Transcription:

Melanie Cole (Host): Many people commonly and occasionally experience acid reflux at some point in their lives. However, if an individual experiences it persistently; they may be diagnosed with GERD. My guest today is Dr. Linda Miller. She’s a gastroenterologist at Lourdes Medical Center of Burlington County. Dr. Miller, welcome to the show. Tell us a little bit about GERD. What is it exactly?

Linda Miller MD, FACP (Guest): Of course, it’s a very important term and it’s actually getting to be a well-known term which is exciting for us because that means that we have patients becoming more aware, more educated and seeking information to change their health status and to improve their health overall. In your introduction, you said that gastroesophageal reflux was common and it can occur occasionally or persistently and that’s a dividing mark that we look at as far as what GERD is. I guess up to 80% of the population will have gastroesophageal reflux symptoms, 80% over a one-month period maybe one episode. And that’s very common. However, patients that have persistent reflux symptoms, then we call that gastroesophageal reflux disorder or disease. And that’s something that we are becoming more interested in educating the public about, because this has to be addressed and this has to be taken care of in a lifestyle change basis and possibly even medical intervention. Because gastroesophageal disease is increasing in severity and frequency in our general population and so there’s a great need for education, so I’m very happy to be on this talk right now.

Melanie: Do we know what causes it and who is at most risk?

Dr. Miller: The patients that are at most risk first of all, are those patients that are overweight or what we call obese and those patients that have dietary indiscretion are two of the risk factors. Now we know that obesity is rising in the United States so of course with an increase in obesity, we are going to have an increase in symptoms of gastroesophageal reflux. It’s also dietary indiscretion and it depends on motility also, how the esophagus can handle food going through, how much acid is in the stomach. It can be multifactorial. But two of the risk factors definitely are obesity and diet.

Melanie: Doctor, can it be silent and how would you know if you have it? Do you always feel it? so, speak about those symptoms and what it is that you would know that you have.

Dr. Miller: Well the biggest concern that we have as physicians or healthcare providers is that yes, gastroesophageal reflux disease can be silent until you develop an ulceration or an erosion in the esophagus that hits a blood vessel and you bleed. So, you can wake up and feel dizzy and lightheaded and see black tarry stools which means you’re bleeding because when blood hits acid in the stomach, it turns black and so you could wake up dizzy, not feel well and just see black stools. That means you are having a GI bleed and you must present immediately to the emergency room because this can be a life-threatening situation. So, the silent GERD which is an example of where you have no symptoms and you have a complication such as a bleed is very concerning. As far as educating the public, all we can do at this point is not preventative because you have no symptoms until you develop a complication. Now that is not very common, so that’s reassuring.

Another situation would be where you have ongoing reflux and you have no symptoms at all also, until you develop difficulty swallowing. And you have no heartburn or indigestion just difficulty swallowing and that comes from chronic reflux of acid into the esophagus causing inflammation and then a narrowing which we call a Schatzki’s ring and that can you to get food stuck in your esophagus and feel like you can’t swallow or something is stuck there and that again, is something that brings us right to the emergency room because that can also be life-threatening just like a bleed. So, those are the two silent situations where you don’t have reflux symptoms, but you develop complications of it that require an emergency room visit, and that’s a GI bleed with black tarry stools or throwing up blood or coffee grounds or the other situation where you develop difficulty swallowing. And those are silent symptoms.

There’s also silent symptoms where people have ongoing reflux disease and then all of the sudden they have no symptoms, but they start developing some heartburn or indigestion, we take a look down and they have advanced disease from reflux disease called Barrett’s esophagus which is precancer situation. So those three scenarios are very concerning because they are not – I don’t have a patient coming in saying oh, I have been having some reflux symptoms a couple of times a week. This is very different and it’s significantly more life-threatening. Not to downplay the patient that comes in or the person that has what we call gastroesophageal reflux disease which is defined technically as two or more episodes of heartburn or reflux per week and that is the clinical criteria that we use now. But because GERD is becoming more common, and the complications of course then becoming more common, we are becoming a bit more relaxed on two or more episodes per week and to try six weeks of treatment before we send you to see a gastroenterologist or the gastroenterologist does an endoscopy to look.

