G.E.R.D. or LPR

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Date Joined Apr 2007
Total Posts : 32602
   Posted 5/26/2009 8:47 AM (GMT -6)   
1. What is GERD?

GERD stands for Gastroesophageal Reflux Disease.

Gastroesophageal reflux describes a backflow of acid from the stomach into the swallowing tube or esophagus. This acid can irritate and sometimes damage the delicate lining on the inside of the esophagus. Almost everyone experiences gastroesophageal reflux at some time. The usual symptom is heartburn, an uncomfortable burning sensation behind the breastbone, most commonly occurring after a meal. In some individuals this reflux is frequent or severe enough to cause more significant problems, that is a disease. Thus, gastroesophageal reflux disease is a clinical condition that occurs when reflux of stomach acid into the esophagus is severe enough to impact the patient’s life and/or damage the esophagus.

Dr. of choice generally  a Gastroenterologist who would perform a Esophagogastroduodenoscopy (EGD) looking at your digestive system.

2. I have never heard of GERD. Is it a new disease?

No. GERD has probably been around as long as heartburn. The term is relatively new (about 20 years), however, and has really come into common usage over the past few years. GERD is often called "reflux," "reflux esophagitis," or sometimes even "hiatus hernia" (although hiatus hernia is a specific diagnosis that may or may not have anything to do with GERD). GERD is the preferred term because it accurately describes the problem - reflux of stomach acid up into the esophagus where it can produce symptoms and sometimes damage. Many patients and health care professionals are not familiar with GERD and its potential consequences, and thus may not have heard the term previously.

3. What are some symptoms of GERD?
The four major symptoms of GERD are:
  • Heartburn (uncomfortable, rising, burning sensation behind the breastbone).
  • Regurgitation of gastric acid or sour contents into the mouth.
  • Difficult and/or painful swallowing.
  • Chest pain.
Heartburn is the most common symptom of GERD. In some patients it may be accompanied by other GERD symptoms, such as regurgitation of gastric contents into the mouth, chest pain and difficulty swallowing. Pulmonary manifestations, such as asthma, coughing, or intermittent wheezing and vocal cord inflammation with hoarseness, occur in some GERD patients.

In addition, acid can be regurgitated into the lungs in some GERD patients, causing wheezing or cough. Acid refluxed into the throat can cause sore throat. If acid reaches the mouth, it can dissolve enamel of the teeth.

4. How do people get GERD? What causes GERD?
GERD is caused by reflux of stomach acid into the esophagus. In most patients this is due to a transient relaxation of the “gate” or sphincter that keeps the lower end of the esophagus closed when a person is not swallowing food or liquids. This transient relaxation happens a few times each day in people without GERD. Why it happens more frequently in GERD patients isn’t known. The esophagus is not able to cope with acid as well as the stomach and is easily injured. It's the acid refluxing into the esophagus that produces the symptoms and potentially damages the esophagus.

5. How many people are afflicted with GERD?
Recent statistics from the US Department of Health and Human Services indicate that about seven (7) million people in the US alone suffer from GERD.

(Source: Digestive Diseases in the United States: Epidemiology and Impact, National Digestive Diseases Data Working Group, James E. Everhart, MD, MPH, Editor, US Department of Health and Human Services, Public Health Service, National Institutes of Health, NIH Publication No. 94-1447, May 1994)

6. Who is afflicted with GERD?
GERD afflicts people of every socioeconomic class, ethnic group and age. However, the incidence does seem to increase quite dramatically above the age of 40. Greater than 50 percent of those afflicted with GERD are between the ages of 45-64 (both male and female).

7. Do children get GERD?

Yes. GERD is most common in adults over age 40 but virtually anyone can get GERD, even infants.

8. What is the difference between GERD and GORD?

The British spelling of esophagus is oesophagus. Hence, GERD is GORD in many European countries.

9. What is the difference between heartburn and GERD?

GERD is a disease and heartburn is its most common symptom. Heartburn is defined as a rising, burning sensation behind the breastbone caused by reflux of stomach acid into the esophagus. Nearly everyone has or will experience heartburn on occasion. Frequent heartburn that disrupts one's lifestyle suggests the diagnosis of GERD.

