Gastroesophageal Reflux Disease

Gastroesophageal reflux occurs when abnormal amounts of gastric contents come up (reflux) into the esophagus. This is usually perceived as heartburn, chest discomfort, or a sense of regurgitation. Some patients have atypical symptoms leading to problems outside of the esophagus, per se. These might manifest as chronic cough, chronic sore throat or throat clearing or hoarse voice. Reflux has also been associated with poor sleeping pattern. After delving into the patients symptoms and performing a pertinent physical exam, testing may be recommended. Endoscopy (EGD) allows direct visualization of the esophagus and upper GI tract to inspect for reflux and related inflammation, assess for the presence of Barrett’s (see below) and other complications of chronic reflux, examine the anatomy for significant hiatal hernia or other abnormalities, and to see if the stomach is functioning properly. Esophageal acid analysis by measuring pH in the esophagus over 1-2 days can objectively quantify reflux. This can be done as part of an endoscopy by attaching a small battery powered wireless pH sensor in the esophagus that measures acid reflux for 48 hours then later spontaneously falls off and is harmlessly passed. Esophageal pH can also be measured with a nasal catheter ambulatory 24 hour pH probe combined with impedance testing. Esophageal impedance is a newer technology that we introduced into the community via leadership as the Director of the Swallowing Center at The Christ Hospital. This allows the addition of assessing esophageal symptoms that may be related to reflux of nonacidic gastric contents. After evaluations, an individualized treatment plan is then recommended including dietary and life style advice, medication, and occasionally surgery.

Barrett’s esophagus is a condition when the normal esophageal lining cells change into intestinal type cells as a response to chronic acid reflux. Barrett’s esophagus is a potentially precancerous condition and when diagnosed, is followed by intermittent endoscopy with directed biopsies. We can utilize a technology called Narrow Band Imaging that highlights the appearance of Barrett’s during endoscopy for focusing biopsies obtained. There is a gradation of changes that can occur that can progress to cancer. These changes are called dysplasia and when it occurs, we offer nonsurgical treatments, when appropriate including Radiofrequency Ablation and Endoscopic Mucosal Resection to remove the Barrett’s and dysplasia to prevent cancer development.