Frequently Asked Questions

I have GERD. Are there complications that I should be aware of before considering surgery?

Complications can occur from surgery with 5-10% of patients. These include making the wrap too tight and developing problems swallowing one’s food, accidental injury to the spleen requiring removal of the spleen, post-operative hernia formation developing diarrhea, inability to burp and loosening of the wrap over time with recurrent reflux needing medication.

I have GERD. When should I consider having surgery?

There are some special circumstances where surgery may be of value for those having troublesome retrosternal burning and extraesophageal symptoms of cough, asthma, voice change and pulmonary infections inspite of a trial with at least a double dose of a proton pump inhibitor. It is important to confirm that there is increased acid present in the esophagus with a 24 hour pH test. Some people who regurgitate fluid that is very troublesome may benefit from surgery. There are some people who respond to the drugs but have side effects from the drugs, find them too expensive or simply don’t like taking medications. This group would benefit from surgery.

People who continue to have symptoms even with a twice a day dose of a proton pump inhibitor and the 24 hour ph test is normal should look to be tested for other problems as this is not in keeping with acid reflux.

What does it mean if I don’t get better with GERD medications?

The medications we use to treat acid reflux are very effective. There is a very small percentage of people who continue to experience acid reflux even with the medications. However there is a group of patients who have symptoms suggestive of reflux and yet there is no increased acid present. These patients may be refluxing bile that is produced by the liver and pancreatic secretions from the pancreas. This is a very difficult diagnosis to make.  Medical treatment of this group may also be difficult and a foam barrier and prokinetic drugs may be helpful. Sometimes more than one drug may be necessary to threat this problem.  Some people may also experience hypersensitivity of the esophagus to normal amounts of acid or contractions of the esophageal wall. This is called visceral hypersensitivitiy. Stress may be a contributing factor to esophageal visceral hypersensitivity. A certain class of antidepressants called tricyclic antidepressants which alter the way the brain perceives painful stimuli may be of value in these situations.

Do the medications for GERD cure acid reflux?

The medications are very effective to treat reflux. However they do not cure the disease. The medications work to decrease the acid production by the stomach and once you stop the drugs the stomach returns to its normal ability to make acid. The symptoms of heartburn will therefore often recur after the medication is stopped. If altering lifestyle measures do not prevent the symptoms from recurring then individuals may require medication on a long term basis. This may include using it as necessary when symptoms recur. Some individuals need medication on a daily maintenance basis.

Are the medications for GERD safe?

The proton pump inhibitors have been used for over 30 years and have an excellent safety profile. Some people may experience problems with headaches, skin rash, diarrhea, and abnormal liver function studies  but these side effects are extremely rare.  Recently, there has been some suggestion that older individuals on long-term high dose, that is twice a day, proton pump inhibitors may have an increased bone fracture rate and, therefore, should be taking a calcium and vitamin D supplement.  However this has not been substantiated.

Does having GERD for a long time put me at risk of other illnesses?

Some people may experience problems from acid reflux in areas other than the esophagus. These are called extraesophageal symptoms.  Sometimes the acid can spill over into the throat region and vocal cords and cause problems with a voice change, hoarseness, sore throat, and lump-like feeling in the throat region. 

If the acid spills into the lungs, it can cause problems with cough, asthma, or infections. These symptoms can be the primary problem of reflux and the person may not even complain of associated burning in the chest or throat region. Some people develop a condition known as Barrett's esophagus, which is severe damage to the cells lining the bottom of the esophagus. Doctors believe Barrett's esophagus may increase the chance of developing esophageal cancer.

Are there certain medical conditions associated with GERD?

Being overweight is a definite aggravating factor for reflux by increasing intrabdominal pressure.

Patients with long standing diabetes may develop decreased gastric emptying due to nerve injury to the stomach.  This can also occur after certain stomach surgeries.  Ulcers or cancers that block the stomach from emptying can cause reflux. Certain medications can contribute to reflux. Scleroderma is a rheumatological problem that can lead to reflux secondary to poor esophageal emptying and a decreased lower esophageal sphincter pressure.

I am pregnant and am suffering from GERD. Is something wrong?

It is very common during pregnancy for reflux to be a problem. The fetus increases the abdominal pressure and the hormones of pregnancy may decrease the lower esophageal sphincter pressure. Also If the stomach doesn’t empty because of a motility problem or a blockage then there is a greater risk for acid to reflux into the esophagus.

What is a hiatus hernia? Could this be causing my heartburn?

Normally the esophagus is located above the diaphragm and the stomach is below the diaphragm. The lower esophageal sphincter lies at the level of the diaphragm in between the esophagus and stomach. The diaphragm is a muscle that separates the chest from the abdomen. A hiatus hernia occurs when a portion of the stomach adjacent to the esophagus pushes up thru the diaphragm and rests above the diaphragm in the chest region. A hiatus hernia is a common occurrence and often causes no problems. Many individuals have reflux and do not have a hiatus hernia. In some individuals it may contribute to reflux. The diaphragm squeezes on the sphincter when it is normally located at the level of the diaphragm and helps to increase the pressure in this region. When the sphincter is situated above the diaphragm in the setting of a hiatus hernia the diaphragm can no longer assist the effect of the lower esophageal sphincter pressure. Also sometimes acid can be trapped in the hiatus hernia and be a reservoir for acid to more readily reflux into the esophagus.

I have a duodenal ulcer. What caused this?

The gastric or duodenal ulcer may be as a result of an infection in the stomach caused by a bacterium called Helicobacter pylori (H. pylori) or by taking aspirin or arthritis-treating medications such as non-steroidal anti-inflammatory drugs.  The most common type of therapy used to treat H. pylori now includes two antibiotics plus a PPI drug. It is important that all the pills be taken as scheduled in order to obtain the greatest chance of eliminating the bacteria.

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