the diaphragm (a thin layer of muscle that separates the stomach cavity from the chest cavity).  Other factors that may contribute to GERD include:

  • obesity
  • pregnancy
  • smoking

The food you eat does not cause reflux but certain foods commonly make reflux symptoms worse.  These foods include:

  • citrus fruits
  • chocolate
  • drinks with caffeine or alcohol
  • fatty and fried foods
  • garlic and onions
  • mint flavorings
  • spicy foods
  • tomato-based foods, like spaghetti sauce, salsa, chili, and pizza

What are the symptoms of GERD?
The main symptom of GERD in adults is frequent heartburn or acid indigestion.  Most children under 12 that suffer from GERD, as well as some adults, may not have heartburn.  Instead they experience a dry cough, asthma symptoms, or trouble swallowing.

What are the long-term complications of GERD?
Chronic GERD left untreated can cause serious complications.  Constant inflammation of the esophagus from exposure to stomach acid can damage the lining and cause bleeding or ulcers - also called esophagitis.  Scars from tissue damage can lead to narrowing or the esophagus, known as strictures, which make swallowing difficult.  Over time, damage to cells can lead to esophageal cancer, which is often fatal.  GERD may also worsen or contribute to asthma, chronic cough and pulmonary fibrosis.  Persons with complicated GERD should be monitored closely by a physician.

Diagnosing GERD
Some times doctors will empirically treat GERD and assess the patient’s response to a trial of acid-suppressive therapy. If a doctor decides to order a diagnostic test, it may be one of the procedures below:

Upper Endoscopy
The upper endoscopy (also known as esophagogastroduodenoscopy or EGD) allows the doctor to examine the inside of the patient's esophagus, stomach, and duodenum (the first part of the small intestine) with an instrument called an endoscope, a thin flexible lighted tube. The doctor will be able to visualize the walls and tissue of the upper digestive tract. During this procedure, a doctor may take a biopsy to see if there are any changes to the lining of the esophagus that may require further monitoring.

Bravo 48-hour Esophageal PH Monitor Examination
A Bravo 48 hour pH study is initiated during an EGD exam.  The doctor will place a small capsule in your esophagus at the time of the EGD exam.  This capsule (wireless) adheres to the wall of the esophagus and monitors pH levels.  The patient is sent home with a small transmitter box which collects data from the capsule.  The patient returns the transmitter box in 48 hours.  The capsule will pass through your GI system. 

Esophageal Manometry
Manometry is a technique that records muscular pressure to determine if the lower esophageal sphincter is functioning properly. A small tube is guided through the patient's nose and into the esophagus. A computer connected to the sensor on the tube will measure the muscular pressure in the esophagus and stomach.

REMEMBER…

  • Anyone experiencing heartburn twice a week or more may have GERD.
  • You can have GERD without having heartburn. Your symptoms may include a dry cough, asthma symptoms, or trouble swallowing.
  • If you have been using antacids for more than 2 weeks, it is time to see your health care provider.
  • Health care providers usually recommend lifestyle and dietary changes to relieve symptoms of GERD.
  • Many people with GERD also need medications.
  • Surgery may be a treatment option when medical management fails or is too burdensome for the patient over time. It can be performed by specially trained surgeons with a brief hospitalization and a short recovery when laparoscopic techniques are used.

To learn more about Hamilton's Endoscopy Services, call 706-272-6559.

Check out A.D.A.M.'s health information for additional GERD information.