10. What is the difference between GERD and a hiatus hernia?
Hiatus hernia refers to dislocation of the stomach through the "hiatus" of the diaphragm and into the chest. This is a common condition that increases in frequency with age. It may or may not be associated with GERD. When GERD is severe enough to be complicated by erosive esophagitis, seen as breaks in the lining of the esophagus, a hiatus hernia is usually present. However, most patients with a hiatus hernia do not have GERD.

11. What is endoscopy and when is it used in GERD patients?

Endoscopy is a diagnostic test wherein a thin, flexible tube is swallowed by the patient to allow the physician to directly inspect the lining of the upper gastrointestinal tract. This procedure can be used to identify complications of GERD and to take small samples (biopsies) for further analysis. GERD patients who have certain symptoms, such as difficulty in swallowing or painful swallowing, should be considered for endoscopy. Patients who fail to respond to therapy are also candidates for endoscopy. Some physicians advocate endoscopy for all patients with long-standing GERD in order to rule out Barrett's esophagus.

12. What are the complications of GERD?

Only a minority of patients develop complications of GERD. These complications include breaks in the lining of the esophagus (esophageal erosions), esophageal ulcer, and narrowing of the esophagus (esophageal stricture). In some patients, the normal esophageal lining or epithelium may be replaced with abnormal (Barrett's) epithelium. This condition (Barrett's esophagus) has been linked to cancer of the esophagus and must be carefully watched. Lung (pulmonary) aspiration, asthma and inflammation of the vocal cords or throat may also be caused by GERD.

13. What makes GERD symptoms worse?

The major factor is meals. Meals stimulate the stomach to produce more acid that can reflux up into the esophagus. In some patients, lying down or taking certain medications can worsen acid reflux.

14. Does eating spicy food cause GERD or make GERD worse?

Spicy foods do not cause GERD, although they do seem to worsen GERD symptoms in some people. Food (in general) can make GERD worse. This is because food fills the stomach and induces more transient relaxations of the lower esophageal sphincter. In addition, all meals stimulate acid production in the stomach to aid digestion and can increase reflux into the esophagus in GERD sufferers. Any very large meal might be expected to produce heartburn in some people. The spicy food story is so compelling, however, that GERD sufferers often relate a spicy (or greasy) meal to their symptoms. Often they are told to avoid certain foods whether or not these foods have anything to do with their symptoms. In this way, many GERD sufferers end up on a very restricted diet or end up blaming their symptoms on dietary indiscretion. If avoiding spicy foods and/or other dietary advice helps, that's great. If it doesn't, GERD sufferers shouldn't feel that they are doing something wrong. They should seek medical advice on managing their disease.

15. What about GERD and smoking?

Smoking doesn't cause GERD and there is little evidence that smoking significantly worsens GERD. Stopping smoking is a good idea anyway.

16. Do any medications make GERD worse?

Yes. Medicines that delay emptying of acid from the stomach or that increase acid backup into the esophagus can worsen GERD. If you have, or suspect you have, GERD and you require medication for other conditions, you should make sure you inform your doctor about all medications you are taking including prescription and over-the-counter medications.

17. What should people with GERD avoid?

GERD is a disease that is caused by gastric acid. However, certain foods can trigger symptoms in some patients. Lying down after a meal, wearing tight-fitting clothing, and even performing certain activities, such as bending over, can also trigger symptoms in patients. A good way to identify these "triggers" is to keep a diary of GERD symptoms noting when they occur. If symptoms follow a pattern and occur after certain foods or activities, these foods or activities should be avoided. A diary will also help patients continue to enjoy those foods or activities that do not seem to provoke symptoms, so that their lifestyle is not restricted unnecessarily. Patients should review their symptoms with their doctor, who can evaluate their condition and advise an appropriate treatment plan.

18. Can GERD cause cancer?

Severe, long-standing GERD can damage the esophagus and cause a condition known as Barrett's esophagus wherein the normal lining of the esophagus is replaced by a lining more like that of the stomach or intestine. It is thought that this replacement may be an attempt by the body to protect itself from further injury by acid. The risk of esophageal cancer appears to increase significantly in patients with Barrett's esophagus. The only way to diagnose Barrett's esophagus is by endoscopy. Some studies suggest that intensive treatment of Barrett's esophagus can reduce the amount of abnormal lining in the esophagus. It is not yet clear whether such treatment will prevent esophageal cancer in GERD patients, but this is under active investigation.

