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Friday, August 28, 2020

Causes, Symptoms, and Treatments for Gastroesophageal Reflux

Posted By: Advancing Care

What you need to know about GERD, heartburn, and acid reflux.

By Debra Bresnan
As seen in the September 2020 Issue of Advancing Care

Approximately 60 million people across the U.S. are affected by heartburn or gastroesophageal reflux disease (GERD) at least once a month, and 15 million Americans experience heartburn every day.

While the terms are often used interchangeably, heartburn and acid reflux have different meanings. Acid reflux is a common medical condition that can cause a burning or tightening sensation in the stomach, throat or chest. Gastroesophageal reflux disease (GERD) is the chronic, more severe form of acid reflux. The term “heartburn” refers to a symptom of acid reflux and GERD.

As Co-Directors at the Esophageal and Reflux Center at Good Samaritan Hospital, a member of the Westchester Medical Center Health Network (WMCHealth), Stephen Goodman, MD, and Vipul Shah, MD, head up a multidisciplinary team of board-certified gastroenterologists, thoracic surgeons, pathologists and radiologists.

To make an appointment with specialist at The Esophageal and Reflux Center at Good Samaritan Hospital, in Suffern, call 845.777.3553. For gastroenterology services elsewhere at wMCHealth, call WMCHealth Advanced Physician Services at 914.220.4530 (Valhalla) or 845.338.1535 (Kingston).

These specialists offer Rockland and Orange County residents access to state-of-the-art diagnostic tests and therapies, including endoscopic ultrasound, wireless BRAVO™ pH testing, high-resolution esophageal manometry, Barrx radiofrequency ablations and in-depth surgical options that can help patients who have been struggling with a condition that is not improving.

Can GERD symptoms be caused by environmental factors?

Dr. Goodman: “Certain conditions can actually be caused by allergic reactions to foods, such as seafood, nuts, eggs and soy. Beyond allergies, certain foods and beverages, including chocolate, peppermint, fried or fatty foods, coffee or alcoholic beverages, may trigger reflux and heartburn.

Can lifestyle modifications make a difference?

Dr. Shah: “Absolutely. When I meet with a new patient, I ask if they’ve tried to lose weight, adjust their diet, quit smoking, decrease alcohol, and reduce caffeine intake — all shown to help ease esophageal problems. Then, I reinforce their attempts to make these helpful changes. However, some patients will still require medication to control symptoms and prevent damage. Our team is here to find the solution that works for each patient.”

I’ve been taking proton pump inhibitors (PPIs) for years. Is this safe?

Dr. Shah: “If you have chronic heartburn, GERD or other complications and need to be on prescription medication, PPIs can be used effectively to control symptoms and prevent damage. There have been some observational studies that have found an association with side effects of these drugs, such as bone fractures, kidney failure, dementia, heart attack and overall mortality, but none have actually confirmed PPI use as the direct cause — and some were later debunked. However, these news headlines have had a beneficial effect, by encouraging people to call their doctors and discuss any concerns.”

GERD occurs when stomach acid frequently flows back into the tube connecting the mouth and stomach.

Dr. Goodman: “Chronic heartburn can lead to a precancerous condition called Barrett’s esophagus. If you are regularly using PPIs and chronic symptoms are not going away or are getting worse, it’s a good idea to see a specialist. We have found some patients with misdiagnosed acid reflux and others who have been given high doses of medications they do not need.”

What kinds of tests can I expect?

Dr. Shah: “Many of our patients have had previous testing, so we start by reviewing prior workups. Then, in order to determine if the problem is related to reflux, a motility disorder or an inflammatory condition, we use various diagnostic testing. These can include a high-resolution endoscopy, with or without placement of pH monitor (a wireless device worn for 24-48 hours). We can also consider motility testing – a type of physiologic study on the esophagus movement and presence of reflux. From there, a trial of higher-dose acid-suppression medication may follow. We will also review a biopsy taken during the endoscopy, and if a certain type of long-term damage from reflux is present, we can offer a unique method to ablate or destroy the abnormal cells. This is called RFA, or radiofrequency ablation.”

Can you tell me more about endoscopies?

Dr. Shah: “An endoscopy is a common procedure that utilizes a small, thin, flexible tube that is passed through your mouth and into your esophagus and stomach that allows the physician to visually assess the esophagus and upper GI tract. This type of endoscopy is also used for more advanced techniques, one example is Barrx ablation, which is a treatment for Barrett’s esophagus, a precancerous condition of the GI tract. It uses radiofrequency (heat) to kill abnormal cells.”

Dr. Goodman: “All of the specialists here perform a variety of advanced endoscopic procedures, and the endoscopic tests can be used to remove precancerous tissue without more invasive surgery. Most endoscopic procedures have minimal after effects, and most people can resume normal activity the next day.”

The Esophageal and Reflux Center

The Esophageal and Reflux Center at Good Samaritan Hospital opened in late 2019 to centralize high-quality care and efficient diagnosis and treatment for patients. The Center offers treatment for GERD, hiatal hernia, Barrett’s esophagus (a precancerous condition), motility disorders of the esophageal muscles, achalasia (swallowing disorder) and esophageal cancer.

“Acid reflux is the number-one condition we treat,” says Dr. Goodman. “But if you have chronic heartburn, an unusual sore throat, unexplained chest pain, difficulty swallowing, coughing or if you’re concerned about long-term use of medications, we are here to discuss your concerns and offer help. Some symptoms that occur outside the gastrointestinal tract, such as asthma, chronic coughing, food allergies and sore throat, may in fact be caused by gastroesophageal issues.”

To make an appointment with specialist at The Esophageal and Reflux Center at Good Samaritan Hospital, in Suffern, call 845.777.3553. For gastroenterology services elsewhere at wMCHealth, call WMCHealth Advanced Physician Services at 914.220.4530 (Valhalla) or 845.338.1535 (Kingston).

Visit us at Good Samaritan Hospital, a member of Westchester Medical Center Health Network, to learn more. Advancing Care. Here.