Gastroesophageal Reflux or “GERD” is also known as “Acid Reflux”.   Patients with GERD typically have a burning sensation in the upper abdomen or lower chest.  It can be mild, moderate or so severe it is mistaken for a heart attack.

Mild to moderate cases of Gastroesophageal Reflux can be diagnosed just by the symptom history and treated with simple acid blocking medication.   Some common medications in the U.S. include Zantac, Prilosec and Protonix.  There are a couple different causes of GERD, but fortunately most cases do not require an operation to improve the symptoms.  The most common operation that is done in the U.S. for symptoms that are not manageable with medications is called the “Laparoscopic Nissen Fundoplication”.  You can read about this operation by clicking here.

To understand Gastroesophageal Reflux, I first want to talk a little about the anatomy of the problem. Basically, the esophagus is a long muscular tube that takes the food from the mouth to the stomach.  At the junction of the esophagus and stomach is a muscular valve.  When we are not eating, the muscle should closed tight enough to not allow the acidic juice of the stomach to go “upstream” into the esophagus.

The stomach is used to an acid environment and actually has a special lining that can tolerate the acid.   The reason we have symptoms of Gastroesophageal Reflux is because the esophagus is not used to the acid, and when the acid from the stomach goes “upstream” to the esophagus, the esophagus lining gets irritated by the acid, and we feel pain and discomfort.  This is the typical “reflux” that people refer to when they are having upper abdominal pain or lower chest burning pain.

The most common reasons we have Gastroesophageal Reflux is a malfunction of the muscle that blocks the upstream flow of acid.  This muscle is called the “Lower Esophageal Sphincter”.  As the name implies, it is a valve at the lower part of the esophagus that does not allow the acid to go into the esophagus.  As I mentioned before, if this valve (really a muscle) is not working properly, the  acid goes up into the esophagus and we get reflux pain.

A second common cause of reflux pain is due to a hiatal hernia.  The hiatal hernia is a little bit more complex of an issue and I have written a separate article to talk about that, which you can find here.  Essentially the hiatal hernia creates a problem with the “Lower Esophageal Sphincter” and we get a functionally inept muscular valve, again causing the reflux.

If you have been diagnosed with Gastroesophageal Reflux and you have been taking acid blockers for more than 2-3 years, it’s usually recommended to have a “stomach scope” or upper endoscopy.  You can read about this procedure in one of my other articles entitled “Upper GI Endoscopy“.  Basically this is a visual examination of the esophagus to check for damage to the esophagus.  Your doctor will also take a small piece of the esophagus tissue (called a biopsy) to look at it under the microscope.  This microscopic examination will reveal if and how much the esophagus has been damaged by the acid.

It’s important to have this upper endoscopy at least once as people with longterm reflux (over 10-15 years) have a higher chance of developing cancer in the esophagus than those who do not have longterm reflux.

I hope this answers some questions for you about “GERD”,  and gives you a better understanding of what exactly is going on in there, and what you should be aware of to best take care of yourself in the future.

-Dr. Buck