Gastroesophageal Reflux (GER) is a condition in which gastric contents, principally acid, flow back up into the esophagus. Gastroesophageal Reflux Disease (GERD) occurs when this back flow is frequent and excessive causing symptoms and damage to the esophageal lining. GERD causes a myriad of symptoms including heartburn, chest pain, regurgitation, globus sensation, nausea, vomiting, hiccups, burping, trouble swallowing, food getting stuck or pain when swallowing.
Interestingly, GERD can also result in a range of so-called “extra-esophageal” symptoms affecting the respiratory tract, throat and sinuses. If you have chronic issues with halitosis, hoarseness, laryngitis, hypersalivation, dental enamel erosions, gingivitis, frequent throat clearing, sore throat, chronic cough, wheezing, difficult to control asthma, sinus infections, aspiration pneumonia or sleep apnea you may have significant GERD.
It is estimated that 50%, 15%, 5% of American experience heartburn per month, per week and per day, respectively. GERD occurs equally among both genders and all ethnicities however complications tend to occur more commonly in Caucasian males. Family history and the presence of a hiatal hernia appears to increase one’s risk. GERD is more common in those of advancing age and those who have gained weight or are pregnant. There are certain rare medical conditions which also increase your risk of GERD (eg. scleroderma). In most cases the cause of GERD is multifactorial.
GERD is typically diagnosed clinically based on history and physical examination. If there are complicating, alarming or atypical features then you should visit Dr. Mantas for evaluation. Sometimes additionally testing is needed including endoscopy, pH/impedance monitoring, manometry and radiographic upper GI series. Dr. Mantas has specialty training in each of these modalities.
There are a number of measures one can take to minimize GERD related symptoms. These include certain lifestyle changes, dietary modifications and medications changes including avoidance of certain drugs and the use of over-the-counter and prescription agents. Please visit Dr. Mantas for more information.
Aside from discomfort heartburn can overtime, if left untreated, result in multiple complications:
Factors that increase one’s risk of developing complications include: Caucasian ethnicity, male gender, obesity, smoking, age of diagnosis >55 years old and concurrent hiatal hernia.
The foundation for treatment includes lifestyle change and medications but in some instances patients continue to have symptoms. Dr. Mantas is expertly trained in treating these challenging cases with more advanced medical therapy and is able to offer guidance for those considering various anti-reflux operations. Dr. Mantas also studies non-invasive anti-reflux endoscopic techniques which may be options for those suffering from GERD in the future.
Medications used for management of GERD include those that decrease gastric acid specifically antacids, histamine 2 blockers and proton pump inhibitors. Other medications with different mechanisms exist which can be used for treatment of refractory cases of GERD. Please visit Dr. Mantas to discuss these potential options.
A variety of other disorders can affect the esophagus. Suggestive symptoms include chest or upper abdominal pain, nausea, vomiting, regurgitation, troubled swallowing, food sticking, pain after swallowing, indigestion, heartburn and hiccups. Please visit Dr. Mantas if you feel that you have an esophageal disorder. Other common disorders include strictures, achalasia, eosinophilic esophagitis and esophageal cancer.