19. Are there long-term consequences of GERD?

Long-standing GERD can lead to damage of the esophagus. This damage usually consists of breaks in the lining of the esophagus. In some cases ulcers can develop. In some patients, such damage can result in scarring and narrowing of the esophagus, making swallowing painful or difficult. A condition called Barrett's esophagus is thought to result from long-standing GERD in some patients. Barrett's esophagus is a risk factor for the development of esophageal cancer. In some patients, acid backup caused by GERD is thought to result in damage to the vocal cords or teeth and may even cause asthma.

20. Is there relationship between GERD and asthma?

Many investigators believe that there is a link between asthma and reflux of stomach acid up into the throat and then down into the lungs in some patients. It appears that some patients who suffer from asthma might benefit from treatment of GERD. This is a topic of active research at the moment.

21. Can GERD cause inflammation of the throat?

In some patients, acid can reflux into the throat causing inflammation of the back of the throat which can lead to pharyngitis, or into the vocal cords, which can lead to laryngitis and hoarseness. Although there are many other causes for sore throat and laryngitis, GERD should be suspected in a patient with chronic sore throat or other GERD symptoms or when no other cause can be found.

22. Can GERD be cured?

Unfortunately, GERD, in general, cannot be cured at present. In some cases, it may be a temporary condition associated with a specific aggravating factor such as pregnancy. In such cases, GERD will go away on its own when the pregnancy has ended. In most cases GERD is a chronic condition. However, it can be effectively managed with medications and lifestyle modifications in almost everybody. In severe cases, surgery is an option. Surgery does not cure the underlying problem, but wraps part of the stomach around the lower end of the esophagus to help keep acid from getting back up into the esophagus. A doctor can evaluate the condition and advise on an appropriate treatment plan. Surgery for many people provides a whole new quality of life.

23. I think I have GERD. What should I do?

See your doctor. Your doctor can establish the diagnosis and work with you to get you symptom-free. Primary care and physicians of many specialties are becoming increasingly familiar with GERD. Gastroenterologists and  gastrointestinal surgeons are usually very familiar with GERD and its treatment.

24.  GERD Surgical Options: Nissen Fundoplication

The most common surgery for GERD is called Nissen fundoplication. During the surgery, the upper part of the stomach — called the fundus — is wrapped around the lower part of the esophagus to make it tighter and stronger. This prevents the stomach acids from flowing back into the esophagus.

If the patient also has a hiatal hernia, as some GERD patients do, it can be repaired during the same operation. A hiatal hernia is a condition in which part of the stomach pushes up into the chest.

25. Where can I go for more information about GERD?

If you think you might have GERD - see your doctor who can determine if you have GERD and, if so, can evaluate its severity.


Moderator: Anxiety, Osteoarthritis,
GERD/Heartburn and Heart/Cardiovascular Disease.

"She Stood in the Storm & When the Wind Did Not Blow Her Away, She Adjusted Her Sails."

Post Edited (stkitt) : 9/4/2013 9:33:27 AM (GMT-6)

Elite Member

Date Joined Apr 2007
Total Posts : 32602
   Posted 5/13/2012 3:36 PM (GMT -6)   
Laryngopharyngeal reflux (LPR) is similar to another condition -- GERD -- that results from the contents of the stomach backing up (reflux). But the symptoms of LPR are often different than those typical of gastroesophageal reflux disease (GERD).

With laryngopharyngeal reflux, you may not have the classic symptoms of GERD, such as a burning sensation in your lower chest (heartburn). That's why it can be hard to diagnose and is sometimes called silent reflux.

Dr. of choice - an  ENT who may use the Laryngoscope to  check out the vocal cords for reflux damage, nodules or lesions.

Causes of Laryngopharyngeal Reflux

At either end of your esophagus is a ring of muscle (sphincter). Normally, these sphincters keep the contents of your stomach where they belong -- in your stomach. But with laryngopharyngeal reflux, the sphincters don't work right. Stomach acid backs up into the back of your throat (pharynx) or voice box (larynx), or even into the back of your nasal airway. It can cause inflammation in areas that are not protected against gastric acid exposure.

