Joey Wahler (Host): It's a condition that can cause heartburn and a number of other unpleasant symptoms. So, we're discussing gastroesophageal reflux disease, commonly called GERD. Our guest, Dr. Pete Peterson. He's a general and bariatric surgeon for BayCare. This is BayCare HealthChat, a podcast from BayCare. Thanks for listening. I'm Joey Wahler. Hi, Dr. Peterson. Thanks for joining us.

Dr Pete Peterson: Yeah. Hey, Joey. Thanks for having me.

Host: Yeah. Great to have you aboard. So first, for those that aren't entirely familiar, in a nutshell, what exactly is GERD? And is it more widespread than people likely realize? Because it seems like it is in fact more common than people know.

Dr Pete Peterson: it's definitely more common than people know. So what it is in a nutshell, the acid that's normally in the stomach travels backwards up the esophagus, which is the food tube that connects the stomach to your mouth. A lot more people have it than what they realize, even if it's just after eating a real spicy meal and they have kind of a sour stomach or feel like something's in their back of the throat, then they go take a Tums, that's acid reflux.

Host: And so, would it be akin, say, to having a pipe backup?

Dr Pete Peterson: Yes. That is actually a really good way to say it. Normally, there's a little muscle right before things go into the stomach. And kind of like the stomach acts like the reservoir at the end of the pipe, which would be the esophagus. When that little valve muscle doesn't work properly or close as tight as it should, it's kind of like if a one-way valve doesn't work good for a pipe for your plumbing, things can then back up and flow the wrong direction, and that's not pleasant for anybody.

Host: So having said that, what's the usual cause of GERD? Is it in fact the wrong foods that don't agree with us? Is it something internally or could it be a combination of the two?

Dr Pete Peterson: A little bit of a combination of the two, it's mainly an anatomy problem. I was saying that valve muscle, it's called the lower esophageal sphincter, if it's not tight enough or strong enough, then that's when things flow backwards. That and if someone has something called a hiatal hernia, because there's muscles on either side called the diaphragm, your breathing muscles; and if there's a big opening there, that doesn't give the valve muscle enough strength to keep things shut.

Host: Interesting. I didn't know about the hernia portion of that. So, GERD has a wide variety of possible symptoms. What would you say from your experience are the most prevalent ones?

Dr Pete Peterson: Most prevalent would definitely be heartburn. After eating a meal around 30 minutes or so, or even sometimes right after, you feel just kind of like a burning almost right underneath the chest bone. And then if you drink some milk, some yogurt or take a Tums, that kind of tends to usually help make it go away a little bit. That's probably the most classic symptom of GERD. Less classic symptoms, but equally concerning, sometimes more so, would be even chronic cough can be caused from GERD, or regurgitation of chewed food when someone lays flat after eating.

Host: So, you mentioned milk and, of course, Tums, when that works, what's actually happening internally?

Dr Pete Peterson: It's actually helping to neutralize the acid content. Milk is more of what we call a basic solution. So ideally, if you mix an equal acid with an equal base, you get something with a neutral pH, that's not caustic, so to speak. Therefore, it's less irritating. The milk in the Tums, they also can kind of coat the lining of the esophagus and the stomach, which helps relieve some of the irritation as well.

Host: So, other than spicy foods, what other factors in our daily lives could contribute to getting GERD?

Dr Pete Peterson: Caffeine intake is a big one that a lot of people don't realize. The caffeine actually causes the lower esophageal sphincter, that's that valve muscle we were talking about, it actually causes it to relax a little bit. So for some people, just decreasing caffeine intake can have a notable difference with decreasing their GERD. Other things, having a high BMI, that causes increased pressure on the stomach; therefore, pushing things to go backwards the wrong direction.

Host: So if you suspect someone has GERD, how do you go about diagnosing the specific cause of it?

