Jan. 28, 2008 A recent study from the Agency for Healthcare Research and Quality shows that hospitalizations for disorders caused by gastroesophageal reflux disease or GERD rose 103 percent between 1998 and 2005. Also, hospitalizations for patients who had milder forms of GERD (in addition to the condition for which they were admitted), rose by 216 percent during the same time period. The numbers underscore the importance of seeing a physician if symptoms suggestive of GERD are present.
Gastroesophageal reflux is a normal physiologic event, which occurs in all individuals. When this occurs frequently, however, and an individual develops recurrent symptoms and/or complications, then this is considered gastroesophageal reflux disease (GERD). It is estimated that GERD affects up to 30 million people in the U.S., with 10 percent of those individuals experiencing symptoms on a daily basis.
"If you suspect you or a loved one may have GERD, the first step is to consult your healthcare provider or a gastrointestinal specialist to obtain an accurate diagnosis," said Grace H. Elta, MD, FASGE, president of the American Society for Gastrointestinal Endoscopy (ASGE). "GERD is very common. Classic symptoms include heartburn and regurgitation. Work in partnership with your physician to initiate the best available treatment plan and avoid emergency trips to the hospital."
The study suggests that one of the factors leading to the increase in GERD hospitalizations may be the obesity epidemic, since obesity has been linked to GERD. The study also notes that across age groups, the elderly accounted for roughly 30 percent of hospitalizations with a primary GERD diagnosis, and 50 percent of all GERD diagnoses in both 1998 and 2005. The largest increase in discharges with any primary or secondary GERD diagnosis between 1998 and 2005 was for patients age 18 to 34, increasing at a rate of 273 percent. This age group, however, also had the steepest decline in primary GERD diagnosis, down 16 percent. GERD hospital stays occurred more among women than men.
The most typical symptoms of GERD are heartburn and regurgitation. Contents of the stomach, including acid, reflux (move back up) into the esophagus, which may result in uncomfortable symptoms as well as damage to the lining of the esophagus. Individuals with these symptoms are straightforward in their diagnosis. Symptoms, however, may be varied, including, but not limited to: chest discomfort (often difficult to discern from cardiac-related pain), asthma, cough, nausea, bad breath and loss of tooth enamel.
Complications of acid reflux can include dysphagia (difficulty swallowing), regurgitation, and an increased risk of esophageal cancer. This is due to progressive damage to the esophagus, resulting in inflammation, ulceration and possible scarring with narrowing. In addition, these symptoms may be indicative of esophageal cancer. All of these symptoms merit seeing a doctor for further care. At that time, the physician may perform an upper endoscopy to evaluate the source of the problem.
In some cases, individuals can alter their diet and take over-the-counter antacids to reduce symptoms. Dietary changes include avoiding acidic foods, fat-laden foods and overeating. Specific foods, such as chocolate, peppermints and tomato products, can exacerbate symptoms. Other lifestyle measures, such as losing weight, reducing or eliminating smoking and alcohol consumption, not eating late at night and elevating the head of the bed, may be helpful as well. Obesity is strongly associated with both GERD and its complications.
Some individuals may be on medications that promote acid reflux, such as calcium channel blockers and nitrates. These medications, however, should not be stopped by the patient without consultation from their doctor.
For individuals who do not have adequate symptom improvement with lifestyle alterations, medications may be necessary. These include histamine2-receptor antagonists (H2RAs), proton pump inhibitors (PPIs) and prokinetic agents. Although H2RAs and PPIs are available over the counter, patients who have frequent GERD symptoms or use these OTC medications regularly should see a physician.
Surgical therapy is available for those who do not respond to lifestyle and medication therapy or who do not wish to remain on medications. Surgery consists of wrapping the top of the stomach to reform the natural acid barrier and fixing the defect in the diaphragm and hiatal hernia if present. Surgical therapy is --at least over the short term -- equivalent to medical therapy. The decision of medical versus surgical therapy depends on how well the patient would tolerate surgery, their response to medical therapy and the underlying causes of the GERD. In addition, there are several endoscopic treatments for GERD. However, these are still relatively new and, for the most part, unproven or still investigational.
Do you have GERD?
If you can answer "yes" to two or more of the following questions, you may have GERD.
Do you frequently have one or more of the following?
- An uncomfortable feeling behind the breastbone that seems to be moving upward from the stomach?
- A burning sensation in the back of your throat?
- A bitter acid taste in your mouth?
- Do you often experience these problems after meals?
- Do you experience heartburn or acid indigestion two or more times per week?
- Do you find that antacids only provide temporary relief from your symptoms?
- Are you taking prescription medication to treat heartburn, but still having symptoms?
Seek diagnosis and treatment if symptoms occur on a regular basis. Your GI specialist can help you enjoy every day by defining your discomfort and providing treatment designed for you.
Endoscopy is performed by specially-trained physicians called endoscopists using the most current technology to diagnose and treat diseases of the gastrointestinal tract. Using flexible, thin tubes called endoscopes, endoscopists are able to access the human digestive tract without incisions via natural orifices. Endoscopes are designed with high-intensity lighting and fitted with precision devices that allow viewing and treatment of the gastrointestinal system. In many cases, screening or treatment of conditions can be delivered via the endoscope without the need for further sedation, treatment or hospital stay.
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