Gastroesophageal reflux disease. (Women's Health Adviser).

Gastroesophageal reflux disease is more than the occasional heartburn that causes discomfort after a rich meal. The condition causes frequent, severe heartburn and acid regurgitation. It often interferes with sleep, destroys the pleasure of eating, and can be associated with all kinds of seemingly unrelated symptoms, from erosion of dental enamel to chest pain and asthma.

In its most serious form, affecting about 10% of gastroesophageal reflux disease (GERD) patients, the constant reflux of acid can cause Barrett's esophagus, a metaplastic change of the esophageal lining that is associated with the development of esophageal cancer.

Diagnosis. GERD is a constellation of symptoms that compose a chronic, lifelong condition. The etiology is unknown, but the symptoms--caused by gastric contents entering the esophagus through the lower esophageal valve--are usually associated with large or high-fat meals eaten quickly.

Highly specific symptoms include heartburn or regurgitation, or both, more than twice a week and usually occurring after meals, especially large or fatty ones. The symptoms are often aggravated by postural changes such as bending or lying down, and can be relieved by antacids.

When patients present with these symptoms, it's usually reasonable to assume that GERD is present. Offer them a trial of empirical therapy, including dietary and lifestyle modifications. But the following warning signs suggest complicated GERD and should prompt additional diagnostic testing: dysphagia, bleeding, weight loss, choking (acid causing coughing, shortness of breath, or hoarseness), and chest pain.

Ambulatory pH testing, in which a nasoesophageal catheter records the amount of acid entering the esophagus, has a sensitivity and specificity of 90%95% for abnormal acid exposure and is the best method for determining the amount of acid reflux. Endoscopy can identify areas of esophagitis caused by acid reflux.

Treatment. Lifestyle modifications should be considered. Patients should be advised to elevate the head of their bed, so that gravity can help reduce the amount of acid entering the esophagus, and to sleep on their left side. They also should decrease fat intake, eat smaller meals, stop smoking, and avoid lying ...