Gastroesophageal reflux occurs when contents in the stomach flow back into the esophagus. This happens when the muscle between the stomach and the esophagus is weakened or when there is a hiatal hernia, where part of the stomach is displaced into the chest.
Common symptoms include heartburn, a burning sensation felt behind the breast bone and acid regurgitation, a sensation of gastric fluid coming up into the mouth. Less common symptoms include chest pain, wheezing, sore throat and dry cough, among others.
Obesity, pregnancy, smoking, caffeine, excess alcohol use and consumption of a variety of foods may also contribute to reflux symptoms.
When the symptoms are common, additional tests prior to starting treatment are unnecessary. However, when there is no response to treatment or if other symptoms such as weight loss, trouble swallowing or bleeding are present, additional testing become necessary.
Lifestyle modifications help decrease the symptoms of reflux. Avoiding some dietary items like coffee, citrus drinks, tomato based products, chocolate, peppermint and fatty foods may reduce the patient’s discomfort. Having an early dinner and propping up the head of the bed at night are also helpful.
When symptoms persist, antacids help decrease the discomfort but only work for a short time. Histamine H2 receptor antagonists like ranitidine decrease acid production in the stomach and work well for treating mild reflux symptoms. Proton pump inhibitors (omeprazole, lansoprazole, pantoprazole, esomeprazole, and rabeprazole) are all highly effective and are typically taken once or twice daily prior to meals.
Surgery should be considered in patients with well-documented reflux disease who cannot tolerate medications or continue to have regurgitation despite therapy. The surgery is known as fundoplication whereby a hiatal hernia, if present, is eliminated and part of the stomach is wrapped around the lower end of the esophagus to strengthen the barrier between the esophagus and the stomach.