GERD: Gastroesophageal REFLUX Disease
Gastroesophageal reflux is when contents from the stomach travel back up into the esophagus. Several factors contribute to how much a patient refluxes and how badly.
The disease of GERD is a condition in which patients’ reflux consistently cause symptoms like heartburn, cough, trouble sleeping, hoarseness, regurgitation and even chest pain. Stomach acids, bile and other enzymes that are not meant to be in the esophagus travel up during these reflux episodes and can cause damage to the lining of the esophagus. Worsening reflux has been shown to lead to conditions like Barrett’s Esophagus (pre-cancerous) and esophageal cancer.
Often times, this refluxing is caused by a weak muscle called the LES (lower esophageal sphincter). When this muscle weakens, it does not open and close properly thus allowing contents to flow back up into the esophagus. We can address this weakened muscle surgically by augmenting it with a LINX implant or attempting to recreate it with a fundoplication procedure.
Many patients are prescribed proton pump inhibitors or PPI’s, a popular medication which aides in symptom relief. These medications can often reduce or eliminate heartburn symptoms but they do not actually address the cause of the disease. PPIs reduce the amount of acid that is produced by the stomach thus altering the amount of acid that is refluxed into the esophagus. However, they do not stop a patient from refluxing. They can also have side effects such as causing diarrhea and stomach polyps. They can be associated with an increase risk of developing pneumonia and osteoporosis (losing calcium from the bones). Recent studies have also associated them with an increased risk of dementia, kidney disease and premature death.
Achalasia is a disease in which it becomes difficult for a patient to pass food or drink from the esophagus into the stomach. The symptoms of achalasia can sometimes mimic the symptoms of reflux including regurgitation, chest pain, and weight loss. But the cause of achalasia is different. In patients with Achalasia, the Lower Esophageal Sphincter is often exerting too much pressure.
The appropriate pre-operative testing helps to identify which patients suffer from Achalasia versus GERD. It is important to diagnose achalasia, as there are excellent procedures available to treat that disease.
The presence of a hiatal hernia also contributes to reflux. This occurs when a patients crural muscles (the muscles that support the esophagus as it passes through the diaphragm) have separated and are no longer supporting the esophagus at the area of the hiatus. A portion or all of the stomach can then herniate or move up into the chest. In certain circumstances, the stomach can twist causing pain, bleeding or lead to strangulation of the stomach. This can also be addressed surgically by suturing the muscles back together after returning the stomach into the abdomen.