Understanding Gastroesophageal Reflux Disease (GERD) -- Diagnosis and Treatment
How Do I Know If I Have GERD?
Your doctor may be able to diagnose gastroesophageal reflux disease, or GERD, from your description of symptoms. The doctor may also suggest tests to rule out other possible causes of your symptoms, to monitor the degree of damage, or to determine the best treatment for you.
The three main tests used when GERD is suspected or known are esophageal pH monitoring, endoscopy, and manometry. With pH monitoring, the doctor measures the amount of acid in the esophagus over a 24-48 hour period. This test is used mainly to rule out GERD if symptoms are not typical for acid reflux. It is also very helpful in identifying patients who may need surgery as a treatment for GERD.
Endoscopy uses a flexible tube with a light and video camera on the end. The tube is passed through the throat into the esophagus so the doctor can examine the esophagus for esophagitis (inflammation of the esophagus), strictures (narrowing of the esophagus, and for Barrett's esophagus (a specific, abnormal change in the lining of the esophagus). This is important to recognize because -- rarely -- Barrett's can lead to cancer of the esophagus. Endoscopy usually is not done if symptoms are mild. If they are more severe, prolonged, or do not respond to treatments, including lifestyle changes and medications, your doctor may want an endoscopy. If you have Barrett's esophagus or severe esophagitis, your doctor may suggest regular endoscopy monitoring to screen for cancer.
Manometry identifies problems with motility and valve pressure in the esophagus. This study allows doctors to measure function of the lower esophageal valve (LES). Manometry can also be helpful in evaluating GERD patients for surgery.
What Are the Treatments for GERD?
GERD is a chronic disease, and the goal of treatment is to manage it; that means reducing the amount of acid in the stomach and the amount of reflux that occurs. For mild GERD, this can sometimes be accomplished by using over-the-counter antacids and making certain lifestyle changes. If more treatment is needed, other types of drugs, either over-the-counter or prescription, are available. Treatments are also available that can be done using the endoscope. Very rarely, surgery will be needed.
Conventional Medicine for GERD
Three types of drugs are generally used to treat GERD. They are:
Antacids such as Maalox, Rolaids, and Tums
Histamine H2-blockers such as Axid, Pepcid, Tagamet, and Zantac
Proton pump inhibitors such as Aciphex, Nexium, Prevacid, Prilosec, Protonix, Kapidex, Dexilant, and Zegerid
Taking antacids when needed may be appropriate for the initial treatment of minor symptoms. H2-blockers help cut the stomach's production of acid and work best for people with mild GERD. They are available in prescription strength and over-the-counter (half) strength. For moderate or severe GERD, doctors may start with these drugs or another type of drug known as a proton pump inhibitor, which is stronger than H2-blockers. These drugs turn off the acid pumps that stimulate the production of acid from the stomach. They are all available in prescription strength, and Prilosec OTC, Prevacid 24hr, Nexium 24HR, and Zegerid OTC are available over the counter. For complicated or chronic GERD, proton pump inhibitors are often taken indefinitely. A doctor needs to be consulted if these medications are used more than occasionally, because more serious problems may be overlooked.