Definition, Causes, Symptoms, Problems DRAFT

UW MEDICINE | PATIENT EDUCATION

|| LIN X Pro ce d u re || A treatm ent for gastroesophageal reflux disease

Co n te n ts

Wh at is gas troe s oph ageal reflu x dis ease (GERD)?........2-3 Definition, Causes, Sy m ptom s, Problem s

H o w is GERD tre ate d? ...................................................... 4

D R A F T Diet Changes, Lifestyle Changes, Medicines LIN X Pro ce du re ................................................................ 6 Definition, Minim ally Invasive Surgery After Surgery ....................................................................6 In the Recovery Room Go in g H o m e .................................................................. 7-11 Driving, Pain Control, Medicines, Activity , Dressing and Skin Care, Show ering, Diet and Nutrition Fo llo w -U p Care , Qu e s tio n s Yo u May H ave ...................... 11 W h e n to Call Yo u r Su rgical Te am ................................... 12

Talk with your doctor about any questions you have.

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Surgical Specialties Cen ter | Box 356 165 1959 N.E. Pacific St., Seattle, WA 98 19 5 | 20 6.598 .4477

What is gastro eso phageal reflux disease (GERD)?

Gastroesophageal reflux disease (GERD) is a condition that affects the esophagus, the tube that carries food from the m outh to the stom ach. GERD occurs when stom ach acid flows back into the esophagus.

DRAFT

GERD occurs when stomach acid flows back into the esophagus. GERD is the m ost com mon esophagus problem in the United States. It affects about 20% (20 out of 10 0 ) of people in the U.S. This num ber includes infants and children .

What caus es GERD?

GERD is often caused by problem s with the lower esophageal sphincter (LES) m uscle. This m uscle acts as a valve between the esophagus and stom ach.

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Surgical Specialties Cen ter | Box 356 165 1959 N.E. Pacific St., Seattle, WA 98 19 5 | 20 6.598 .4477

A healthy LES prevents reflux by closing right after you swallow. But, if the m uscle is weak or relaxes at the wrong tim e, stomach acid can rise up into the esophagus. All of these conditions can cause GERD: ? Dam age to the LES or esophagus. ? A hiatal hernia, where part of the stom ach pushes up through a large

hole in the diaphragm and out of the abdom inal cavity. This affects the LES and keeps it from working well. GERD does n o t occur in every person who has a hiatal hernia. ? Too m uch weight and fat from obesity or pregnancy can push on the stom ach. This can m ove or put pressure on the LES.

D R A F T ? Acid and bile do not fully empty out of the stomach. ? Diet and lifestyle choices can m ake sym ptom s worse (see below).

What can m ake GERD w o rse?

? Som e eating habits, such as eating: ? Too m uch spicy, fatty, or citrus food ? Too m uch caffeine, alcohol, and chocolate ? Large m eals ? Too close to bedtim e

? Using tobacco of any kind ? Using som e m edicines

? Wearing clothing that is tight around your waist

What are the sym pto m s o f GERD?

? The m ost comm on sym ptom of GERD is heartburn. Heartburn is a feeling of pain behind the sternum (breastbone) or in the abdom en. Other sym ptom s include:

? Chest pain or heartburn ? Bad breath and a sour taste in the throat

? Nausea after eating ? Regurgitation (food or stom ach acid com es up into your esophagus

from your stom ach)

? Burping ? Bloating

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Surgical Specialties Cen ter | Box 356 165 1959 N.E. Pacific St., Seattle, WA 98 19 5 | 20 6.598 .4477

? Dy sphagia (pain or problem s when you swallow)

? Hoarseness or voice changes

? Airway problem s

? Coughing

? Throat-clearing

? Pneum onia

? Asthm a

? Lung diseases

Alm ost everyone has acid reflux at som e tim e. Talk with your doctor if you have reflux 2 or more tim es a week for 3 m onths.

D R A F T What other problems can occur with GERD? ? Over tim e, stom ach acid can harm the sensitive lining of the esophagus. This can cause esophagitis (inflam m ation, irritation, or swelling of the esophagus), which can lead to esophageal ulcers (sores).

? Dam age to the esophagus from stom ach acid can cause scar tissue to form . This can m ake the esophagus m ore narrow and lead to problem s with swallowing.

? Stom ach acid can change the cell structure of the esophagus so that it becom es m ore like the inner lining of the stom ach and intestine. This is called Barrett's esophagus. It is linked with a higher risk of esophageal adenocarcinom a (cancer), especially in older adults.

? Cancer of the larynx.

? Asthm a.

? Pulm onary aspiration, in which secretions, food or drink, or stom ach contents rise into the larynx (voice box) and lower respiratory tract.

? Pulm onary fibrosis, a disease in which scars are form ed in the lung tissues, causing serious breathing problem s.

H o w is GERD treate d?

At first, doctors m ost often prescribe changes in diet and lifestyle to treat GERD sym ptom s. Medicine m ay also be used. Your doctor m ay advise surgery if these things do not work or becom e less effective over tim e.

D ie t Ch an ge s ? Keep your weight in a healthy range

? Eat sm aller m eals

? Eat fewer fatty, fried, and spicy foods

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Surgical Specialties Cen ter | Box 356 165 1959 N.E. Pacific St., Seattle, WA 98 19 5 | 20 6.598 .4477

? Avoid foods such as

? Peppers

? Onions

? Citrus

? Chocolate

? Caffeine

? Carbonated beverages

See our handout "Managing Reflux" to learn m ore about dietary guidelines when you have GERD.

Life s tyle Ch an ge s

D R A F T ? Exercisemore. ? Avoid wearing clothes that fit tightly around your waist.

? Eat your last m eal at least 2 to 3 hours before you go to bed.

? Quit sm oking and avoid secondhand sm oke.

? Stop drinking alcohol.

? Raise the head of your bed. Use a pillow to raise your head above your chest level while sleeping.

Me d icin e s Your doctor m ay prescribe m edicines to help reduce your stom ach acid. These m edicines either neutralize the acid or keep your stom ach from producing them .

? An tacid s are used to help control m ild to moderate heartburn. Your doctor m ay prescribe an antacid, or advise you to use one you can buy without a prescription, such as TUMS, Mylanta, or Alka-Seltzer. These m edicines neutralize stom ach acid. But, because the stom ach needs acid to work well, taking antacids too often can affect how well you digest food. They can also cause diarrhea and other side effects.

? H is tam in e H 2 -blo cke rs (Ranitidine, Cim etidin e, Zantac, and Tagam et) work well for m ild, occasional reflux. Th ese m edicines block histam ine, a horm one in the body that causes stom ach cells to create acid. These are not as strong as proton pum p inhibitors.

? Pro to n pu m p in h ibito rs (Nexium , Prilosec, an d Prevacid) are prescribed when GERD sym ptom s are moderate to severe. They are strong drugs that suppress the secretion and release of stom ach acids.

? Mu co s al pro te ctive age n ts (alginic acid and sucralfate suspension) are gels or foam s that coat the inside of the esophagus. This protects the esophagus from being dam aged by refluxed stom ach acid.

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Surgical Specialties Cen ter | Box 356 165 1959 N.E. Pacific St., Seattle, WA 98 19 5 | 20 6.598 .4477

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