The most common problem with the esophagus is gastroesophageal reflux disease (GERD).
Gastroesophageal reflux disease (GERD) occurs when the lower esophageal sphincter, which acts as a valve between the esophagus and stomach, becomes weak or relaxes, causing stomach contents to rise up. The most common problem with the esophagus is GERD, which can cause damage to the esophagus over time.
Anyone, including infants and children, can have GERD. If not treated, it can lead to more serious health problems, including the risk of developing cancer of the esophagus. If you have had symptoms of GERD and have been using antacids or other over-the-counter reflux medications for more than two weeks, see your healthcare provider.
Diagnosis
Patients with GERD need a full evaluation of their esophageal anatomy and function. The work-up for GERD typically begins with an upper endoscopy, in which the lining of the esophagus can be evaluated and biopsied to determine if any premalignant changes have occurred (Barrett’s esophagus). A hiatal hernia may also be detected during this procedure. Hiatal hernias and other structural variations may be further evaluated by an upper GI barium swallow exam, which will allow the esophagus and stomach to be visualized on an X-ray. The function of the esophageal muscles should also be evaluated by a manometry test, which measures the pressures in the esophagus during swallowing.
The diagnosis and severity of GERD is finally confirmed with a 24-hour pH test. This is accomplished either by placing a small tube into the esophagus which protrudes from the nose or an implantable device that eventually passes out through the GI tract. Information regarding acid exposure to the lower esophagus is recorded and may be analyzed to generate a score (DeMeester score) that describes the severity of GERD.
Treatment
GERD is initially managed medically using H2 blockers or proton pump inhibitors, as well as lifestyle modifications. Many people can improve their symptoms by:
- Avoiding alcohol and spicy, fatty or acidic foods that trigger heartburn
- Eating smaller meals
- Not eating close to bedtime
- Losing weight if needed
Both H2 blockers and proton pump inhibitors (PPIs) relieve symptoms of acid reflux or gastroesophageal reflux disease (GERD). H2 blockers include:
- Famotidine (Pepcid AC, Pepcid Oral)
- Cimetidine (Tagamet, Tagamet HB)
- Ranitidine (Zantac, Zantac 75, Zantac Efferdose, Zantac injection, and Zantac Syrup)
- Nizatidine Capsules (Axid AR, Axid Capsules, Nizatidine Capsules)
Proton pump inhibitors (PPIs) are:
- Omeprazole (Prilosec), also available over-the-counter (without a prescription)
- Esomeprazole (Nexium)
- Lansoprazole (Prevacid)
- Rabeprazole (AcipHex)
- Pantoprazole (Protonix)
- Dexlansoprazole (Kapidex)
When a person cannot manage severe GERD symptoms through medication or lifestyle changes or if tests show premalignant damage to the esophagus (Barrett’s esophagus), your doctor will likely recommend surgery.
Why Ohio State?
At The Ohio State University Wexner Medical Center, we offer a variety of advanced procedures and personalized treatment. We are leaders in the field of endoluminal, incisionless fundoplication and have performed over 500 laproscopic antireflux operations; laparoscopic repair has been the standard here for fifteen years. We were the first center in the U.S. to perform the Esophyx and thus have the longest experience of any American center for this type of treatment for GERD.
Also, in accordance with the American College of Physicians (ACP), American Gastroenterological Association (AGA) and American Association for the Study of Liver Disease (AASLD) we have developed a “fast-track” methodology to coordinate care for patients with gastroesophageal reflux disease, chronic diarrhea, rectal bleeding, abdominal pain, Hepatitis C and abnormal liver function tests.