GERD, or gastroesophageal reflux disease, is the excessive reflux or regurgitation of stomach contents into the esophagus causing symptoms and injury to the lining or mucosa of the esophagus. More than 38 million Americans have GERD, and 44 percent of Americans have heartburn at least once per month. Seven percent of Americans have daily symptoms.
The classic symptoms are heartburn and regurgitation along with indigestion. We see chronic cough, laryngitis or frequent sore throats, bronchitis, aspiration pneumonia and difficulty swallowing food, especially meats.
It is a multi-billion dollar industry. Medicines to treat the symptoms of GERD include Tums, Rolaids and Pepto-Bismol. As the disease progresses, we go to stronger medicines such as H2 blockers like Zantac or Tagamet, and eventually to the strongest antacids called PPIs like Prilosec or Nexium.
GERD does affect one’s quality of life. We have poor sleep, avoid foods we would like to eat and depend on antacid medication. There is also a known association between chronic GERD and adenocarcinoma of the esophagus, which is a cancer that has dramatically increased in the U.S. over the past 20 years despite improvement in antacids.
GERD happens when our body’s natural barrier to the reflux of acid into the chest or esophagus is broken down. This barrier is the lower esophageal sphincter muscle. The muscle can become defective as well as a hiatal hernia can develop and make the sphincter less effective, leading to reflux or GERD.
If left untreated, about 10 percent of patients with chronic heartburn will progress to a condition called Barrett’s esophagus. This is a change in the lining of the esophagus caused by chronic acid exposure. Cancer will develop in Barrett’s at a rate of .5 percent per year. These patients will have to have upper endoscopy (known as EGD) for life to hopefully prevent progression to cancer of the esophagus, which carries a poor prognosis compared to other more common cancers.
The treatment of GERD is medical first. If you have any of the above symptoms on a weekly basis, you should see a gastroenterologist and be scoped. The gastroenterologist will place you on medication if he or she finds evidence of GERD. Remember, symptoms don’t always correlate with the severity of disease.
Some patients begin to fail medical therapy, can’t tolerate the medication, or have concerns about long-term effects of taking these medications for life. These long-term effects include osteoporosis and/or continued reflux of non-acid gastric juices and the continued cancer risk from this.
Whichever the reason, the next step is referral to a surgeon for evaluation for surgical treatment of your reflux. We now have several options available. All are performed through a minimally invasive technique called laparoscopy. Patients are discharged after an overnight stay, which is usually to prevent nausea.
The most common procedures are the laparoscopic Nissen and the LINX procedure. Both are effective in restoring function to the lower sphincter. The Nissen procedure has been around for many years and must be done with large hiatal hernias and patients with more advanced diseases. The LINX procedure is ideal for patients in early stages of GERD even when they still respond to antacids. The LINX is nice in these patients because it has fewer side effects.
The LINX device consists of a ring of magnetized titanium beads. We place the device over the sphincter, right where the esophagus enters the stomach, to help reinforce that area and prevent the reflux. After the LINX procedure, the patient still retains the ability to vomit and belch.
The best results come from close collaboration between the surgeon and gastroenterologist. A proper workup is essential. When the time is right, a referral will be made to a surgeon to decide which option is best for you.
Dr. Robert McAuley is a board-certified general surgeon with Surgery Clinic of Tupelo and on the medical staff of North Mississippi Medical Clinic.