Question: What is GERD?
Answer: The backflow of stomach juices, including acids and
ingested foods, constitutes gastroesophageal reflux disease or GERD.
Question: What are the symptoms of GERD?
Answer: Common esophageal symptoms of GERD include repeated
of heartburn, difficulty swallowing, hoarseness, lump-in-the-throat sensation, chronic cough and
throat clearing, and mucus build-up in the throat. People can suffer from one or more of these
Question: What is the the relationship between GERD and
Answer: Sometimes, the symptoms of GERD can mimic some of the
symptoms of sinusitis. The sensation of post-nasal draining and the need
to clear your throat constantly may be due to post-nasal drainage -- but
may also be due to GERD. The sinus specialist
may therefore examine you in the office to see if there is physical evidence of GERD.
Acid reflux can sometimes actually contribute to sinusitis! That is to say, the acid can
travel all the way up to your nose and sinuses (for instance, while you are lying down asleep),
and this acid can inflame the nose and sinus linings. This problem is more common in children
-- but it may also be seen in adults.
Question: What causes GERD?
Answer: There is a one-way valve near the top of the stomach. Stomach
acid can escape through a weakened valve and travel up the esophagus -- even up to the voice
box and throat -- and produce the symptoms listed above.
Question: How do you diagnose GERD?
Answer: Heartburn is easily recognized by the family doctor. However,
some of the symptoms relating to the throat and voice box should be evaluated by a
specialist. The specialist will then perform a complete
examination including taking a look at the voice box with a small endoscope placed through the
nose. If you have GERD, your sinus specialist may ask you to also see a gastroenterologist.
Question: Are there any diagnostic tests?
Answer: A gastroenterologist may decide to order some additional tests
evaluate your GERD. A Barium swallow is a series of x-ray films that monitor dye as it
travels through the stomach. A PH monitoring test is a 24-hour test to record the back flow of
acid from the stomach into the esophagus and even the throat. A small flexible tube is placed
in the stomach through the nose and is connected to a small computer to record 24-hour acid
Endoscopy is sometimes performed to evaluate the esophagus for damage from acid burns and
the stomach for irritation and ulceration.
Question: How is GERD managed?
Answer: With lifestyle and dietary changes, with medical treatment, and
times surgical treatment.
Question: Tell me about life style and dietary changes.
Answer: Don't drink alcohol, and don't smoke. Both nicotine and
alcohol irritate the stomach and increase acid production. Also,
- Avoid clothing that is tight around the waist -- corsets, belts.
- Avoid bending over.
- Lose weight.
- Raise your head when lying down. This is best achieved NOT with pillows, but by
raising the head of the bed by 6 to 8 inches. This can be done by sliding blocks under the legs
at the head of the bed or a wedge under the head of the mattress.
Question: Tell me about dietary modifications.
Answer: You may wish to avoid coffee and tea, carbonated beverages,
alcohol, fatty fried foods, spicy food, citrus fruits and juices, tomato juice, orange juice, and
grapefruit juice, tomatoes, onions, peppermint, spearmint, chocolate, cheeses, and eggs.
Avoid large meals, especially in the evenings. Do not lie down
right after eating. Allow three to four hours after supper and lying down. Make the mid day
meal the heavier meal of the day and eat small, well-balanced meals.
Question: Tell me about medical treatment.
Answer: Medical treatment is based on neutralizing stomach acid,
reducing or eliminating stomach acid and improving gastric emptying. Neutralizing stomach
can be achieved by using over-the-counter antacids in liquid or tablet form such as Sucralfate
suspension, Maalox, and Ryopan. Reducing or eliminating stomach acids can be achieved with
H-2 blockers, which are drugs that depress acid production, such as Cimetadine (Tagamet),
Ranitidine (Zantac), or Famotidine (Pepcid). These are also now available over-the-counter at
Antacids and H-2 blockers should be taken one hour apart as antacids may reduce the other
drugs' effectiveness. New drugs like Omeprazole (Prilosec) and Nexium completely stop
stomach acid production. These drugs are generally prescribed for short-term use.
Improving gastric emptying can be undertaken by Cisapride, Metoclopromide, Bethanachol,
and other drugs. These drugs increase the squeezing action of the esophagus and tighten the
esophageal sphincter, in addition to making the stomach empty faster.
Question: Tell me about surgical treatment of GERD.
Answer: Surgical treatment is undertaken as a last resort. If the dietary
and medical treatments do not bring relief, or if the patient finds them hard to comply with, they
may be candidates for surgery. One procedure is called "fundoplication." It involves
wrapping the top of the stomach around the top of the esophagus in order to strengthen support
and prevent reflux. If possible, it is preferable to control GERD with medical treatment!