Gastroesophageal reflux disease (GERD) occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of your esophagus. Many people experience acid reflux from time to time. GERD is a mild acid reflux that occurs at least twice a week, or moderate to severe acid reflux that occurs at least once a week.
Most people can manage the discomfort of GERD with lifestyle changes and over-the-counter medications. Several conditions may be associated with GERD including Barrett’s esophagus and hiatal hernia. Barrett’s esophagus is a condition in which the lining of the esophagus changes, becoming more like the lining of the small intestine rather than the esophagus. This occurs in the area where the esophagus is joined to the stomach. Hiatal hernia occurs when the upper part of the stomach moves up into the chest through a small opening in the diaphragm.
GERD is characterized by symptoms and/or tissue damage that results from repeated or prolonged exposure of the lining of the esophagus to contents from the stomach. If tissue damage is present, the individual is said to have esophagitis or erosive GERD. The presence of symptoms with no evident tissue damage is referred to as non-erosive GERD. GERD symptoms are often persistent, such as chronic heartburn and regurgitation of acid. But sometimes there are no apparent symptoms, and the presence of GERD is revealed when complications become evident. Symptoms of GERD vary from person to person. The majority of people with GERD have mild symptoms, with no visible evidence of tissue damage and little risk of developing complications. Periodic heartburn is a symptom that many people experience. If it occurs occasionally just after a meal and less than once per week, it is likely a “benign” condition. Heartburn that occurs more frequently than once a week, becomes more severe, or occurs at night and wakes a person from sleep, may be a sign of a more serious condition, and consultation with a physician is advised. Even occasional heartburn – if it has occurred for a period of 5 years or more, or is associated with difficulty in swallowing– may signal a more serious condition. Chronic heartburn is the most common symptom of GERD. Acid regurgitation (refluxed material into the mouth) is another common symptom. But numerous less common symptoms other than heartburn may be associated with GERD. These may include belching, difficulty or pain when swallowing, waterbrash, dysphagia (the sensation of food sticking in the esophagus), chronic sore throat, laryngitis, inflammation of the gums, and chronic irritation in the throat.
Your doctor is likely to recommend that you first try lifestyle modifications and over-the-counter medications. If you don’t experience relief within a few weeks, your doctor might recommend prescription medication or surgery.
The over-the-counter medication options include antacids that neutralize stomach acid, H-2-receptor blockers, and proton pump inhibitors. Antacids, such as Mylanta, Rolaids, and Tums, may provide quick relief. But antacids alone won’t heal an inflamed esophagus damaged by stomach acid. Overuse of some antacids can cause side effects, such as diarrhea or sometimes kidney problems. H-2-receptor blockers will reduce acid production. H-2-receptor blockers don’t act as quickly as antacids, but they provide longer relief and may decrease acid production from the stomach for up to 12 hours. Proton pump inhibitors are stronger acid blockers than H-2-receptor blockers and allow time for damaged esophageal tissue to heal. Over-the-counter proton pump inhibitors include lansoprazole (Prevacid 24 HR) and omeprazole (Prilosec OTC, Zegerid OTC).
The prescription medications options include prescription-strength H-2-receptor blockers, prescription-strength proton pump inhibitors, and medication to strengthen the lower esophageal sphincter. Prescription-strength H-2-receptor blockers include prescription-strength famotidine (Pepcid) and nizatidine. These medications are generally well-tolerated but long-term use may be associated with a slight increase in the risk of vitamin B-12 deficiency and bone fractures. Prescription-strength proton pump inhibitors include esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec, Zegerid), pantoprazole (Protonix), rabeprazole (Aciphex) and dexlansoprazole (Dexilant). Although generally well-tolerated, these medications might cause diarrhea, headache, nausea, and vitamin B-12 deficiency. Chronic use might increase the risk of hip fracture. Medication to strengthen the lower esophageal sphincter may ease GERD by decreasing the frequency of relaxations of the lower esophageal sphincter. Side effects might include fatigue or nausea.
GERD can usually be controlled with medication. But if medications don’t help or you wish to avoid long-term medication use, your doctor might recommend fundoplication (where the surgeon wraps the top of your stomach around the lower esophageal sphincter, to tighten the muscle and prevent reflux), insert a LINX device (a ring of tiny magnetic beads is wrapped around the junction of the stomach and esophagus and the magnetic attraction between the beads is strong enough to keep the junction closed to refluxing acid, but weak enough to allow food to pass through), and a transoral incisionless fundoplication (a procedure that involves tightening the lower esophageal sphincter by creating a partial wrap around the lower esophagus using polypropylene fasteners).
The table below includes the most commonly used ICD-10 codes for GERD:
Author: Tonoya Ahmed