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GERD
Dr. Yash Mittal explains GERD, how it's different from reflux and heartburn, symptoms and treatment options available.
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Learn more about Yash Mittal, MD
Yash Mittal, MD
Yash Mittal, MD, is a Board Certified Gastroenterologist at the Eisenhower Gastroenterology Specialty Clinic in Rancho Mirage, California. After receiving his bachelor’s degree from the University of California, Los Angeles, Dr. Mittal earned his medical degree from the University of California, San Diego. He completed his residency in Internal Medicine at Yale New Haven Hospital in Connecticut and then completed a fellowship in Gastroenterology at the University of California, San Diego.Learn more about Yash Mittal, MD
Transcription:
You're listening to another episode of Living Well with Eisenhower Health, healthcare as it should be.
Scott Webb: Gastroesophageal reflux disease, commonly referred to as GERD can cause heartburn and other symptoms and be quite serious if left untreated and joining me today to explain GERD and how it's diagnosed and treated as Dr. Yash Mittal. He's a gastroenterologist at the Eisenhower Gastroenterology Specialty Clinic. And doctor, thanks so much for being on. Let's start here. What is GERD?
Dr. Yash Mittal: Yeah. So gastroesophageal reflux disease or called GERD is basically when stomach contents are coming up into the esophagus. And when we think of GERD, we're really thinking about two major symptoms. And those symptoms are heartburn, which is that burning sensation that comes up the chest because of the acid that is sitting in the esophagus. And then the other symptom is actually a regurgitation. And that's where liquid and food is coming up into the esophagus. And patients can feel both of those symptoms, because of those stomach contents that are coming up into the esophagus.
Scott Webb: Right. And is GERD different from, let's say, acid reflux or heartburn?
Dr. Yash Mittal: Yeah, so many different names for the same kind of phenomenon. Acid heartburn or reflux, that's just some of the symptoms of GERD. And as I mentioned previously, you know, GERD, we really think of comprises both heartburn and regurgitation.
Scott Webb: And who's at the greatest risk of getting GERD?
Dr. Yash Mittal: Yeah. So it's a little bit unclear exactly who is at the greatest risk. Um, we definitely know some people such as people who are obese, um, and then some people who have anatomic defects that are sometimes age-related, um, when they have hiatal hernias and that's where some of the stomach actually slides up into the chest, uh, which causes kind of barrier problems as we like to think about it.
So I think those are two of the kind of people that are at risk for it. Now, obviously hiatal hernias, um, we won't know until we do the formal testing for it. Um, so I think sometimes age is really kind of the thing that we think about, but many younger people have it as well. So it's hard to say. Uh, really what we think about is kind of doing a very careful history and asking patients what they're feeling. And that obviously tells us whether they're actually having heartburn or not, or reflux or GERD symptoms.
Scott Webb: Do we know specifically what causes GERD?
Dr. Yash Mittal: So one of the things, as I mentioned previously, you know, hiatal hernias, uh, do cause a decreased barrier to the passage of contents from the stomach into the esophagus. So that's one etiology. Um, but otherwise, you know, the actual symptoms of GERD, a lot of it is caused by the acid or the things that are regurgitating into the esophagus. Um, so that's what we kind of think of as what's causing it in the pathogenesis.
Scott Webb: And so if we have a sense of what's causing it, which is the things presumably we're putting into our body, does that then mean that we can treat GERD by changing our diet?
Dr. Yash Mittal: So a lot of times patients say specific things will cause them very troublesome symptoms and they say spicy foods, tomato sauce, citrus, uh, fruits or coffee, chocolate. Um, and you know, our more formal guidelines and studies have not necessarily shown that there are specific, um, causative foods. However, patients do frequently come in saying that they're having trouble with some symptoms, uh, from certain foods.
So we always say, you know, if there is something that you notice that is causing you symptoms, avoid that, because it will cause you discomfort. However, if you are really in the mood or desire to have something like that, know that you will have some symptoms, which can be treated with taking some antacid therapy.
Scott Webb: Yeah. And I think we've all been in that position where we know that something, as you say, maybe chocolate or coffee or pasta sauce or something might cause us some discomfort, but we kind of weigh the risk and reward and, you know, "How much do I really want that cup of coffee?" You know? And I think all of us have kind of been there. Is GERD chronic?
