Diseases 
GERD
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Gastroesophageal reflux disease (GERD) is caused by the movement of acidic stomach contents into the esophagus. Patients with this disorder suffer from a wide spectrum of symptoms including heartburn, regurgitation and dysphagia (difficulty swallowing).
Medical therapy, consisting of anti-acid medications and lifestyle modifications, results in symptomatic relief for most patients. Surgical therapy is indicated for patients in whom medicine has proven ineffective, is poorly tolerated, or is too expensive to continue. It is also indicated for complications of reflux disease such as an esophageal stricture (narrowing) and the development of pre-cancerous changes in the esophagus.
A defective LES (lower esophageal sphincter — a muscle at the junction of the esophagus and stomach) contributes to the failure of the body's natural anti-reflux mechanism.
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| Normal LES valve keeps food in stomach. | Weak LES valve allows food to wash back into esophagus. |
Diagnosis of GERD
It is important that the diagnosis and particular cause of the GERD is confirmed. The patient's history of signs and symptoms is reviewed, and tests are performed. Tests include:
- ManometryManometry involves inserting a thin tube with a sensitive probe through the nose, into the throat and esophagus. The patient is asked to swallow several times. Muscle contractions in the smooth muscle of the esophagus are analyzed at several points as the tube is slowly pulled back through the esophagus.
- pH probeA pH probe measures the amount of acid refluxed into the esophagus over 24 hours.
- An upper endoscopyIn esophagoscopy/endoscopy of the esophagus, a thin, flexible tube with a camera is inserted through the mouth into the esophagus, allowing the physician to view the interior of the esophagus and obtain small tissue samples for biopsy, if necessary. may also be necessary to look for possible areas of stricture. Biopsies (small tissue samples) can also be obtained from an endoscopy to confirm the diagnosis of esophageal inflammation and to exclude Barrett's esophagus, the transformation of esophageal cells into stomach lining cells after years of reflux.
- Other tests include an upper GI series or a barium swallow x-rayIn an upper GI series, or a barium swallow, also called barium contrast X-ray, the patient swallows a solution of barium, a compound that will appear inside the body during X-ray so the physician may observe how fluid moves through the esophagus as well as the appearance of the stomach., which can show the acid reflux and inflammation of the esophagus as well as the presence of hiatal hernia, which occurs when the upper part of the stomach moves up into the chest through a small opening in the diaphragm, often causing LES dysfunction.
Visit our Esophageal Disorders Program website to read about GERD and its treatment.
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