Conditions and Treatment

Esophagus

GERD or Heartburn | Hiatal Hernia | Barrett’s Esophagus

The esophagus is a long muscular tube that helps to push food that you have swallowed down to your stomach using muscular action.

GERD or Heartburn
Gastroesophageal reflux disease (GERD) is a common health problem that affects many people. You may or may not experience symptoms. Some symptoms of GERD include heartburn, a burning sensation in your chest, sour taste in your mouth, chronic cough, or frequent burping. Often symptoms are worse when you lie down or shortly after a meal, especially if you overeat. GERD occurs when the muscle that blocks the opening of the esophagus into the stomach is weakened. This weakened muscle allows stomach acids and digestive juices to travel back up your esophagus. Acid can cause irritations of your esophagus and the discomfort you experience with GERD.

Some changes that you can make to reduce the symptoms of GERD are losing weight, eating smaller meals, eliminating tobacco and alcohol, avoiding caffeine and peppermint, and any other food that worsens your symptoms. You should also raise the head of your bed by 6-8" to prevent reflux at night while you are sleeping. Your physician may also prescribe medications to help control the acid production in your stomach.

Longstanding uncontrolled reflux can cause other problems including ulcers in the esophagus, difficulty swallowing, and a precancerous condition called Barrett's esophagus (see Barrett's). Anyone with persistent reflux symptoms uncontrolled with medication or lifestyle changes should consider being seen by a gastroenterologist. An upper endoscopy can be performed to determine how much irritation there is and to rule out Barrett's esophagus (see EGD). Rarely, surgery is needed to help strengthen the muscle in the lower esophagus to prevent reflux.

Hiatal Hernia
The esophagus, which is a muscular tube that extends from the mouth to the stomach, normally enters the stomach through a small hole in the diaphragm. The diaphragm is a muscle that separates the stomach from the chest and helps to keep the stomach in place. It also helps to prevent the reflux of food and acid from the stomach back up into the esophagus. Obesity, coughing, vomiting, straining, or sudden physical exertion can cause increased pressure in the abdomen, which allows the upper portion of the stomach to slide up into the chest cavity through the hole in the diaphragm. The portion of the stomach that is now located above the diaphragm is known as a hiatal hernia. Food and acid can accumulate in this hernia "sac" and easily reflux into the esophagus causing heartburn and irritation of the esophagus.

Many otherwise healthy people have small hiatal hernias and have symptoms. People who do have reflux symptoms can control these with diet and lifestyle changes including weight loss, small meals, and abstinence from tobacco, alcohol, caffeine, and peppermint. Symptoms can also be relieved with different medications that cut down on the acid that is produced in the stomach. People with persistent reflux symptoms or a large hiatal hernia in danger of becoming strangulated (twisted in a way that cuts off the blood supply) usually require surgery. This surgery is known as a "fundoplication" can often be performed laparoscopically and involves wrapping part of the stomach around the end of the esophagus to prevent movement into the chest. After surgery, people either have no reflux symptoms or are able to manage their symptoms with low dose medications.

Barrett’s Esophagus
If you have Barrett's esophagus, part of the lining of the esophagus near the stomach has changed. This change is caused by the acid reflux that occurs with GERD.

The stomach is protected from its own acid by a special lining. Stomach acid normally stays out of the esophagus. So the esophagus doesn't need an acid-resistant lining. If acid backs up during GERD, it damages the esophagus. To protect itself, the esophagus may develop a more acid-resistant lining. This is Barrett's esophagus. The changes lining is not normal. If the lining continues to change, it may be more likely to become cancer in the future.

GERD (gastroesophageal reflux disease) is stomach acid backing up into the esophagus. The esophagus is the tube that carries food and liquid from your mouth to your stomach. Acids in the stomach help break down and digest the food. Normally, the sphincter muscle keeps stomach acid from flowing back into the esophagus. If this muscle is weakened, GERD may occur.

You may have GERD and feel no symptoms. Or you may have symptoms such as:

Heartburn
Sour-tasting fluid backing up into your mouth
Frequent burping or belching
Symptoms that get worse after you eat, bend over, or lie down

The muscle can be weakened by smoking, excess body weight, certain medications or foods, and some types of medical problems, such as a hiatal hernia.

Barrett's esophagus is often found when a test for another problem is done. An exam for Barrett's may also be one if your GERD symptoms are severe. The best way to diagnose Barrett's is with a test called endoscopy. This test lets your doctor look into your esophagus.

Endoscopy is an exam of your digestive tract. During the exam, an endoscope (a narrow tube containing a light and a small camera) is used. It is placed through your mouth into your esophagus. Then it is moved to the lower part of your esophagus, where Barrett's is usually found. This area is examined closely. Some tiny samples of tissue are taken. The samples can be examined later for signs of cancer. Your doctor may give you instructions on how to prepare for an endoscopy. Follow them carefully.

To keep track of the changes in your esophagus, your doctor may suggest regular tests. He or she may also suggest ways for you to control GERD. This should help keep your Barrett's from getting worse.

Some changes in your lifestyle can help control your GERD. Your doctor may recommend:

Losing weight
Avoiding foods and drinks that make GERD worse, such as high-fat foods and chocolate
Avoiding alcohol and tobacco
Raising the head of your bed on 6" blocks

Your doctor may prescribe medications to help control your GERD. Your health care provider or pharmacist can also tell you which medications may make GERD worse.

Surgery can help treat reflux that doesn't get better with treatment. It can also help treat cancer. Your doctor can give you more information.

Stay in touch with your doctor and keep your appointments. Get checkups as often as your doctor suggests. This may include an endoscopy every 2 years. Regular exams help catch any signs of cancer early, when it is easier to treat.