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An Update on GERD

You may get the feeling right after a heavy or spicy dinner. You may keep a roll of antacids at your desk, in your car, or they are right now in your pocket. You have heartburn. What you may not know is that talking to your doctor about this common condition may save your life.

Heartburn, or Gastroesophageal Reflux Disease (GERD) affects 20% of all adults and is usually caused by acid from the stomach refluxing into the esophagus. Up to 50% of patients with GERD can have damage to the lining of their esophagus. Over time, continuous injury to the esophagus can cause a reaction leading to cell mutation. These transformed cells are at risk for turning into cancer. So all of a sudden that annoying sensation has turned into much more.

The appropriate initial medical treatment of GERD in most cases is to place a patient on a medication called a proton-pump-inhibitor (PPI). These extremely effective medications essentially turn off the acid producing mechanisms of the stomach. Your doctor should prescribe these medications and you should feel relief within a month or so. If relief does not come, your doctor may need to do further investigation. Most likely, he will recommend an upper endoscopy to examine the lining of your esophagus and stomach.

If you are a patient who does not respond to medications to control your heartburn, your doctor will want to perform an endoscopy to look for ulcers or evidence of Barrett’s esophagus. Barrett’s esophagus occurs when the lining of the feeding tube changes into a pre-cancerous form. If your doctor sees this kind of tissue, a biopsy will be taken to determine future steps. Usually, you and your doctor can take a “watch and wait” approach and undergo another endoscopy in a few months.

New techniques are being developed for the treatment of GERD for patients who do not respond to medicines. These include radiofrequency ablation to the muscle, which keeps food from passing backwards from the stomach to the esophagus. Other treatments include endoscopic surgery to create a fold or plication or the injection of a polymer into the tissue to prevent acid from damaging the esophagus.

No one treatment for heartburn has proved to be a cure-all for every patient. Instead, you and your doctor should take an individualized approach to your problem. But the future of treating GERD is bright, so if you’ve just finished that antacid roll, consider talking to your doctor about your symptoms before you buy your next one.

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