GERD (gastroesophageal reflux disease) is a digestive disorder that is caused when gastric acid from your stomach flows back up into your esophagus.
Heartburn is the most common symptom of GERD.
A muscle at the bottom of the esophagus opens to let food in and closes to keep food in the stomach.
This muscle is called the LES or lower esophageal sphincter. When your LES relaxes too often or for too long, acid backs up into your esophagus. This causes heartburn.
Jamie Ulbrich, MD is here to help you better understand acid reflux, GERD and how you can prevent and manage the symptoms.
Selected Podcast
Get a Handle on Heartburn and Acid Reflux
Featured Speaker:
Jamie Ulbrich, MD
Jamie Ulbrich, MD., specialty is family medicine. Diseases/Conditions Treated: Preventative care for infants, children and adults, care for acute and chronic conditions, immunizations and allergy shots and sports/camp/employment physicals. Transcription:
Get a Handle on Heartburn and Acid Reflux
Melanie Cole (Host): Many people get occasional heartburn and it can be an uncomfortable feeling of burning or warmth in the chest. However, if it persists or happens often, it might be a sign of a more serious condition called GERD. My guest today is Dr. Jamie Ulbrich. She's a family medicine physician at Hendricks Regional Health. Welcome to the show, Dr. Ulbrich. Tell us a little bit about heartburn and GERD and what is the difference between those two?
Dr. Jamie Ulbrich (Guest): Well, thank you for having me on your show. Heartburn and acid reflux are two different things. Heartburn is a symptom, or can be a symptom, of acid reflux. So, when you eat food, it goes through your esophagus--the long tube into your stomach. There's a little valve that's there, kind of like a gate, and it opens and closes to let food pass through. If that gate doesn't close all the way, the acid that's in your stomach can come back up into your esophagus and that's what we call “acid reflux”. That's the symptom that you feel that you get that irritated and burning feeling in your chest that we call “heartburn”.
Melanie: So then, when is it you term "GERD" what we're feeling?
Dr. Ulbrich: Sure. When you have that symptoms along with the other ones that some people will have with GERD, such as difficulty swallowing or, sometimes patients will complain of a cough that won't go away, or the feeling that the food from your stomach is coming back up into your mouth or regurgitating. If you have those symptoms on a more regular basis--more that two or three times a week--then we'd call that “GERD” or “gastroesophageal reflux disease”.
Melanie: So then, if somebody is suffering from this, how often would they notice it or would they notice it? Can it be silent?
Dr. Ulbrich: It can be silent. Some patients will have no symptoms of the burning part of it at all. Rather, they'll come in and say that they noticed that they're getting a hoarse voice or that they're coughing more often than they usually were. So, it's not always just those heartburn type symptoms that people will have but sometimes the heartburn can be so severe that it causes chest pain that people think they're having a heart attack. That can cause them to go to the emergency room to find out that really it was just acid reflux causing the symptoms. So, it can be mild and silent or it can be pretty severe.
Melanie: Are there certain risk factors? People who are predisposed to suffering from GERD?
Dr. Ulbrich: The things that we commonly see in patients who have GERD are obesity. A lot of patients are overweight. That can cause more problems. People who are smokers can have issues more than people who are non-smokers. It's pretty common in patients who have asthma to have GERD. Certain medications can cause issues as well, and then, just dietary lifestyle factors, too, like drinking a lot of coffee or caffeine, drinking more alcohol, or carbonated drinks, or eating a lot of citrus or spicy foods. Those can contribute to it, as well.
Melanie: So, when does it require medical care?
Dr. Ulbrich: If patients are having symptoms more often than a few times a week and the usual things, like antacid you can buy over the counter or medications like Pepcid, if they're not helping, those would be reasons to come and see your doctor. Also, if you have some more serious side effects that we call “red flags”--things like weight loss that you can't explain, difficulty with swallowing, either liquids or solid food, blood in your stool or dark stools; that could be a sign that you have maybe an ulcer that could be bleeding. Those would be reasons to go to see your doctor more quickly.
Melanie: So, tell us, first of all, about the diagnosis. Do you take a history or is an endoscopy usually what's required? Are you looking for complications, maybe Barrett's Esophagus, from this?
Dr. Ulbrich: Sure. If patients come in and they don't have any of those warning signs, and a lot of times, we can take their history and find out what's going on and allow them to give medications a try first. If they've already tried the over-the-counter ones, we use medications like PPI or proton pump inhibitors, most commonly, people have heard of Omeprazole or the ones you can buy over-the-counter, but also have prescription versions, too. If they try those things and are given a good course of them and they're still having symptoms, then we do get concerned with more other possible complications such as esophagitis, or inflammation in the esophagus, which can lead to Barrett's Esophagus, which is changes in the lining of the esophagus which can lead to cancerous changes. So, that's a big one that we want to make sure we're not missing.
