Transcription:
GERD Treatment

Prakash Chandran: Welcome back to Hello Healthy. I'm your host, Prakash Chandran. We all experience heartburn or acid reflux from time to time, sometimes after indulging in spicy foods or alcohol. But if your heartburn is persistent, it might be a sign of a digestive order called GERD. And luckily, there are minimally invasive procedures that can help.

Joining me today to discuss is Dr. Alfred Johnson, a gastrointestinal surgical specialist for Dignity Health, and his two patients Dora Chapa and Karla Casanova. So, thank you all so much for joining me here today. Dr. Johnson, I'd love to get started with you. Can you tell us a little bit about what GERD is and what that acronym stands for?

Dr. Alfred Johnson: GERD stands for gastroesophageal reflux disease. And essentially, it is when you get what's known as pathologic reflux of contents from the stomach, flushing back up into the esophagus. And usually it is determined by the degree of deterioration of the normal functioning valve between the esophagus and the stomach. And so this is affected by different foods, peppermint, chocolate, onions, citrus, tomato sauce, nicotine, alcohol, all these things can affect the valve. So if you imbibe those things, then you may experience more severe reflux, especially when you have the condition. Also a very large meal will cause reflux. So if your stomach gets really full, then you can anticipate that you're going to have more reflux.

Prakash Chandran: Got it. And can you talk a little bit about the differences between just normal acid reflux and GERD? Like how do you distinguish between those two things?

Dr. Alfred Johnson: So anticipated that, you know, sometimes when you have a large meal, you may have a little bit of stomach upset. And you may have what we would call GERD symptoms, but not necessarily GERD the condition. So it's not unusual to have heartburn after a large meal. What's unusual is that you're getting this every single day or several times a week to the point that it starts to affect your lifestyle.

Prakash Chandran: Yeah. And I actually want to move on to maybe one of your patients to talk about some of the symptoms that they were experiencing. So Dora, why don't we go ahead and start with you? What are some of the symptoms that you were experiencing when you thought, "Hey, this might be something a little bit more than normal heartburn or that acid reflux."

Dora Chapa: I would feel a lot of like burning in my stomach. I would feel very full, like topped off. I couldn't even drink anything, really eat. Dr. Johnson was saying it does affect your daily every day deal that you do. It was to the point to where I barely muscled up enough energy to go to work and come home, and then I'd be done with the day because it's just so uncomfortable. And you get a lot of like acid coming up, your burping, just a lot of discomfort.

Prakash Chandran: Yeah, absolutely. Karla, did you find that it was the same for you?

Karla Casanova: Yes. I think for me the worst part, it was at night. I have to sleep sitting up because even water will make my heartburns like one of the worst things ever.

Dora Chapa: Yeah, I agree with her. You need like four pillows to prop you up.

Karla Casanova: Yeah. Like sitting up and like that was my way to sleep in. And that was not a way just to live your life. That's not nice.

Prakash Chandran: Yeah, I can imagine that. And I imagine that the symptoms that both Dora and Karla experienced, Dr. Johnson, are not atypical. So are there any other symptoms that people should be aware of when they have GERD?

Dr. Alfred Johnson: Sometimes there are what we consider atypical symptoms. And when you might experience that, you may have someone who doesn't really have a lot of heartburn, but they have a persistent cough that doesn't go away. They have persistent hoarseness. They have increased postnasal drip. Those are some more atypical symptoms. And many times it's something it's due to what we call laryngopharyngeal reflux or LPR. And essentially that the reflux is coming up so high, that it comes back down into the voicebox and can kind of access your nasal passages from your pharynx, kind of the posterior part of your mouth, the back part of your mouth.

So those are more atypical symptoms and sometimes when treating those, the atypical symptoms get better because we do some of the more typical treatments for reflux in terms of some medications that are used to treat it.

Prakash Chandran: So Karla, you were talking about some of the discomfort that you experienced, especially at night. Did you have an idea that, "Hey, this is GERD. This is something that I need to get looked at." Talk a little bit about how you got it initially diagnosed.

