Gastroesophageal reflux disease is far more than run-of-the-mill indigestion or acid reflux — a painful reality for 60 million American adults, or about 20% of the population.
“Up to one in five adults have regular heartburn or reflux,” says Benjamin Elsbernd, MD, gastroenterologist on the medical staff at Methodist Dallas Medical Center. “Different symptoms come with it, and some are easier to miss.”
Heartburn is often unmistakable — that burning sensation behind the breastbone — but reflux can also cause a chronic cough or throat clearing, hoarseness, or dysphagia, the feeling of food being stuck in the esophagus.
“Some people feel heartburn more as an actual pain in the chest,” Dr. Elsbernd says. “For those patients, we don’t want to blame heartburn when it could be a heart issue.”
Speaking with a group from Methodist Generations, Dr. Elsbernd discussed GERD, how it’s diagnosed, and when the symptoms might signal another condition entirely.
HOW IT’S DIAGNOSED
GERD is the inflammation caused when acid from the stomach frequently backs up into the esophagus, often because of a malfunctioning muscle at the base of the esophagus — the lower esophageal sphincter.
When patients experience heartburn several times a week and see no improvement with over-the-counter medications, that’s usually when it’s time to visit a gastroenterologist to diagnose the problem.
“Symptoms and risk factors vary by patient, so no single lab test can diagnose GERD,” Dr. Elsbernd says. “The patient’s symptoms guide the route for diagnosis and treatment.”
There are a few primary ways to diagnose GERD:
- Upper endoscopy — This procedure involves inserting a thin, flexible tube with a light and camera through the mouth, down the esophagus, and into the stomach and upper small intestine. “It takes us about five minutes, and patients are generally asleep the whole time,” Dr. Elsbernd says. The doctor can view the internal lining, check for inflammation or ulcers, and even perform biopsies if needed.
- Ambulatory acid probe test — The Bravo test uses a small, capsule-sized pH sensor attached to the esophagus that wirelessly transmits data to a receiver worn on your belt for 48 to 96 hours. Patients record their meals and symptoms to help doctors connect acid levels with discomfort. The capsule naturally detaches and passes through the body after the test.
- X-ray of the upper digestive tract — X-rays are taken of the esophagus and stomach after the patient drinks a chalky liquid containing barium sulfate. This coats the upper digestive tract, allowing a physician to see any abnormalities.
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BARRETT’S ESOPHAGUS
Left untreated, GERD can lead to serious complications like inflammation or ulcers in the esophagus or even Barrett’s esophagus, a condition that raises the risk of esophageal cancer.
“We see Barrett’s in 5% to 12% of patients with chronic reflux,” Dr. Elsbernd says. “It changes the lining of the esophagus to look more like the intestines because it’s trying to protect itself.”
The goal is to diagnose Barrett’s esophagus early enough to treat it and lower the risk of esophageal cancer.
“We want to catch those patients that are progressing into low-grade or high-grade dysplasia and treat them to prevent cancer,” Dr. Elsbernd says.
WHAT IF IT’S NOT GERD
Achalasia is another condition that mimics some of GERD’s symptoms but differs in treatment because the valve between the esophagus and stomach is too tight, rather than too loose.
“Achalasia is a different animal. It isn’t a lifestyle disease,” Dr. Elsbernd says. “The nerves that tell the valve to relax get destroyed, probably by an immune process, and diet has nothing to do with it.
That causes difficulty swallowing, regurgitation, and heartburn, just like GERD. But medications used to treat GERD don’t work, and a different diagnostic technique may be necessary, too.
“EndoFLIP is a thin catheter with a fluid-filled balloon on it and a line of sensors inside the balloon,” Dr. Elsbernd says. “We do it during a standard sedated upper endoscopy.”
The data provided by an EndoFLIP procedure is what sets it apart from a traditional endoscopy, he explains.
“I see a lot of people with real swallowing problems whose endoscopy looks completely normal,” Dr. Elsbernd says. “With the EndoFLIP, the sensors measure how the esophagus and the valve at the bottom respond, so instead of a picture, I get numbers.”
AVOIDING TRIAL AND ERROR
That data informs the treatment for a patient with achalasia, allowing physicians like Dr. Elsbernd to avoid months of trying different medications to see what works.
“On average, it can take up to six months for patients with esophageal motility disorders to try different medications and undergo various tests,” he says. “With this testing, we can cut down the diagnostic time significantly.”
A quick solution isn’t certain because sometimes symptoms don’t line up neatly with just one test, Dr. Elsbernd says.
“Sometimes it’s a specific diagnosis, like GERD or achalasia, and sometimes we rule things out quickly,” he says. “Either one beats guessing.”
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