Dr. Yash Mittal: Yes. So a lot of times it is, and there's not necessarily a good treatment. Um, if someone actually is proven to have GERD, uh, you know, we kind of face two different scenarios. One is patients are okay with taking medications and the other is that they say, you know, "I'm not comfortable with taking medications and I would like to undergo surgery." So there are surgical options as well.
Scott Webb: Yeah. And I want to also talk about Barrett's in a little bit, but last question about GERD, can it lead directly to cancer?
Dr. Yash Mittal: Yes. So there's been a lot of studies on, uh, reflux disease and cancer. So we think of reflux disease leading to Barrett's esophagus. Barrett's esophagus is where there's a change in the lining of the esophagus to that of the stomach and small intestine. And that we think of as a precancerous condition. And with that precancerous condition, obviously over time, it can go through the stages and become cancer. So, yes, GERD is considered a precancerous condition, and that really has been studied by a lot of epidemiological data that has actually shown that the most consistent risk factor for Barrett's esophagus and cancer is acid reflux.
Scott Webb: Got it. Okay. And you're touching on Barrett's there. So what are the treatment options for Barrett's? Is it medication? Surgery? And if it is surgery, then can that be minimally invasive?
Dr. Yash Mittal: Yes, that is a very in-depth question, because, uh, Barrett's is a very complex disease in itself. So Barrett's esophagus has different stages. And it really depends on the stage of the disease that we tailor the therapy towards. So, as I mentioned, Barrett's esophagus has many different stages from very, very far from cancer to very close to cancer. So depending on where in that spectrum a patient is, will determine the therapy that they undergo.
And there are many endoscopic tools that we do have some here at, uh, Eisenhower Hospital that we can utilize to treat patients for Barrett's esophagus, depending on the stage of the disease that they do have. Now, sometimes if it is actually cancer, then they will need surgery for it.
Scott Webb: Got you. And we've touched on this a little bit, but let's go through this. How is GERD diagnosed or Barrett's diagnosed? What's the process for people who think that they may have either or potentially, you know, GERD has led to Barrett's?
Dr. Yash Mittal: Number one is the most important thing, is taking a very careful history and understanding exactly what the patient's symptoms are. And if a patient is having symptoms that are consistent with gastroesophageal reflux disease, then our number one trial is to do medical management, as well as some lifestyle management. We frequently recommend weight loss if patients are overweight, uh, and then dietary kind of substitutions, if there are those things that are contributing.
So then we measure what a patient's responses are to that as well as medical treatment and the medical treatment most commonly is PPI therapy. So depending on how a patient responds to PPI therapy will really determine if we think it's GERD versus something different. Because if a patient is not responding to maximal dose PPI therapy, then we really have to consider whether there could be a different problem that is presenting with similar symptoms that GERD has.
And those could be motility abnormalities. That could be inflammatory conditions that are going on in the esophagus as well, which we do further evaluation for. The first test is usually endoscopy and endoscopy is how we also diagnose Barrett's esophagus, because we look directly at the mucosa and we can take biopsies to see if there are abnormalities there that are consistent with Barrett's esophagus, with GERD or if there's another condition that we need to be considering.
Scott Webb: Yeah, definitely. And so much great information here today. And doctor, as we wrap up, tell everybody the importance of diagnosing and treating GERD.
Dr. Yash Mittal: GERD is becoming a very well recognized disorder. The management of GERD has many different options as more data comes out about the longterm effects of PPIs. A lot of providers even have lots of questions on whether they should recommend these to patients are not. Getting a gastroenterologist involved is always a good thing, because then the patient has more reassurance that a provider who is dealing with this on a very regular basis is evaluating to make sure that there's nothing more sinister going on or make sure that we have the correct diagnosis in the first place.
So we have lots of tools available. Here at Eisenhower, we do utilize those tools as well. And we are always happy to help evaluate and manage these patients. And if there's ever a question don't hesitate to refer over to the Gastroenterology Service to make sure that we, number one, have the right diagnosis and, number two, have the best treatment for that patient.
Scott Webb: That's great. What a perfect way to end, doctor. Thanks so much for your time today breaking all this down for us and you stay well.
Dr. Yash Mittal: Thank you so much.
Scott Webb: That's Dr. Yash Mittal, gastroenterologist at the Eisenhower Gastroenterology Specialty Clinic. And for more information on GERD, visit EisenhowerHealth.org/GI.