Karla Casanova: Well, I had this condition back in 2014. I always had problems with my stomach. But back then, they did a surgery to repair. I had a hiatal hernia, and I thought it was just coming from that. It was repaired and everything, but I don't know how, what happened. But the doctor said that it was not the same thing. And this time, it was almost exactly the same feeling. So I knew that it was just getting worse and it was going to get worse before it got better. But I had this problem before. The only difference now, after back in 2014, the surgery, now it was like an upgrade. I felt the relief right away after my second surgery.

Prakash Chandran: Got it. And we definitely want to get into that immediate relief. But before we do, Dora, I just wanted to move to you and just talk a little bit about how you got this initially diagnosed and kind of knew that you needed something different to get this treated.

Dora Chapa: Well, I was going to. I had even changed my doctor, the doctor's office I was going to. And everybody just said, "Oh, you have acid reflux." They were giving me medication to take throughout the day and at night. And in between that, I was also taking Pepto-Bismol because of how horrible I was feeling.

Like Dr. Johnson stated, I did have hoarseness, my throat did feel raw a lot. And it was just very uncomfortable. And until I came to see Dr. Johnson, I asked to be referred to a different specialist. He's the one that discovered it. And he's the one that told me about it. Otherwise, I had no clue. I just know I did not feel good and everything they were telling me to do was not helping.

And then after the procedures, after the pain went away from the procedure, I haven't taken any acid reflex medicine that was prescribed to me. I do feel a little bloated at times and I feel a little bit of acidy in my stomach and I will take just a Pepto-Bismol, but that takes it away. So since my surgery, I've only had to do that like twice to where I was taking things constantly on the daily.

Prakash Chandran: Definitely. And as I mentioned, we'll definitely get more into that. But before that, Dr. Johnson, both Karla and Dora have explained what they were experiencing that made them feel like they needed to come in and get things looked at. Is there anything else that you want to share with our audience around how GERD gets initially diagnosed?

Dr. Alfred Johnson: Well, I think the first thing that you have to kind of consider is that it's a matter of the doctor listening to the symptoms, listening to what the patient's telling you in terms of the symptoms they're having. And then once, you know, the doctor understands that, you know, this really does sound a little bit like reflux, and many times they'll be given an initial medication to treat it such as omeprazole or Pepcid. And these are both medicines that basically reduce the acid that's in the stomach, so that if reflux were to occur, it doesn't irritate the esophagus as much. And sometimes the diagnosis can be made because you give the patient the medication and the symptom is resolved or it goes away.

But apart from that type of a diagnosis we do, there are studies that we do to make the diagnosis. One of those studies would be what's called a barium esophagram or a barium swallow, which is an x-ray where the radiologists will give you something to drink which is a little bit chalky, but it goes down okay and it lights up on an x-ray. So, while it's being swallowed in your esophagus, pictures are taken as it moves down and coats the lining of your esophagus and stomach. And we can many times see the reflux when this study being done and we can diagnose patients with hiatal hernias on this study.

Prakash Chandran: Yeah. So let's talk a little bit more about the first line treatments when you discover that there is an issue. I think you mentioned the omeprazole or Pepcid. Are there any other first-line treatments that are made available to people before other procedures are considered?

Dr. Alfred Johnson: So first-line treatment for reflux is usually to counteract the acid. There is no medication that addresses the underlying problem, which is a failure of the valve. But medication can relieve the symptoms. And so the medication that's given, first will be something like antacid, Maalox, Mylanta even Pepto-Bismol has an antacid function.

The next line of treatment in terms of medication would be things like Pepcid or Tagamet or Zantac. Now, Zantac was taken off the market because of some other complications people had from taking it. But that's what we call them the H2 blocker and that's the next line of therapy.

The next line after that, which is a little bit more effective in reducing the acid, would be things like omeprazole or Prilosec as it is commonly known. And then things like Nexium and Protonix and Dexilant. These are all very strong medications, very potent at reducing the acid. So that in the event that the reflux occurs, what comes up into the esophagus doesn't contain acid and doesn't cause the irritation.

