Diagnostics

How is GERD diagnosed? There are multiple methods used to determine whether a person has GERD or not. If symptoms become worse/frequent enough, and a person seeks medical attention to figure out what is going on, the provider will likely choose one or multiple of the following exams.

pH testing can be done with a catheter placed through the nose and into the catheter. This is typically left in place for 24 hours and records the pH into a portable computer device which would be kept on the person for the examination period. As we know stomach pH is more acidic than the pH in our esophagus, this can provide information about the presence of acid in the esophagus and how often it is refluxing.

X-rays are another way of obtaining a visual of the anatomy in the digestive tract. This is usually done with a liquid substance (barium) which the patient drinks before the x-ray. The barium coats the GI tract and creates a more distinct visual when the x-ray is performed. This will provide anatomical information and could help determine if the GERD is being caused by a hiatal hernia, for example.

Another common exam is an endoscopy, this is when the doctor views the inside of the esophagus and stomach with a camera attached to a small tube. The tube is inserted into the throat and down the esophagus to search for any abnormal/inflamed tissue and/or problems with the sphincter. If problem areas are identified, this procedure allows for an opportunity to take a biopsy (extraction of a small portion of tissue) to test for disease.

Based on the results from these exams the provider can make a more accurate diagnosis and determine the best treatment option.


A brief overview of what an endoscopy procedure looks like:

What causes GERD?

Etiology is the term used for causes of a disease process. We know that GERD results from gastric reflux into the esophagus, but there are several ways this can occur.

The esophageal sphincter, a ring like muscle, which normally prevents back-flow of content from the stomach may be defective. When this is unable to adequately seal the opening, the esophagus is at risk for being exposed to acid.

Hiatal hernias can also cause GERD. This is when a portion of the stomach slips up through the diaphragm (a large muscle separating the chest and abdominal cavities). The stomach is then overwhelming the esophagus and exposes the area to gastric content.

 Pregnancy can cause GERD as well. If we simply consider the changes in anatomy during pregnancy it is easy to understand why this would occur. As the fetus grows and the woman's belly enlarges, the abdomen and chest are being squished and may place pressure on the stomach, causing acid reflux.

Other causes may include a variety of medications, obesity, alcohol, and smoking.

GERD is the progressed form of frequent heart burn. So if a person has GERD it's a chronic problem that can lead to further, more serious problems. If not controlled well, GERD can cause ulcers in the esophagus, if these are bad enough they may increase the risk of esophageal cancers. With the presence of ulcers and tissue trauma comes the risk of infection as well.








References:

1. Gastroesophageal Reflux Disease. (2015, April 9). Retrieved April 16, 2015, from http://www.nlm.nih.gov/medlineplus/ency/article/000265.htm

Who is effected? Where is it common?

Epidemiology is a branch of medical science which focuses on the populations and regions effected by specific diseases. We will look into the epidemiology of GERD. There are two important terms to understand when identifying epidemiological data; prevalence and incidence. Prevalence is the proportion of a given population which are positive for the condition, in this case GERD. It may be helpful to think of this as a fraction or percentage. Incidence is the number of newly identified occurrences in a given time period. If 100 people were being evaluated for GERD over a two year period and 25 of them were positive for GERD at the end of two years, the incidence would be 25%.

In the US, the prevalence of GERD is 10-20% of the population. Although all ages and races are at risk, the greatest concentration of GERD occurs in the age range of 50-70 year olds. This will likely increase the prevalence of GERD as this age range is the fastest growing and life expectancy continues to prolong (1). East Asia holds the lowest rate of prevalence (2.5-7.8%), with all other nations falling in the range of approximately 10-30%. (2)

It is difficult to capture an accurate prevalence of GERD, as this disease is often self-treated by patients with over the counter medication, unless it progresses to a level requiring medical attention. In comparison to heart attacks or cancer, which are more frequently reported as they require emergent medical attention or the inability to self-treat is obvious.




References:

1. Gastroesophageal Reflex Disease (GERD). Upper GI and General Surgery. Retrieved from http://www.surgery.usc.edu/uppergi-general/gastroesophagealrefluxdisease-epidemiologypathophysiology.html

2. El-Seraq HB., & Sweet S., & Winchester CC., & Dent J. (June 13, 2013). Update on the epidemiology of gastro-esophageal reflux disease: a systemic review. PubMed. Retreived from http://www.ncbi.nlm.nih.gov/pubmed/23853213

What is this?

Let's get gerdy. GERD is an acronym for a long title of disease which hurts your esophagus - that food tube in your throat, the thing that food goes down when you swallow, or back up when you vomit. If you must know the entire word sequence of the acronym, it's GastroEsophageal Reflux Disease.

Let's break this down a bit, gastro refers to your stomach, which is highly acidic (think lemons and vinegar). In connection we have esophageal, simply stating that the gastric acid is refluxing (backflowing) into the esophagus. You have muscles surrounding the end of the esophagus forming a sphincter, typically this prevents backflow, but not always.When it fails the tissue lining your esophagus is exposed to acid, ouch! Only your stomach's special tissue lining can handle that. Most of us have experienced gastric reflux; recall that burning feeling after throwing up? Exactly. When someone has the unfortunate case of frequent recurrence of this problem we call it GERD and their esophagus tissue becomes injured and this can cause pain, bleeding, ulcers, and increased risk for infection and cancer.

This disease process is quite common and can occur in all ages and types of people. Fortunately it can be treated and usually kept in control if treatment begins early. Medications are commonly used for maintenance therapy. Though depending on how severe the disease has progressed, GERD may cause enough damage to require surgery.

Some ways to prevent GERD from affecting you could include some of these lifestyle modifications:
healthy body weight, limit spicy, acidic, fatty, carbonated, and caffeinated foods, eat small meals, do not lie down after eating, quit smoking, and limit alcohol intake.

References:

1.     Clinic, M. (2015, January 1). Diseases and Conditions GERD. Retrieved April 1, 2015, from http://www.mayoclinic.org/diseases-conditions/gerd/basics/symptoms/con-20025201

2.     Gastroesophageal Reflux Disease. (2014, January 1). Retrieved April 2, 2015, from http://www.sts.org/patient-information/esophageal-surgery/gastroesophageal-reflux-disease#2

3.     Thompson Jr., D. (2015, January 1). 10 Ways to Prevent GERD. Retrieved April 3, 2015, from http://www.everydayhealth.com/gerd/preventing.aspx