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If you have GERD, you may experience heartburn.
Gastroesophageal reflux, or GER, describes the upward movement of acidic stomach contents into your esophagus. When symptoms of GER become persistent or troublesome, or when acid reflux damages the lining of your esophagus, GER is called gastroesophageal reflux disease, or GERD. This condition is initially treated with lifestyle changes and medications, but surgery may be necessary if symptoms persist despite these measures. Your doctor will determine the most appropriate treatment approach for you.
GER symptoms are generally divided into esophageal and extra-esophageal categories. Esophageal symptoms are called "typical," while extra-esophageal symptoms may be referred to "atypical." Most people with GER complain of heartburn and acid regurgitation, which comprise the esophageal symptoms of acid reflux. However, not every episode of reflux causes esophageal symptoms. In fact, a 2003 review in "American Family Physician" reports that only 2 to 3 percent of acid reflux events are perceived by people with GERD.
More than 40 percent of Americans complain of heartburn at least once a month. But many people with GERD never have heartburn or only have it on rare occasions. Instead, they may develop extra-esophageal signs and symptoms, such as a chronic cough, chest pain, erosion of the teeth, asthma, recurrent laryngitis or a persistent sore throat. People who have such symptoms often undergo exhaustive medical evaluations before the underlying cause of their problem -- GERD -- is identified.
If your doctor suspects you have GERD, she may recommend lifestyle changes, such as weight loss and avoiding high-fat foods, caffeine, alcohol or other substances that can worsen acid reflux. Your doctor may also prescribe acid-blocking medications, such as omeprazole (Prilosec), lansoprazole (Prevacid), cimetidine (Tagamet) or ranitidine (Zantac). For most people, lifestyle changes and medications control GERD symptoms. If your symptoms persist or you develop esophageal ulcerations or other complications of GERD, surgery may be an option.
The classic surgical procedure for controlling acid reflux is fundoplication, which involves wrapping a portion of your upper stomach around your lower esophagus. Since the 1990s, most fundoplication procedures have been performed through laparoscopes. During a laparoscopic fundoplication, your surgeon will make several small incisions in your abdomen and insert a scope and surgical instruments through the incisions. Fundoplication alleviates heartburn and acid regurgitation in more than 90 percent of patients, but it is much less effective for eliminating extra-esophageal symptoms of GERD.
A May 2001 review in "The Journal of the American Medical Association" revealed that up to 20 percent of people who undergo fundoplication have postoperative complications, such as swallowing difficulties, bloating, diarrhea, nausea or inability to eat large meals. Some people still need to take acid-blocking medications after surgery. Despite these issues, patients whose symptoms are controlled tend to be satisfied with their surgery.
Several newer anti-reflux surgeries have been developed. The Stretta procedure uses radiofrequency energy to heat the junction between your stomach and esophagus. The Endocinch procedure involves placing stitches on the inside of your stomach to tighten its upper end. Both of these procedures -- and newer techniques being tested in research studies -- are "endoluminal" procedures, meaning they are performed through an endoscope that has been passed down your esophagus. All of these methods improve esophageal symptoms, and approximately 70 percent of patients are able to stop using acid-blocking medications. The long-term effectiveness and complication rates of these procedures are still being evaluated.