People with GERD experience chronic acid reflux. When it persists for years, it can pose a greater risk for developing precancerous esophageal lesions and esophageal cancer, says Dr. Jason Samarasena, a UCI Health interventional gastroenterologist.
Many of us will experience the uncomfortable sensation of heartburn from overindulging in rich food and drink this holiday season.
But for millions of people, heartburn — also known as acid indigestion or acid reflux — is more than an occasional nuisance.
When heartburn occurs frequently, even daily, it is an indicator of gastroesophageal reflux disease (GERD), which involves chronic exposure to stomach acids and food flowing back up the esophagus.
GERD sends more than 18 million people in search of medical help each year.
Over time, this chronic acid reflux can inflame and damage the lining of the esophagus, leading to Barrett's esophagus or esophageal cancer. Both conditions usually involve a weakened esophageal sphincter — the band of muscle connecting the esophagus to the stomach that normally prevents food, acid and stomach bile from refluxing into the esophagus.
“Between 5% and 10% of GERD sufferers can develop pre-cancerous Barrett’s esophagus,” says interventional gastroenterologist Dr. Jason Samarasena, director of advanced endoscopic imaging at the UCI Health Chao Digestive Health Institute (CDHI).
“Prolonged exposure to stomach acids can change the cellular structure of the esophageal lining, putting Barrett’s sufferers at increased risk for a type of cancer called esophageal adenocarcinoma.”
This makes managing GERD especially important, he adds.
What causes GERD?
It’s not fully understood why some people develop GERD and others don’t, says Samarasena. However, contributing factors can include:
- Asthma medications, antihistamines, pain relievers, sedatives, antidepressants and calcium channel blockers
- Obesity
- Pregnancy
- Smoking or inhaling secondhand smoke
- Delayed stomach emptying
- A hiatal hernia, which occurs when the upper part of the stomach pushes through the diaphragm
In some cases, genetics may also play a role. “I’ve seen families with generation after generation suffering from GERD,” he says.
People with GERD often experience other lesser-known symptoms, such as frequent regurgitation, hoarseness, a persistent cough and pain when swallowing. Signs of GERD may also include nausea, sour stomach, a lump in the throat, bad breath and even asthma.
Easing discomfort
Many people take over-the-counter antacids to relieve heartburn. But chronic acid reflux experienced over a long period of time should be cause for concern.
“If you’re experiencing heartburn more than three times a week for a period of five years, you should get checked by your doctor,” Samarasena advises.
This is especially true, he says, for white men over age 50 with a high body mass index (BMI) and body fat around the abdomen.
The GERD specialists at CDHI focus on controlling or eliminating symptoms, with the ultimate goal of preventing Barrett's and esophageal cancer.
This may involve stronger prescription antacid medications combined with dietary and lifestyle changes that may include:
- Losing weight, if necessary
- Eating smaller meals
- Avoiding foods and drinks that worsen symptoms — such as tomato sauce, fried and fatty foods, citrus juices, soda, caffeine, chocolate, garlic, onions, mint and alcohol, especially red wine
- Eating at least three hours before going to bed
- Sleeping with your head elevated
- Quitting smoking
Fortunately, most patients — between 75% to 80% of people with GERD — respond to medication and lifestyle changes. However, when these conservative methods no longer relieve symptoms, people should consider seeking alternative treatment.
No need to suffer
At UCI Health, patients seeking a permanent cure can choose from several incision-less treatment options using advanced endoscopy. Each procedure works by strengthening a weakened esophageal sphincter that can no longer prevent stomach contents from refluxing into the esophagus. These include:
- LINX® Reflux Management System, which involves inserting a magnetic bracelet around the esophageal sphincter to tighten it and block acid reflux.
- TIF® with EsophyX®, which positions a device within the lower esophageal sphincter muscle to create a sturdy anti-reflux valve.
- Stretta® is a procedure that uses radiofrequency energy to heat the esophageal sphincter muscles causing them to thicken and prevent reflux.
Two minimally invasive laparoscopic procedures are also available:
- Nissen fundoplication involves wrapping the upper part of the stomach around the esophageal sphincter through a few tiny incisions.
- A procedure called c-TIF combines laparoscopic hiatal hernia repair with the TIF® procedure, solving both digestive issues at the same time.
Personalized care
This array of FDA-approved alternatives allows the esophageal disease specialists at CDHI to combat GERD with a personalized approach for each patient.
“We look at your whole anatomy and individualize the treatment to your specific situation,” says Samarasena. “If we discover Barrett’s or early-stage cancer, we can take care of them as well. The earlier the conditions are treated, the better the outcome."
"Our whole team is committed to using the most advanced endoscopic and laparoscopic procedures to give our patients a better overall experience with shorter recovery times and less pain and discomfort," he adds.
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