And if you found this podcast helpful, please share it on your social channels and check out the entire podcast library for topics of interest to you. This is Living Well with Eisenhower Health. I'm Scott Webb. Thanks for listening. Stay well. Eisenhower Health, healthcare as it should be.
You're listening to another episode of Living Well with Eisenhower Health, healthcare as it should be.
Scott Webb: Gastroesophageal reflux disease, commonly referred to as GERD can cause heartburn and other symptoms and be quite serious if left untreated and joining me today to explain GERD and how it's diagnosed and treated as Dr. Yash Mittal. He's a gastroenterologist at the Eisenhower Gastroenterology Specialty Clinic. And doctor, thanks so much for being on. Let's start here. What is GERD?
Dr. Yash Mittal: Yeah. So gastroesophageal reflux disease or called GERD is basically when stomach contents are coming up into the esophagus. And when we think of GERD, we're really thinking about two major symptoms. And those symptoms are heartburn, which is that burning sensation that comes up the chest because of the acid that is sitting in the esophagus. And then the other symptom is actually a regurgitation. And that's where liquid and food is coming up into the esophagus. And patients can feel both of those symptoms, because of those stomach contents that are coming up into the esophagus.
Scott Webb: Right. And is GERD different from, let's say, acid reflux or heartburn?
Dr. Yash Mittal: Yeah, so many different names for the same kind of phenomenon. Acid heartburn or reflux, that's just some of the symptoms of GERD. And as I mentioned previously, you know, GERD, we really think of comprises both heartburn and regurgitation.
Scott Webb: And who's at the greatest risk of getting GERD?
Dr. Yash Mittal: Yeah. So it's a little bit unclear exactly who is at the greatest risk. Um, we definitely know some people such as people who are obese, um, and then some people who have anatomic defects that are sometimes age-related, um, when they have hiatal hernias and that's where some of the stomach actually slides up into the chest, uh, which causes kind of barrier problems as we like to think about it.
So I think those are two of the kind of people that are at risk for it. Now, obviously hiatal hernias, um, we won't know until we do the formal testing for it. Um, so I think sometimes age is really kind of the thing that we think about, but many younger people have it as well. So it's hard to say. Uh, really what we think about is kind of doing a very careful history and asking patients what they're feeling. And that obviously tells us whether they're actually having heartburn or not, or reflux or GERD symptoms.
Scott Webb: Do we know specifically what causes GERD?
Dr. Yash Mittal: So one of the things, as I mentioned previously, you know, hiatal hernias, uh, do cause a decreased barrier to the passage of contents from the stomach into the esophagus. So that's one etiology. Um, but otherwise, you know, the actual symptoms of GERD, a lot of it is caused by the acid or the things that are regurgitating into the esophagus. Um, so that's what we kind of think of as what's causing it in the pathogenesis.
Scott Webb: And so if we have a sense of what's causing it, which is the things presumably we're putting into our body, does that then mean that we can treat GERD by changing our diet?
Dr. Yash Mittal: So a lot of times patients say specific things will cause them very troublesome symptoms and they say spicy foods, tomato sauce, citrus, uh, fruits or coffee, chocolate. Um, and you know, our more formal guidelines and studies have not necessarily shown that there are specific, um, causative foods. However, patients do frequently come in saying that they're having trouble with some symptoms, uh, from certain foods.
So we always say, you know, if there is something that you notice that is causing you symptoms, avoid that, because it will cause you discomfort. However, if you are really in the mood or desire to have something like that, know that you will have some symptoms, which can be treated with taking some antacid therapy.
Scott Webb: Yeah. And I think we've all been in that position where we know that something, as you say, maybe chocolate or coffee or pasta sauce or something might cause us some discomfort, but we kind of weigh the risk and reward and, you know, "How much do I really want that cup of coffee?" You know? And I think all of us have kind of been there. Is GERD chronic?
Dr. Yash Mittal: Yes. So a lot of times it is, and there's not necessarily a good treatment. Um, if someone actually is proven to have GERD, uh, you know, we kind of face two different scenarios. One is patients are okay with taking medications and the other is that they say, you know, "I'm not comfortable with taking medications and I would like to undergo surgery." So there are surgical options as well.