Prakash Chandran: Got it. That makes a lot of sense. And so one of the things that we are talking about are, I guess, these more minimally invasive procedures that can help out. You talked about the medication only being able to relieve the symptoms. Talk a little bit about this TIF procedure and how it works.

Dr. Alfred Johnson: So the way the TIF procedure works, you kind of have to understand one of the things that's done to make the diagnosis and to evaluate patients with reflux is something called an endoscopy or upper endoscopy, otherwise known as an EGD. And that's when you take a flexible lighted scope, it goes down the esophagus. We can look at the esophagus, we could take biopsies. And then once we're in the stomach, we can turn the scope around to look back at the connection between the stomach and the esophagus, which will tell us if there's a significant hiatal hernia associated with the condition.

So assuming there's no large hiatal hernia with the condition, what we're able to do is to use the TIF device, actually called the EsophyX device made by a company called EndoGastric Solutions. And it does what's called the TIF procedure. Now, TIF is short for transoral incisionless fundoplication, otherwise known as TIF. And what it is is a device that fits over the endoscope that we're able to insert into the patient. And then we're able to look back to the connection between the esophagus and the stomach and essentially repair the valve, basically pulling some tissue down that kind of corrects the normal appearance of the valve. And once we're able to do that, we have very good results in terms of symptom relief from typical reflux symptoms.

Prakash Chandran: Yeah, that sounds pretty amazing. So if I'm understanding this properly, there are no incisions. This is completely done endoscopically.

Dr. Alfred Johnson: This part is done endoscopically. Now, you know, we do have to account for the fact that many patients have large hiatal hernias. And so, unfortunately, that requires a laparoscopic component to the procedure. But for many patients who have either small hernias or no hernias, but significant reflux, this is an option with no incisions and it is an outpatient procedure. In fact, even when we're fixing the hiatal hernias laparoscopically, this is all still outpatient.

Prakash Chandran: So Dora, I want to move on to you here for a minute. We've kind of talked about this procedure. Talk a little bit about what you thought when you first heard about it and your experience going into the procedure itself.

Dora Chapa: I had never like heard of anything like this before, but when Dr. Johnson explained it to me, it seemed pretty simple. And I also did have the hiatal hernia. So when I would have, I would call them flare ups, it would aggravate my hernia. So it was like a double whammy. Any procedure is nerve wracking, but it wasn't nowhere near how I expected it to be. I was in some pain and discomfort after, but it didn't last long. And the outcome of it is I'll do the procedure any day over the way I was feeling.

Prakash Chandran: Absolutely. And before we get to that piece, Karla, talk a little bit about your experience. So, you know, what did you think when you heard about the TIF procedure for the first time? And talk about your experience going into it.

Karla Casanova: At first when they said, "Okay, you have this and we just have to do this. There is a cure for it." I was like, oof, I went for it. I didn't even think it twice. I was just down with the way I was living. And it gave me a much -- Well, now I can say that I'm living life for now. I can eat. Of course, I still take my precautions and everything. But it was not invasive. And there was just a little bit of pain afterwards, but nothing compares to the pain and the way that I was feeling before. I was like, I will do it anytime.

Prakash Chandran: Yeah. So clearly an effective procedure for you. Talk a little bit about your recovery time specifically, Karla.

Karla Casanova: It took me I will say like three days after the surgery for my throat feel better because, you know, you have tubes and all that stuff. But after a week, I was eating small, like really small bites and things like that and I was taking it really slow, but I was eating. I was not afraid of food no more. And it was just little by little, it was just liquids. And I know that I can say it was like two weeks max that I was just eating the small portions, but I was eating normal.

Prakash Chandran: Yeah, that's amazing. Dora, moving onto you. Talk a little bit about afterwards. You know, you said that, you know, you definitely would do it again. Talk a little bit about your recovery time and just your experience afterwards.

Dora Chapa: Yeah. Along with Karla, like she said, it takes about like the three days for not even really pain, just more discomfort of the throat and a little bit in my stomach, you know, because they pump you with air, so it was discomforting. But after all that passed, I still stayed on the strict diet that we were on, the liquids and, you know, mashed food and broths and stuff for a while.