Silent reflux is common in infants because their sphincters are undeveloped, they have a shorter esophagus, and they lie down much of the time. The cause in adults may not be known.

Symptoms of Laryngopharyngeal Reflux

Symptoms in infants and children may include:

  • Hoarseness
  • "Barking" or chronic cough
  • Reactive airway disease (asthma)
  • Noisy breathing or pauses in breathing (apnea)
  • Trouble feeding, spitting up, or inhaling food
  • Trouble gaining weight

With laryngopharyngeal reflux, adults may have heartburn or a bitter taste or burning sensation in the back of the throat. But they are less likely to have such classic signs of GERD. More often, symptoms in adults are vague and may be easily confused with other problems. The most common symptoms include:

  • Excessive throat clearing
  • Persistent cough
  • Hoarseness
  • A "lump" in the throat that doesn't go away with repeated swallowing

Other symptoms include:

  • A sensation of postnasal drip or excess throat mucus
  • Trouble swallowing
  • Trouble breathing
  • Sore throat

Complications of Laryngopharyngeal Reflux

Stomach acid that pools in the throat and larynx can cause long-term irritation and damage. Without treatment, it can be serious.

In infants and children, laryngopharyngeal reflux can cause:

  • Narrowing of the area below the vocal cords
  • Contact ulcers
  • Recurrent ear infections from problems with Eustachian tube function
  • Lasting buildup of middle ear fluid

In adults, silent reflux can scar the throat and voice box. It can also increase risk for cancer in the area, affect the lungs, and may irritate conditions such as asthma, emphysema, or bronchitis.

Diagnosis of Laryngopharyngeal Reflux

Although silent reflux is harder to diagnose than GERD, a doctor can diagnose it through a combination of a medical history, physical exam, and one or more tests. Tests may include:

  • An endoscopic exam, an office procedure that involves viewing the throat and vocal cords with a flexible or rigid viewing instrument.
  • pH monitoring, which involves placing a small catheter through the nose and into the throat and esophagus. Here, sensors detect acid and a small computer worn at the waist records findings during a 24-hour period.

Silent reflux treatment for adults may include these home care steps:

  • Lose weight, if needed.
  • Quit smoking, if you are a smoker.
  • Avoid alcohol.
  • Restrict chocolate, mints, fats, citrus fruits, carbonated beverages, spicy or tomato-based products, red wine, and caffeine.
  • Stop eating at least three hours before going to bed.
  • Elevate the head of the bed about 4 to 6 inches.
  • Avoid wearing tight-fitting clothes around the waist.
  • Try chewing gum to increase saliva and neutralize acid.

You may also need to take one or more types of medicine such as:

  • Proton pump inhibitors (such as Prilosec, Prevacid, Aciphex, Protonix, Zegerid, Kapidex, or Nexium) to reduce gastric acid
  • H2 blockers (Axid, Pepcid, Tagamet, or Zantac) to reduce gastric acid
  • Prokinetic agents to increase the forward movement of the GI tract and increase the pressure of the lower esophageal sphincter. These medications are not as commonly used because they have been linked to adverse effects on heart rhythm and diarrhea.
  • Sucralfate to protect injured mucous membranes
  • Antacids to help neutralize acid. This is more to help with symptoms of heartburn.

Some people respond well to self-care and medical management. However, others need more aggressive and lengthy treatment. If this is not effective or if symptoms recur, your doctor may suggest surgery.

Fundoplication is a type of surgery which involves wrapping the upper part of the stomach around the lower esophagus to create a stronger valve between the esophagus and stomach. It is usually done laparoscopically, with small surgical incisions and use of small surgical equipment and a laparoscopic to help them see inside. Fundoplication can also be done as a traditional open surgery with large incision.

Reference:   WebMD : http://www.webmd.com/heartburn-gerd/laryngopharyngeal-reflux-silent-reflux

The information is this article is not intended as a substitute for consulting with your physician. All matters regarding your physical health require medical supervision.

Moderator: Anxiety, Osteoarthritis,
GERD/Heartburn and Heart/Cardiovascular Disease.

"She Stood in the Storm & When the Wind Did Not Blow Her Away, She Adjusted Her Sails."

Post Edited (stkitt) : 9/4/2013 9:32:04 AM (GMT-6)

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