Scott Webb: Yeah. And I want to also talk about Barrett's in a little bit, but last question about GERD, can it lead directly to cancer?
Dr. Yash Mittal: Yes. So there's been a lot of studies on, uh, reflux disease and cancer. So we think of reflux disease leading to Barrett's esophagus. Barrett's esophagus is where there's a change in the lining of the esophagus to that of the stomach and small intestine. And that we think of as a precancerous condition. And with that precancerous condition, obviously over time, it can go through the stages and become cancer. So, yes, GERD is considered a precancerous condition, and that really has been studied by a lot of epidemiological data that has actually shown that the most consistent risk factor for Barrett's esophagus and cancer is acid reflux.
Scott Webb: Got it. Okay. And you're touching on Barrett's there. So what are the treatment options for Barrett's? Is it medication? Surgery? And if it is surgery, then can that be minimally invasive?
Dr. Yash Mittal: Yes, that is a very in-depth question, because, uh, Barrett's is a very complex disease in itself. So Barrett's esophagus has different stages. And it really depends on the stage of the disease that we tailor the therapy towards. So, as I mentioned, Barrett's esophagus has many different stages from very, very far from cancer to very close to cancer. So depending on where in that spectrum a patient is, will determine the therapy that they undergo.
And there are many endoscopic tools that we do have some here at, uh, Eisenhower Hospital that we can utilize to treat patients for Barrett's esophagus, depending on the stage of the disease that they do have. Now, sometimes if it is actually cancer, then they will need surgery for it.
Scott Webb: Got you. And we've touched on this a little bit, but let's go through this. How is GERD diagnosed or Barrett's diagnosed? What's the process for people who think that they may have either or potentially, you know, GERD has led to Barrett's?
Dr. Yash Mittal: Number one is the most important thing, is taking a very careful history and understanding exactly what the patient's symptoms are. And if a patient is having symptoms that are consistent with gastroesophageal reflux disease, then our number one trial is to do medical management, as well as some lifestyle management. We frequently recommend weight loss if patients are overweight, uh, and then dietary kind of substitutions, if there are those things that are contributing.
So then we measure what a patient's responses are to that as well as medical treatment and the medical treatment most commonly is PPI therapy. So depending on how a patient responds to PPI therapy will really determine if we think it's GERD versus something different. Because if a patient is not responding to maximal dose PPI therapy, then we really have to consider whether there could be a different problem that is presenting with similar symptoms that GERD has.
And those could be motility abnormalities. That could be inflammatory conditions that are going on in the esophagus as well, which we do further evaluation for. The first test is usually endoscopy and endoscopy is how we also diagnose Barrett's esophagus, because we look directly at the mucosa and we can take biopsies to see if there are abnormalities there that are consistent with Barrett's esophagus, with GERD or if there's another condition that we need to be considering.
Scott Webb: Yeah, definitely. And so much great information here today. And doctor, as we wrap up, tell everybody the importance of diagnosing and treating GERD.
Dr. Yash Mittal: GERD is becoming a very well recognized disorder. The management of GERD has many different options as more data comes out about the longterm effects of PPIs. A lot of providers even have lots of questions on whether they should recommend these to patients are not. Getting a gastroenterologist involved is always a good thing, because then the patient has more reassurance that a provider who is dealing with this on a very regular basis is evaluating to make sure that there's nothing more sinister going on or make sure that we have the correct diagnosis in the first place.
So we have lots of tools available. Here at Eisenhower, we do utilize those tools as well. And we are always happy to help evaluate and manage these patients. And if there's ever a question don't hesitate to refer over to the Gastroenterology Service to make sure that we, number one, have the right diagnosis and, number two, have the best treatment for that patient.
Scott Webb: That's great. What a perfect way to end, doctor. Thanks so much for your time today breaking all this down for us and you stay well.
Dr. Yash Mittal: Thank you so much.
Scott Webb: That's Dr. Yash Mittal, gastroenterologist at the Eisenhower Gastroenterology Specialty Clinic. And for more information on GERD, visit EisenhowerHealth.org/GI.
And if you found this podcast helpful, please share it on your social channels and check out the entire podcast library for topics of interest to you. This is Living Well with Eisenhower Health. I'm Scott Webb. Thanks for listening. Stay well. Eisenhower Health, healthcare as it should be.