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GERD and Laryngopharyngeal Reflux

RefluxGERD (gastroesophageal reflux disease) is a chronic digestive disease that typically is the result of a weak gastroesophageal sphincter muscle. When this muscle is not working properly, stomach acid and other contents flow back into the esophagus. The faulty sphincter muscle causes reflux, heartburn, and chronic regurgitation.

Aside from the discomfort associated with GERD, if left untreated, GERD can lead to more severe complications, such as pneumonia, asthma, cough, Barrett’s esophagus, dysplasia, and esophageal cancer. Laryngopharyngeal reflux is a condition where reflux of gastric juices or “mist” reaches the voice box or lungs and creates symptoms and conditions, such as adult-onset asthma, chronic cough, and lung fibrosis.

Possible Esophageal Disease Progression in those with GERD and laryngopharyngeal reflux:

Chronic Inflammation → Barrett’s Esophagus → Dysplasia → Esophageal Cancer

Tests & Diagnosis

Sedated traditional endoscopy uses a flexible tube with a light and camera to visually inspect your esophagus, stomach and part of the small intestine. The camera is passed into the digestive tract through your mouth. Therapeutic treatment can be combined with this procedure. This is an outpatient procedure.

Unsedated transnasal endoscopy is an alternative to sedated endoscopy that uses an ultrathin endoscope, which is passed through your nose and into your esophagus. This visual inspection does not require sedation, can be performed as part of a clinic visit, and allows you to drive yourself home directly afterward. We also use capsule endoscopy when needed, which is a pill camera that is swallowed and sends images wirelessly to an external receiver. 

pH acid monitoring is a disposable capsule placed into your esophagus using an endoscope. It wirelessly transmits information about esophageal acid levels to a receiver worn around your waist for 48 hours.

High resolution manometry measures the strength, pressure and coordination of your esophagus' muscles. A specially trained nurse guides a small catheter through your nose and into the esophagus and instructs you to swallow small amounts of liquid at specific intervals.

A 24-hour impedance catheter is used to measure the reflux of fluid and gauge its proximity to your voice box. This test is typically used for patients who are experiencing cough, respiratory or non-classical GERD symptoms. A small catheter is inserted through your nose and records data in receiver worn around your waist during while you conduct your regular daily activities.

 

Treatments

Medications: Proton Pump Inhibitors (PPI) and H2 blockers can be very effective in reducing the amount of acid produced by the lining of the stomach. Many people notice an improvement in symptoms (particularly heartburn) as a result of consistently taking prescribed GERD medications.

Surgical options: Some individuals do not improve with medical therapy or find that they no longer respond to medication or have severe side effects and may need to consider other treatment options. There are several types of surgical interventions that can treat the cause of GERD, including:

  • Laparoscopic fundoplication: There are several variations in fundoplication including complete (360-degrees) and partial (270-degrees) that wrap the lower esophagus with the floppy upper part of the stomach for a short distance (2 centimeters) to strengthen a weak sphincter muscle and prevent stomach contents from backing up into the esophagus. We perform this laparoscopically through very small external incisions. The operation typically lasts one to two hours and patients go home after 24 hours.
 
  • LINX reflux management system is an FDA-approved LINX Device used to strengthen a weak gastroesophageal sphincter muscle. The LINX device is wrapped around the bottom of the esophagus. Similar to tiny beads on a bracelet, magnetic beads hold the sphincter closed while at rest but allow food to pass into the stomach during a swallow. This procedure is performed laparoscopically, is removable, and is typically performed as an outpatient procedure.

 

GERD EndoStim Clinical Trial Information

Allegheny Health Network is looking for patients with acid reflux to participate in a clinical study. We need 110 patients to try out something called EndoStim. EndoStim works like a pacemaker, only it attaches to your esophageal sphincter, helping your body work the way it is supposed to. For more information, visit WTAE's website