Until about maybe four weeks after, I started eating a little bit more. But you still do gotta be careful because when you do swallow, it hurts. So you got to cut it up and chew it really good, so it can pass properly and you won't have the pain. But about two weeks after that, it was fine.

And, you know, now you get invited to go somewhere and I'm like, "Sure, I'll go now," because before it was like, "No, I can't. I'm going to stay home," because you don't know how bad you're going to feel. You don't know what's going to affect you, you know, at certain points, so you just would kind of shut down and not do anything. You'd rather not do or go anywhere. And now I'm like, "Sure. Let's go." I recommend this procedure to anybody who needs it because it works.

Prakash Chandran: Yeah. Dr. Johnson, this seems like an incredibly effective procedure and it seems like anyone suffering from GERD should get this. Is this for any demographic of person that experiences GERD? Talk a little bit about who this procedure is for.

Dr. Alfred Johnson: Well, correct. This is really for any patient who suffers from GERD on a frequent basis, several times a week or has documentation of complications of GERD on endoscopy. And we've seen patients have from multiple age groups. We've had patients in the 20s, we've had patients in the 80s all benefiting from the procedure.

Prakash Chandran: So, you know, this is the question that I want to ask all of you, but Dr. Johnson, I will start with you. There are going to be people listening to this that are you know, considering this procedure, they might have GERD. They might have some of the symptoms that you described before. Do you have any advice around how they should make this consideration on getting this type of procedure for themselves?

Dr. Alfred Johnson: Well, one would be whether or not you need to take medications such as a Prilosec or a Nexium. If you have to take that every single day in order to feel good, in order to feel better or if you have to take it on a long-term basis, those are people that probably need to consider some type of treatment or minimally invasive treatment to address the reflux. Because the actual recommendation by the FDA for these types of medications, it's not lifelong, you know, for you to have to take the medicine every single day of your life for the rest of your life in order to feel normal. So if that's the situation you're in, you probably should consider some type of treatment for reflux.

Prakash Chandran: Dora, I'll ask the same question to you. You know, you kind of mentioned your experience going into it, and now this experience afterwards, you know, you don't have to say no to going to things anymore. Any other advice that you want to share with people that might be considering getting this procedure?

Dora Chapa: I would just say be persistent with your doctors and if your doctor's not helping you or giving you the answers that you need, I mean, it took me a long time and I was like, "You know what? This is enough." And finally, I found Dr. Johnson who actually, like he said, he did listen to me and my problems and my symptoms and just be persistent because it's not fun having it. And, you know, like I said, any surgery, any procedure is scary, but it's well worth it. And it wasn't nowhere scary as I thought it was at the end.

Prakash Chandran: And Karla, we'll end with you. Any parting words of advice or wisdom to our audience that might be considering getting this procedure done?

Karla Casanova: That there is another way of living. There is a healthy way to living and it's just in our hands. It's there. You would just have to speak up and say, and be willing to not be afraid of getting better. I think that's one of the worst part for a lot of people. I know a lot of people that goes through all of this and is going through all this, and I told them about my experience and they're like, "Oh, you know, I have to think about it." But they're so afraid of just being under or being in a surgery settings. And me seeing myself before and after, it has helped me get my life back. I think that's one of my main things, getting to eat with my kids and be free to eat. It's amazing. It's just amazing.

Prakash Chandran: Well, I don't think I could have closed this conversation any better. So thank you so much for all of your time today. This has been truly informative and helpful, and I'm hoping that anyone that might be experiencing some of the symptoms of GERD will call in and get some help and consider getting this life-changing procedure done for themselves. So thank you so much for your time.

That's Dr. Alfred Johnson, a gastrointestinal surgical specialist for Dignity Health, and his two patients, Dora Chapa and Karla Casanova. For more information, call the Dignity Health Medical group at (209) 564-3700 and ask about getting referred to Dr. Johnson. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks for checking out this episode of Hello Healthy. My name is Prakash Chandran, and we'll talk next time.