Evaluation and management of GERD

Evaluation and management of GERD

Gastroesophageal reflux disease (GERD) is a chronic condition characterized by the frequent occurrence of acid reflux, where stomach acid flows back into the esophagus, causing irritation and inflammation. This reflux occurs due to a weakening or malfunctioning of the lower esophageal sphincter (LES), the muscle that normally prevents stomach contents from flowing backward into the esophagus.

What are the symptoms of GERD?

"GERD is more than just occasional heartburn," says Bao C. Nguyen, MD, FACS, General Surgery at ARC Far West Medical Tower in Austin. "It's a persistent and potentially serious condition that can significantly impact one's quality of life." The symptoms of GERD can vary from person to person, but commonly include:

  • Heartburn: A burning sensation in the chest or throat, often after eating or when lying down.
  • Regurgitation: Sour or bitter-tasting fluid moving up from the stomach into the throat or mouth.
  • Dysphagia: Difficulty swallowing, often due to narrowing of the esophagus from chronic inflammation.
  • Chronic cough: A persistent cough, especially at night, which may be exacerbated by refluxed stomach acid irritating the throat.
  • Hoarseness: Changes in the voice caused by irritation of the vocal cords.
  • Chest pain: Sometimes confused with heart-related pain, GERD-related chest pain can feel sharp or squeezing.
  • Esophagitis: The inflammation or irritation of the esophagus.

How is GERD evaluated?

When evaluating GERD, your doctor often begins with a thorough medical history and physical examination to assess symptoms and potential risk factors. However, to confirm the diagnosis and assess the severity of GERD, several diagnostic tests may be employed:

  • Upper endoscopy (EGD): A procedure in which a thin, flexible tube with a camera (endoscope) is passed through the mouth and into the esophagus and stomach to visually inspect the lining and look for signs of inflammation, irritation, or complications like Barrett's esophagus.
  • Upper GI (barium swallow): This test looks at the organs of the top part of your digestive system. It checks your food pipe (esophagus), stomach, and the first part of your small intestine (duodenum). You will swallow a chalky fluid called barium. Barium coats the organs so that they can be seen on an X-ray.
  • pH monitoring: This test measures the amount of acid that flows into the esophagus from the stomach over a 24-hour period, providing valuable information about the frequency and severity of reflux episodes.
  • Esophageal manometry: This test evaluates the function and strength of the esophagus and lower esophageal sphincter by measuring muscle contractions and pressure within the esophagus.

Can GERD be treated?

GERD can be managed effectively through a combination of lifestyle modifications, medications, and, in some cases, surgical intervention.

Lifestyle modifications: These may include dietary changes (avoiding trigger foods like spicy or acidic foods, caffeine, and alcohol), maintaining a healthy weight, elevating the head of the bed while sleeping, and quitting smoking.

Medications: Over-the-counter and prescription medications can help reduce acid production, improve lower esophageal sphincter (LES) function, or neutralize stomach acid. Common medications include proton pump inhibitors (PPIs), H2 receptor antagonists, and antacids.

Surgical intervention: When lifestyle changes and medications do not reduce symptoms, your doctor may suggest surgery.

Surgical treatment of gastroesophageal reflux, including hiatal hernia repair and partial or complete fundoplication, can be performed in a minimally invasive fashion with the utilization of da Vinci robotic system technology that allows faster recovery and eliminates symptoms.

The most common surgical procedure for GERD is gastric fundoplication. During fundoplication, the surgeon wraps the top of the stomach (the fundus) around the lower esophagus to strengthen the valve between the esophagus and the stomach. This helps prevent stomach acid from refluxing into the esophagus.

GERD is a common and often chronic condition that requires ongoing management to alleviate symptoms and prevent complications. "In our approach to managing GERD, we focus on a balanced strategy involving lifestyle adjustments, medications, and, in some cases, surgery like gastric fundoplication," says Dr. Nguyen. "It's crucial to diagnose GERD early and conduct a thorough evaluation to create tailored treatment plans that bring relief and improve patients' daily lives."

Learn more about GERD treatment at ARC.

Make an appointment today

ARC General Surgeons have specialized knowledge and experience related to diagnosis, pre-operative, operative, and post-operative management of surgery, combined with a patient-centered philosophy of coordinated care. At ARC, we provide the most up-to-date surgical and treatment options available.

Take the first step towards a healthier you and schedule an appointment today. Dr. Nguyen is accepting new patients ages 16 and older at ARC Far West Medical Tower in Austin. Call 512-346-8888 or make an appointment today through ARC MyChart or ARC Help Me Book.

Tags: gastroesophageal reflux disease, GERD