Heartburn (burning sensation behind the breastbone), acid reflux (presence of the gastric acid content in the esophagus) and GERD - gastroesophageal reflux dissease are different terms that describe a condition in which the gastric acidic content leaves the stomach and travels back into esophagus causing discomfort. Find more about the mechanism of reflux here.
What is heartburn, reflux and GERD?
GERD in obese patients versus normal weight patients.
It is not uncommon that patients who suffer from obesity to also complain about GERD symptoms. GERD it's considered to be one of the complications of obesity. However, the normal weight population can also be affected by GERD. While for both categories of patients the medical treatment of GERD is basically the same (dietary modification, antacid medication, endoscopic surveillance), reducing the body weight in the normal range for the obese patients is essential for their symptom resolution. Therefore, the weight loss surgery is recommended for obese patients with GERD while antireflux surgical procedures without weight loss component are suitable for normal weight patients who suffer from intractable GERD. Regardless of the medical or surgical approach, all these patients should have regular endoscopic surveillance done by an experienced endoscopist in order to assess the progression of the pathologic changes.
Reflux and heartburn after sleeve gastrectomy.
Some patients may suffer from reflux symptoms after sleeve gastrectomy. Normally these symptoms should subside with the weight loss after the surgery. Avoiding smoking, late night eating, fatty or fried food, alcohol, coffee, continuing to exercise to maintain weight loss combined with antacid medication could successfully control the reflux in these patients. However, in a small proportion of patients GERD could become a chronic problem and lead to esophagitis and Barrett s esophagus. It is important to diagnose this condition early and proceed with adequate treatment. Antireflux procedures, repair of hiatal hernia and gastric bypass are some of the procedures used to treat these conditions.
What is Barretts Esophagus ?
Barrett's esophagus is an abnormal condition that often results as a complication of reflux disease. In Barrett's esophagus, the normal tissue lining the junction between the esophagus and stomach changes to tissue that resembles the lining of the intestine. This is a potentially harmful condition if not diagnosed in time and left untreated, as it may progress to cancer of the esophagus. Click here to watch a short video describing this problem.
Which GERD Patients Should be Screened for Barrett's Esophagus?
Hiatal hernia and GERD
Hiatal hernia is usually associated with acid reflux. Hiatal hernia is a condition in which more or less of the upper part of the stomach is displaced in the chest instead of being contained in the abdomen below the diaphragm. The diaphragm is a thin muscle that separates the thoracic cavity from the abdominal cavity. A special type of hiatal hernia may occur in patients that had sleeve gastrectomy when the upper part of the sleeve slides in the chest. It is important to see your doctor in order to diagnose and fix any of these conditions as they can be the cause of unpleasant symptoms and they could progress to more severe conditions. Endoscopy, pH Bravo study, manometry and x-ray imaging are some of the diagnostic methods that are useful to diagnose hiatal hernia.
How is GERD diagnosed?
Endoscopic surveillance.
Bravo capsule pH study.
Esophageal manometry.
BRAVO pH study
BRAVO pH study tutorial