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Esophageal Reflux Disease

Why should you receive treatment of
esophageal reflux disease in AMC?

Gastroesophageal reflux disease (GERD) is a digestive disorder in which the gastric acid refluxes into the esophagus and causes symptoms of heartburn or chest pain. The esophageal sphincter between the esophagus and stomach normally stays tightly closed and opens only when a person ingests food or belches. The sphincter also prevents stomach contents from flowing back into the esophagus. In some cases, the esophageal sphincter becomes weak or opens inappropriately, causing gastric acid to flow backward into the esophagus. This is called gastroesophageal reflux. In this condition, the stomach contents irritate the lining of the esophagus resulting in pain and soreness. Sometimes this can lead to esophagitis, esophageal ulcers, and in severe cases, esophageal strictures, the refluxed gastric acid can pass through the esophagus and reach the neck, causing laryngitis, asthma, or chronic cough.

GERD is usually triggered by various factors including an increased pressure in the stomach, a weakened esophageal sphincter between the stomach and esophagus, and an increase in the amount of stomach contents.

AMC’s Department of Gastroenterology plays a pivotal role in the treatment of liver, gastrointestinal, colorectal, and pancreatic diseases in Korea. Since the foundation of AMC in 1989, the Department of Gastroenterology has provided Korea’s best medical services and research activities. Each specialty has had a leading role in research to overcome gastroenteric diseases. Continuous efforts have been made to attain the ultimate goal of prolonging human life.

Diagnosis

Diagnostic tests for GERD include endoscopy, 24-hr esophageal pH monitoring, and esophageal manometry. Endoscopy reveals the severity and scope of esophagitis, the complications that are present, and the histological diagnosis of the esophageal mucosa.

Endoscopy

Endoscopy is used to identify any esophageal damage that might have occurred due to stomach acid reflux. GERD is diagnosed if a mucosal break is observed at the esophagastric junction. Endoscopy is the most objective method of diagnosing, but more than half of patients have normal structures without evidence of erosive esophagitis.

24-hr esophageal pH monitoring

This is a diagnostic method that measures the esophageal pH for more than 24 hours to see how morbidly excessive acid reflux takes place in one day. A slim tube with a sensor is inserted into the esophagus to measure the pH level. During the examination, a patient is allowed to go back home to return to their daily routines. If any relevant symptom occurs, the patient is asked to press a button to mark the event. This time of this event is later on compared to the time of the acid reflux.

Treatment Options

  • Lifestyle changes

    Lifestyle changes are the standard treatment for GERD and should be maintained for life.

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    Lifestyle Changes
    Diet
    • Avoid overeating and late-night snacks
    • Avoid greasy food, alcohol, smoking, coffee, tea, mint, chocolate, etc.
    • Avoid sour fruit juice, tomato, coke or soda, etc.
    • Replace drugs (calcium channel blocker (CCB), sleeping pills, and anti-gout) that lower the pressure of the esophageal sphincter with other drugs. calcium channel blocker (CCB), sleeping pills, and antigout agents
    Weight control
    • Reduce weight in case of diabetes
    Posture correction
    • Avoid lying down right after eating
    • Avoid wearing tight clothes
    • Avoid leaning forward during daily activities
    • Patients with a severe acid reflux/esophageal mobility disorder: Sleep with head of the bed raised bat least 6-8 inches

  • Drug therapy

    Drugs for GERD are intended to inhibit gastric acid secretion. Drugs that control acid reflux include an antacid agent that neutralizes stomach acidity, a histamine antagonist that suppresses gastric acid secretion, and a proton pump inhibitor (PPI) that inhibits acid secretion. A PPI is the most effective in inhibiting gastric acid secretion, followed by the histamine antagonist and then the antacid agent.

    Taking PPI for 4 weeks or 8 weeks improves the symptoms of acid reflux and mostly cures esophagitis. However, if the symptoms appear again immediately after stopping the medication, it is important to continue taking a reduced dose of the drug.

  • Surgery

    An anti-reflux valve is placed at the weakened esophagastric junction to prevent stomach acid from being back flowed into the esophagus. Surgery will be considered for the following conditions: 1) when acid reflux continues despite medication to inhibit gastric acid secretion 2) when acid reflux is accompanied by complications such as esophageal stricture or Barrett’s esophagus 3) when patients have a fear of adverse effects from the medication even though they have been responsive to drug therapy and 4) when patients are less likely to be responsive to the prescribed medication.

  • Stretta therapy

    Stretta therapy is a non-surgical treatment for patients who experience the symptoms of GERD despite drug therapy. This method is used in patients with hiatal hernias smaller than 3 cm whom are responding well to drug therapy, yet are unsuitable for a long-term drug therapy due to adverse effects or compromised compliance.

    Stretta therapy uses super-high frequency that makes the esophageal walls thicker by reconstructing the lower esophageal sphincter. This therapy improves tissue elasticity and temporarily decreases the pressure of the lower esophageal sphincter. Stretta therapy addresses the two biggest factors contributing to GERD: recovering the lower esophageal sphincter’s function as a barrier and alleviating the symptoms of acid reflux caused by a temporary relaxation of the esophageal sphincter.

Medical staff

The department of gastroenterology is comprised of a liver team, a pancreatic team, and a gastrointestinal team. It provides medical services at the endoscopy unit, the gastroenterology ward, and the outpatient department. To keep in pace with the growing need for multidisciplinary treatment, AMC opened the Asan Liver Center, the Pancreatobiliary Disease Center, and the Inflammatory Bowel Disease Center. They offer fast and customized treatment for each patient led by the department of gastroenterology in cooperation with the departments of surgery, radiology, oncology, radiation oncology, and pathology.