Community Connection: What is Gerd?

GERD – Is this something that impacts you?

by Dr. Stephen VanWylen, Thoracic and General Surgeon at McKenzie Health

I am a General and Thoracic Surgeon with 30 years of experience specializing in the diagnosis and treatment of GERD. Born and raised in Michigan, my wife and I have five children and four grandchildren. For relaxation, I enjoy spending time outside – camping, canoeing, hiking, and swimming. I am excited to be able to offer services in Watford City!

By way of introduction, I received my medical training from Michigan State University College of Human Medicine and post-graduate training in General Surgery at William Beaumont Hospital in Royal Oak, Michigan. Then I attended post-graduate training in General Thoracic Surgery at East Birmingham Hospital in Birmingham England, where I became more keenly interested in esophageal diseases especially reflux.

Over the course of my career, I have developed a unique skill set in the surgical treatment of acid reflux. I provide consultations in Watford City and by telemedicine if you live some distance away. I like to use pictures and diagrams to educate you about GERD and hiatal hernias. My goal is to make an accurate diagnosis, be sure you understand your diagnosis and symptoms, and determine the best treatment for you.

If you need testing or surgery, it will be performed in Watford City. 

What is GERD?

Gastroesophageal Reflux Disease (GERD) is caused when the contents of your stomach back-up into your esophagus. Stomach acid (produced in the stomach to aid in digestion) causes heartburn on contact with the esophagus and can cause inflammation and tissue damage. Sometimes gastric contents will reflux all the way into your throat (regurgitation).

What causes GERD?

The natural barrier to reflux of stomach contents into the esophagus is the Lower Esophageal Sphincter (LES). GERD is caused when the LES is no longer effective in preventing reflux. The LES is a complex structure involving the tissue at the bottom of the esophagus and the diaphragm that encircles that part of the esophagus. A failed LES is often associated with a hiatal hernia (when the top of your stomach migrates into the chest if the diaphragm that encircles the esophagus stretches open).

Symptoms:

• Heartburn – a burning sensation in your chest or upper abdomen.
• Regurgitation (backwash) of food or sour tasting liquid.
• Chest or upper abdominal pain.
• Difficulty swallowing.
• Cough.
• Hoarse voice.

Complications of GERD:

Untreated GERD can cause complications:
 An esophageal stricture from scarring can cause difficulty swallowing.
Barrett’s esophagus – a precancerous condition.

Treatment:

You should first consult with your primary care provider who may recommend:

• Medication to reduce the amount of acid in your stomach, this can often prevent heartburn. 

• • Lifestyle changes:

• • • Diet:

• Avoid eating before bedtime.
• Limit fatty foods.
• Limit alcohol.

• • • Other:

• Maintain a healthy weight.
• Sleep on your left side or with a wedge to sleep in a more upright position. 

 You might need further testing if:

• You still have heartburn or other symptoms despite treatment.
• You have regurgitation. This symptom is often difficult to treat without surgery.
• You have difficulty swallowing.

 Testing:

• Endoscopy – A camera is inserted, while you are sedated, into your esophagus and stomach to look for signs of GERD including inflammation, a hiatal hernia and to inspect the LES.
• BRAVO pH testing – A wireless probe will be temporarily attached to your esophagus that monitors for the presence of acid. An acid event is interpreted as a reflux event as there is not normally acid in your esophagus. Monitoring lasts 2-4 days. You will need to stop your heartburn medication in preparation for BRAVO testing.
• Esophageal manometry. – This is a test that evaluates the function of the muscles of your esophagus and the LES. It is essential prior to surgery. 

Advanced treatment: Surgery

If non-surgical treatments fail to control symptoms the best treatment may surgery to restore the function of your LES:

Surgery involves repair of a hiatal hernia (as is usually the case) and an additional procedure to augment the esophageal portion of the LES. Options include:

• Sphincter augmentation with your own tissues – called a fundoplication.
• Magnetic sphincter augmentation – call LINX.

Surgery is performed laparoscopically for a quick recovery. Talk with me about which technique is right for you; each procedure has its own strengths. For an appointment, please call 701-444-8730.