Knowing Gastroesophageal Reflux Disease
 Understanding GERD
 Lifestyle Changes
 Medical Treatment and Surgery
What is Gastroesophageal Reflux Disease?
When you digest food, the food travels from your mouth through the
esophagus and to your stomach. Before food enters your stomach, it
passes through a one-way valve called the lower esophageal sphincter
(LES). LES opens as you swallow to allow food to reach the stomach.
Then it closes quickly to prevent reflux or back wash.
Gastroesophageal Reflux Disease (GERD) is a chronic digestive
disease that occurs when the LES is weakened and does not function
properly. A weakened LES allows food and stomach acid travel back into
the esophagus. The stomach acid can irritate the esophagus. Sometimes,
the top of the stomach is lodged through an enlarged hiatus, the opening
in the diaphragm which allows the esophagus to pass through. This is
called a hiatal hernia which can make GERD worse.
Symptoms of GERD include frequent bouts of heartburn, a sour-tasting
fluid in your and difficulty swallowing. Heartburn from GERD may occur
after a large meal or when bending over or lying down. Smoking, caffeine
and alcohol may worsen heartburn due to increase in acidity.
How GERD worsens
With GERD, inflammation, ulcers and stricture all occur in the esophagus due to repeated exposure of stomach acid.
Swelling of the esophagus is called esophagitis and it causes pain, pressure and burning in the chest and throat. Ulcers
or sores can develop in the lining of the esophagus and cause pain and bleeding. Stricture or scarring may occur and
cause the esophagus to narrow. People with severe GERD may experience dysphagia which it creates the sensation
that food in lodged in the throat. All of these side effects make it very difficult to swallow.
What tests will I need?
To determine whether you have GERD, your doctor will perform a medical evaluation. You may be referred to a
gastroenterologist, a doctor that specialized in treating digestive problems. Your evaluation will include a patient history
and exam. Your doctor will ask questions about your eating, sleeping, smoking and drinking habits along with your
symptoms. Your doctor will also complete a physical exam to rule out alternative medical causes for your symptoms.
If your doctor suspects you have GERD, you make need more tests to take a closer look at your digestive system.
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A barium upper GI looks at your digestive system in action. You will swallow a barium milk shake and x-rays are
used to monitor the barium dye as it moves through the esophagus to the stomach. It will capture any reflux on
film.
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An esophageal endoscopy sends light and images to a video screen from a probe inserted down your throat.
The doctor is able to view the esophagus and stomach to diagnosis any problems. Your doctor may take a
sample of the tissue, or biopsy.

If you may need surgery, an esophageal manometry will be uses to measure the muscle tone of LES and how
well your esophagus pushes food down to your stomach. Your doctor will guide a flexible tube from your nose to
your stomach. Water is passed through the tube. The pressure of the LES will be measured as the tube is
retracted. This will help your doctor tailor a surgical procedure to you.

A PH monitoring tests uses a thin, acid-measuring probe to record how much stomach acid refluxes into the
esophagus. Your doctor will place the probe in your esophagus for up to 24 hours.
Making Lifestyle Changes
Making simple lifestyle changes can help you reduce the symptoms of GERD

Avoid Certain Foods. The following foods increase the acid in your stomach or relax the LES.
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Coffee, tea and carbonated drinks with
or without caffeine
Spicy food
Onions
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Peppermint
Chocolate
Citrus fruits and tomatoes
Fried and fatty foods
Try eating six small meals a day to decrease pressure of LES. After eating, do not lie down, bend over or sleep
for two to hours to prevent heartburn.

Stop drinking alcohol and smoking. Alcohol and the nicotine in tobacco can increase stomach acid production
making GERD worse. Alcohol also relaxes the LES.

Raise you head while sleeping. Reflux often occurs when lying down. To prevent this from occurring, try
sleeping with the head of your bed raised 6 to 8 inches. You can place a wedge under your mattress or books
under the legs at the head of the bed.
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Ease pressure on your stomach. Too much pressure on your stomach can cause reflux. Try to:
□ Maintain a healthy weight
□ Avoid bending over
□ Do not wear tight clothing and keep belt loose
Treating GERD with Medicine
You doctor may suggest trying nonprescription over-the-counter antacids to relieve your symptoms. If these do not work,
your doctor may prescribe stronger medications to help with digestion.

Antacids. Antacids can be uses to neutralize or weaken stomach acid. They can be purchased without a
prescription and are available at most drugstores. Only take antacids as instructed by your doctor.
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H-2 Blockers. H-2 blockers are sold under the generic names of cimetidine, ranitidine, famotidine and nizatidine.
They work to suppress the stomach’s acid production.
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Stimulate stomach muscles. Some medicines work to strengthen the squeezing action of the esophagus and
tighten weakened LES. They are sold under the generic names of cisapride, metoclopramide, and behanechol
chloride. Often, they are used with H-2 blockers.
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Stop Stomach Acid Production. The drug omeprazole works to completely stop stomach acid production. The
drug lansoprazole works similarly.
Treating GERD with Surgery
If you are still experiencing symptoms, your doctor may advise having a
surgical procedure to “re-create” your LES using the top of your stomach
called laparoscopic fundoplication. The surgery usually lasts 2 to 4
hours and you can expect a short hospital stay and recovery time. During
the procedure, your surgeon will make small incisions in your abdomen.
Your surgeon will use carbon dioxide to inflate your abdomen to provide
your surgeon with more space to work. A laparoscope is inserted through
an incision to send images to a video screen. If the hiatus is too large, your
doctor will tighten it with sutures. Your surgeon will wrap the top of the
stomach around your esophagus to help prevent reflex. The surgeon will use a full wrap, goes all around the esophagus,
or partial wrap, does not go all around the esophagus, depending on condition. The wrap is then stitched into place.
If your surgeon does feel it is safe to complete the surgery laparoscopic, he or she might switch to an open
fundoplication. He or she will make a larger incision in the abdomen and finish the operation. This surgery will take a
longer recovery time.