So, we are becoming a little bit more lax on that severe definition. I would say someone that has reflux a couple of times a month is definitely someone that should be seen by their physician or primary care provider to determine if in fact we should send you to a gastroenterologist to take a look down because sometimes that’s the only way we know, especially if someone has been self-medicating with all those over-the-counter medications and they are not getting better. Such as the whole gamut of medications basically over-the-counter now from H2 blockers which are used in the treatment of reflux disease and also proton pump inhibitors such as omeprazole or Nexium or Prilosec to antacids like Rolaids etc. So, if someone comes in and they are already self-treating themselves, those patients need to be seen by their gastroenterologist for intervention to take a look and see if anything is going on. Some people say why should you take a look if you know it’s reflux? Well the thing is that there are other things that present with these symptoms that are not reflux. It could be atypical biliary disease meaning it could be atypical gallstones or gallbladder disease causing heartburn. There are other things such as motility disorders that cause heartburn. There are things such as peptic ulcer disease that cause heartburn that are all treated differently especially if you have helicobacter pylori which is an infection that causes heartburn and ulcers in the stomach. So, there are many reasons to take a look and see what the symptoms are causing. Okay what are the symptoms telling us.

Melanie: So, after you have taken a look and determined what the situation is, and you have talked a little bit about some of the meds available; what do you want listeners to know about lifestyle behaviors, eating late at night or spicy foods or any of these things? Give us your best advice for what you would like us to know about possibly preventing GERD in the first place.

Dr. Miller: Well as a board-certified gastroenterologist in practice for more than twenty-five years both in academics and in private practice, I would say like any disease, that stress is one of the biggest factors that can cause reflux symptoms. So, whatever you can do as far as reducing your stress just like it can reduce high blood pressure and it can reduce heart disease, it can reduce strokes. I think stress meaning how you deal with things is important because we do know that stress increases acid production, okay so stress is lifestyle modifier that we can all deal with through various modes such as even yoga or meditation, prayer, exercise. These are all healthy ways to deal with your body overall but particularly with reflux disease. Now with obesity becoming a national epidemic, we certainly also must look at where we are and the biggest help is realizing – have a talk with your doctor or your provider with regard to how overweight you are, what is your ideal weight, okay because obesity increases your intraabdominal pressure pushing up your stomach, pushing up the acid into the esophagus, plus obesity is like the number one co-killer for many diseases so not only are you targeting reflux, you are targeting other diseases too by decreasing your weight. And so, obesity, eating a healthy well-balanced diet and exercise with stress reduction I would say are very, very important and I stress these because this is something a patient can do without medication. Okay, I am not a doctor that says here’s a pill this will fix it. That’s not always the answer.

So, working on those modalities I think is important. As far as the food that you eat, spicy, let me debunk that. Because having come from California, I have to say I have some of the best, best spicy food and over here now, in New Jersey there are many, many restaurants that serve spicy food. If a spicy food disagrees with you, you stay away from it. If it doesn’t that’s fine. There is nothing in the literature. It’s just a matter of most people feel that it’s just the spicy food. So, if it bothers you, stay away from it. As far as late-night snacking, and the way you sleep, those are important lifestyle changes too. Late night snacking means that your stomach is going to be filled and having your stomach filled with food and going through the food digestion process, and then lying flat or even with a pillow or two, is going to cause automatic reflux. And it’s that late night reflux that we are very concerned about because this is hours of process. We have just recognized that with reflux disease, we do have sometimes associated gastroparesis which means the stomach does not empty correctly. Up to 40% of patients that have gastroesophageal reflux disease, their stomach doesn’t empty correctly and that’s another reason why acid refluxes into the esophagus from the stomach. So, late night and things being left in the stomach is not the way to go. These are important matters and really coming together is that these are things that you can do in order to improve your health. Things that your doctor can do of course is educate you regarding this and refer you at the appropriate time to see a gastroenterologist or independently depending on how your healthcare system works, is to make an appointment to see a board-certified gastroenterologist in your area that has expertise in this disorder and this disease in order to improve your health overall.

Lastly, I just wanted to talk a little bit about Barrett’s esophagus which is a precancer condition that comes from chronic reflux and this is something that’s concerning because esophageal cancer is increasing in incidence in the United States just like gastroesophageal reflux disease is increasing. So, it’s not by any mistake that these two are increasing because they are related. So, if you have chronic reflux, see your doctor. See your gastroenterologist. If you develop Barrett’s esophagus, we follow that. Which percentage of patients go on to develop esophageal cancer? It’s not really clear, however, we know it’s a significant risk factor. So, see your doctor if you do have chronic reflux symptoms because we want to make sure and document that you do not have esophageal reflux complicated by Barrett’s esophagus which is a changing in the lining of the esophagus. And most importantly, if you have symptoms such as black tarry stools or difficulty swallowing, go to the emergency room because these are life-threatening situations.

Melanie: Thank you so much Dr. Miller for sharing your expertise. What great information. Thank you. We can hear the passion in what you do and thanks again for joining us. This is Lourdes Health Talk. For more information please visit www.lourdesnet.org that’s www.lourdesnet.org. This is Melanie Cole. Thanks so much for listening.