I preface this post with a disclaimer: I am no expert here. In fact, I’m not even a very good example. In response to the fact that it’s summer (the time of year when everyone is talking about this), the fascination with Chris Pratt’s body in Jurassic World, and a conversation I heard this past […]
GERD or gastroesophageal reflux disease aka heartburn or acid reflux plagues many people on a weekly and some on a daily basis. GERD occurs when stomach acid or, occasionally, stomach content, flows back into your food pipe (esophagus). The backwash (reflux) irritates the lining of your esophagus and causes GERD.
How is GERD diagnosed?
GERD is typically diagnosed when reflux symptoms occur at least twice a week. Diagnosis of GERD may be clinical (presentation with typical symptoms, such as heartburn); physiologic (evidence of abnormal pH levels in the distal esophagus); anatomic (evidence of esophagitis on endoscopy); or functional (clinical response to antacid medications). However, the correlation between these diagnostic approaches is relatively poor. Some patients may be asymptomatic and have serious esophageal disease or deterioration.
A recent study developed a new diagnostic score, the Gerd Q, which is based on data from primary care patients with upper gastrointestinal (GI) symptoms. The study used variables from several previous symptom scores, and used focus groups to ensure that the resulting questionnaire was easy for patients to use as a self-reported instrument. The reference standard for GERD was defined as any of the following:
•Esophageal pH of less than 4 for more than 80 minutes per day
•Evidence of esophagitis on endoscopy (inflammation of the esophagus)
•Indeterminate esophageal pH in combination with a positive response to a 14-day course of a proton pump inhibitor
•A highly abnormal symptom score
•Narrowing of the esophagus (esophageal stricture). Damage to cells in the lower esophagus from acid exposure leads to formation of scar tissue. The scar tissue narrows the food pathway, causing difficulty swallowing.
•An open sore in the esophagus (esophageal ulcer). Stomach acid can severely erode tissues in the esophagus, causing an open sore to form. The esophageal ulcer may bleed, cause pain and make swallowing difficult.
•Precancerous changes to the esophagus (Barrett’s esophagus). In Barrett’s esophagus, the tissue lining the lower esophagus changes. These changes are associated with an increased risk of esophageal cancer. The risk of cancer is low, but your doctor will likely recommend regular endoscopy exams to look for early warning signs of esophageal cancer
Bell, M. Diagnosis of Gastroesophageal Reflux Disease. Am Fam Physician. 2010 May 15;81(10):1278-1280.
Mayo Foundation for Medical Education and Research. GERD. (2014). http://www.Mayoclinic.org.