Gastroesophageal reflux disease (GERD)

Diagnosis

GERD may be diagnosed by your doctor after reviewing your medical history, signs & symptoms, and physical exam. To confirm a GERD diagnosis or to identify any complications, your physician may recommend the following measures:

• Upper endoscopy. During an endoscopy, a thin and flexible tube equipped with a camera and light is inserted through the patient’s throat to allow the healthcare provider to examine the esophagus and stomach for complications such as esophagitis or Barrett’s esophagus. Biopsy samples may be collected during the procedure for further testing. Additionally, if there is a narrowing in the esophagus causing difficulty swallowing, the healthcare provider may perform a dilation procedure to help alleviate dysphagia. Overall, the endoscopy provides a non-invasive method for examining and diagnosing gastrointestinal issues.
• Ambulatory acid (pH) probe test. To identify the occurrence and duration of stomach acid regurgitation in your esophagus, a monitor is inserted in either of two ways. It could be a flexible catheter, which is placed through your nose and threaded down to your esophagus, or a clip that is inserted through an endoscopy. The monitor is connected to a small computer that you wear around your waist or with a strap over your shoulder. The clip is passed out with your stool after around two days.
• X-ray of the upper digestive system. After you consume a chalky liquid that coats and fills the interior lining of your digestive tract, X-rays are performed. Your doctor may see a silhouette of your stomach and esophagus thanks to the covering. This is especially helpful for those who have difficulty swallowing.

Additionally, you might be instructed to take a barium pill in order to diagnose an esophageal narrowing that might impair your ability to swallow.

• Esophageal manometry. This test counts the regular muscular contractions that occur as you swallow in your esophagus. Esophageal manometry also assesses the efficiency and force of the esophageal muscles. People who have trouble swallowing frequently do this.
• Transnasal esophagoscopy. This test counts the regular muscular contractions that occur as you swallow in your esophagus. Esophageal manometry also assesses the efficiency and force of the esophageal muscles. People who have trouble swallowing frequently do this.

Treatment

Initially, your doctor may suggest making lifestyle changes and trying over-the-counter medications as a first-line treatment. If you do not notice any improvement within a few weeks, your doctor may advise undergoing further testing and taking prescription medication.

Over-the-counter medications

Treatments include:

• Antacids. Antacids containing calcium carbonate, such as Mylanta, Rolaids and Tums, neutralizes the gastric acids 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 blockers Cimetidine, famotidine, and nizatidine are examples of these drugs, also referred to as histamine (H-2) blockers. H-2 blockers do not work as rapidly as antacids to decrease production of gastric acids, but they last longer and can stop the stomach from producing acid for up to 12 hours. By prescription, stronger versions are available.
• Proton pump inhibitors. These medications are more potent acid blockers than H-2 blockers and provide the injured esophageal tissue more time to repair. Lansoprazole, omeprazole, and esomeprazole are proton pump inhibitors available without a prescription.

Tell your doctor right away if you begin taking a non-prescription GERD drug.

Prescription medications

The following are prescription-only therapies for GERD:

• Prescription-strength proton pump inhibitors.  The drugs in question are esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), rabeprazole (Aciphex), and dexlansoprazole (Dexilant). While they are generally well-received, they may lead to side effects such as diarrhea, headaches, nausea. In rare cases, they can cause low levels of vitamin B-12 or magnesium.
• Prescription-strength H-2 blockers. These include famotidine and nizatidine in prescription strength. These drugs’ side effects are often manageable and moderate.
• Baclofen. A medication available only by prescription that works to prevent the lower esophageal sphincter from relaxing and allowing acid backwash.

Surgery and other procedures

Although medication is generally effective in treating GERD, if it fails to provide relief or if you prefer to avoid long-term medication use, your doctor may suggest:

• Fundoplication. To tighten the muscle and stop reflux, the surgeon wraps the top of your stomach over the lower esophageal sphincter. Typically, a minimally invasive (laparoscopic) procedure is used to perform fundoplication. Partial or full wrapping of the upper portion of the stomach is possible (Nissen fundoplication). The Toupet fundoplication is the most widely used partial surgery. The kind that is ideal for you will be suggested by your surgeon.
• LINX device. Around the point where the stomach and esophagus converge, a ring of tiny magnetic beads is wrapped. While being weak enough to let food pass through, the magnetic attraction between the beads is strong enough to keep the junction closed to refluxing acid. A less invasive surgical procedure can be used to implant the LINX device. Magnetic resonance imaging and airport security are unaffected by the magnetic beads.
• Transoral Incisionless Fundoplication (TIF). With this new technique, the lower esophagus is partially wrapped using polypropylene fasteners to tighten the lower esophageal sphincter. There is no surgical incision necessary for TIF because it is done through the mouth using an endoscope. Its benefits include high tolerance and speedy recovery.

TIF alone is not a viable choice if you have a significant hiatal hernia. But if TIF is combined with laparoscopic hiatal hernia repair, it might be feasible.

• Weight-loss surgery: If obesity is a risk factor for your GERD, your healthcare provider may recommend weight-loss surgery as a potential treatment option. To determine your eligibility for this type of surgery, consult with your doctor.