Gastroesophageal Reflux Diseas: Diagnosis and Treatment

Diagnosis

• The initial assessment will include a thorough history and physical examination. It is important to note the characteristics of the heartburn pain, in order to distinguish it from heart disease.
  
  The pain associated with reflux is of a burning quality and may also be felt in the back. It usually occurs within 30 minutes after eating specific foods, is often worsened by lying down, and is relieved by antacids. Unlike cardiac chest pain, the symptoms of reflux are not related to exertion and are not associated with shortness of breath, nausea, sweating, or pain in the arms or jaw.
• If cardiac disease is possible, diagnostic testing may be necessary, including an EKG and blood testing for cardiac enzymes
• Most cases of GERD can be diagnosed by symptoms alone. Doctors will also often try a “therapeutic challenge” using an antacid medication, such as omeprazole. If the medication cures the symptoms, then GERD is diagnosed.
• Further tests for diagnosis may include esophageal manometry, which evaluates the function of the esophageal sphincter, or pH monitoring, which measures the acidity of the fluid in the esophagus.
• In advanced cases, endoscopy may be necessary to examine the esophagus and stomach. Biopsies can also be done during endoscopy to rule out cancer.

Treatment

• Lifestyle modification is the initial therapy for most cases. Along with weight loss, this may include dietary changes to eliminate or minimize predisposing agents, such as alcohol, caffeine, chocolate, peppermint, spicy foods, fatty foods, and other dietary triggers, and avoiding eating within two to four hours of bedtime.
  
  Other modifications include smoking cessation, avoiding lying down after eating, elevating the head of the bed by six to eight inches, avoiding tight–fitting clothing that may increase intra–abdominal pressure, and eliminating medications that decrease esophageal sphincter tone (e.g., calcium channel blockers).
  
  In addition, stress–reduction techniques (i.e., relaxation training) may reduce symptoms.
• If the above measures fail, medications are usually effective for symptomatic relief. Oral antacids (e.g., Tums) or H2 receptor blockers (e.g., cimetidine, ranitidine) are the most common.
• Stronger medicines, called proton pump inhibitors (e.g., omeprazole), are generally reserved for severe or recurrent symptoms.
  
• Severe reflux may require surgery to improve the function of the esophageal sphincter.