Dr Pete Peterson: One of the first things that we like to do is something called an EGD. Now, the big fancy term is esophagogastroduodenoscopy. So esophago-, your esophagus, the food tube; gastro- just means stomach and then, duo- is the really first part of the intestine right after the stomach. So usually, the GI doctors will put a camera down someone's mouth while they're sedated, of course, and take a physical look at the esophagus, that valve muscle and the stomach to see if there's any irritation and see if the valve muscle is loose or not. In addition to the EGD testing, there's something called a Bravo pH where it measures the acid reflux from the stomach into the esophagus. That's what we call a gold standard to see if someone truly has acid reflux or not.

Host: So, because they can't yet describe completely what they're tasting or feeling as well as adults, how about diagnosing GERD in babies or younger children? Because they can get it too, right?

Dr Pete Peterson: Yes, they can. And it's a big problem, especially in newborns. The most common presentation there is actually what we call failure to thrive. So, they're regurgitating or spitting up so much that they don't gain weight. Reflux in a newborn, even in some children, a little bit is normal. That's okay, because especially in newborns, the body is growing at such a rapid rate, that valve muscle doesn't have the same rigid tone that it would in, say, you or I because they're growing so fast. So, a little bit of reflux is okay. But when it's to the point that the child is no longer gaining weight, well, that's when it becomes a problem. And then, usually, it'll be a pediatric surgeon that starts to get involved at that point.

Host: Gotcha. A couple of other things. So, what are the treatment options for GERD?

Dr Pete Peterson: A lot of people will try medication first, which I completely agree with. Different medications, over-the-counter antacid, blockers, if they have a good response to those medications, then anti-reflux surgery is a really good option. That way, you don't have to be taking the medications long-term, you know, 10, 20, 30 years for some people that are diagnosed real early in life.

There's a couple of different types of surgery. One, the fancy term is called a fundoplication, where basically it's taking part of the stomach that expands and wrapping it around itself to create really a one-way valve, so that when the stomach gets full of food after your Thanksgiving meal, things won't flow backwards as much because it helps it basically tighten on itself.

One of the more new approaches is something called the LINX procedure. What it is, is basically magnetic beads on a wire, and there's different sizes. And the surgeon will go in, measure the esophagus and put the right-sized device right near where that valve muscle is to help basically reinforce it and give it a little bit strength. One of the big difference between that and the classic fundoplication, that's the stomach wrap, is people can still belch after having the LINX procedure done and you could still vomit if need be. And while it might sound silly, if you really think about it, it's kind of an important part of what a lot of people do every day. It's just normal bodily function. So, it's really a person by person basis and a good discussion to have with the surgeon regarding it.

Host: So, if left untreated, how serious can GERD become?

Dr Pete Peterson: It can become deadly serious, and no pun intended. That's one of the feared complications of GERD and that's why it's recommended that even if someone does not want to have any type of surgery done for it, that they should undergo surveillance and discuss that with the surgeon or their GI physician. It can progress to something called Barrett's esophagus, which is pre-cancerous. At that stage, it can still be treated without having to actually cut out part of the esophagus. Now, if it advances to what's called esophageal adenocarcinoma, that's a huge problem. Esophageal cancer is very serious. it's a very deadly cancer. The treatment for that is you have to cut out that part of the esophagus that is involved and then, reconnect the stomach to the esophagus. It's a huge major surgery, lots of complications afterwards. So, much better to get ahead of it, rather than let things progress to that.

Host: Absolutely. And so having said that, in summary, doc, what's your message to those listening about GERD that you would say concerning their chances of effectively addressing it with the right treatment if in fact they do have it?

Dr Pete Peterson: I would say it's definitely something to talk with your primary care physician about. Bring up to them, say, "Hey, I have this heartburn. What do you suggest?" Usually, just that will be enough to prompt a referral to either a GI physician or a general surgeon to talk to about things. If they can get in with a GI doctor directly, then that's another route that people can take.

Host: Well, folks, we trust you're now more familiar with GERD's causes, symptoms and treatments. Dr. Pete Peterson, thanks so much again.

Dr Pete Peterson: Absolutely. My pleasure. Thank you, Joey.

Host: Same here. And for more information, please do visit baycare.org. Again, that's B-A-Y-C-A-R-E.org. If you found this podcast helpful, please share it on your social media. I'm Joey Wahler. And thanks again for listening to BayCare HealthChat, a podcast from BayCare.