Melanie: So then, let's speak about some of the treatments, Dr. Ulbrich, because you mentioned proton pump inhibitors and some of those medications. If somebody is on these, is this a lifetime thing? Is this something that can be managed? Maybe go away? How does that work?
Dr. Ulbrich: A lot of it is dependent on the patient's willingness to adhere to the changes in the lifestyle that they have to make. Losing weight, stopping smoking, giving up coffee or alcohol, things that make it worse. Not eating around bedtime can help, too. And, if those things, you're able to do it--some patients are able to ward it off without having to stay on medicines long-term, but it's kind of up to the patient if they're willing to make those changes or sometimes, they end up do having to stay on medications. The other thing I forgot to mention, too, is people often take anti-inflammatory medications like Aleve and Ibuprofen. They don't realize that those medications can cause a lot of irritation to their stomach. They're taking them every day for aches and pains or headaches and if you've been on those for a while, they can certainly be another thing that can cause the reflux to worsen and then cause changes in the stomach that lead patients to come to the doctor for it, too.
Melanie: Are there some things you'd like people to do to possibly prevent GERD and/or to manage it at home? Some things that you really tell people every single day?
Dr. Ulbrich: Yes, the number one is quitting smoking would be the first thing that people can do along with maintaining a healthy weight. If they're overweight, we talk about ways to help them lose weight. The other things that we talk about are not overeating and then eating good foods. Not fatty, greasy foods, but more high-protein, low fat kind of meals. Avoiding excess alcohol can help, too. Then, other things that some patients will try are propping up the head of their bed a few inches so that when they sleep at night, they're more at an angle and that reflux is less likely to occur.
Melanie: What about some of the other kinds of things people hear about? Trying vinegar or regulating the pH? Is there anything to that?
Dr. Ulbrich: There are. I mean, it is a change in the pH and some of the further studies that if a family doctor needs to refer to a specialist for some reason, that can be some of the other testing they do. None of those treatments are well-studied and there's no scientific background to them being beneficial.
Melanie: So, in just the last few minutes, give us your best advice for people that think they may have heartburn and/or GERD. What do you really want them to know about it?
Dr. Ulbrich: The first things I would have them try are the things we've discussed for helping them manage it at home on their own as long as they're not having any of those warning signs of unexplained weight loss or difficulty swallowing, vomiting all the time. If they don't have those red flags, then trying the things at home, like changing their diet and exercising, being a healthy lifestyle; those things can all be the first steps to try followed by trying things like over-the-counter antacids if they're helpful, or even the H2 blocker medications like Ranitidine or Pepcid over-the counter. If they're still experiencing their symptoms two or three times a week despite trying all those things, then they need to come in and speak with their family physician about what they can try next and make sure that no other further testing is needed, or prescription medications that may help them. We don't want them to get any of the complications that come with it and those medications can help to prevent those.
Melanie: Tell the listeners why they should come to Hendricks Regional Health for their care.
Dr. Ulbrich: Here at Hendricks Regional Health we have a great group of doctors from all specialties, starting with the primary care physicians that can help you figure things out and, if we need to refer you on to a specialist, we have plenty of those here, too, that are well-qualified to help patients figure out what's going on when we can't.
Melanie: Thank you so much for being with us today, Dr. Ulbrich. It's such great information. You're listening to Health Talks with HRH. For more information, you can go to hendricks.org. That's hendricks.org. This is Melanie Cole, thanks so much for listening.
Get a Handle on Heartburn and Acid Reflux
Melanie Cole (Host): Many people get occasional heartburn and it can be an uncomfortable feeling of burning or warmth in the chest. However, if it persists or happens often, it might be a sign of a more serious condition called GERD. My guest today is Dr. Jamie Ulbrich. She's a family medicine physician at Hendricks Regional Health. Welcome to the show, Dr. Ulbrich. Tell us a little bit about heartburn and GERD and what is the difference between those two?
Dr. Jamie Ulbrich (Guest): Well, thank you for having me on your show. Heartburn and acid reflux are two different things. Heartburn is a symptom, or can be a symptom, of acid reflux. So, when you eat food, it goes through your esophagus--the long tube into your stomach. There's a little valve that's there, kind of like a gate, and it opens and closes to let food pass through. If that gate doesn't close all the way, the acid that's in your stomach can come back up into your esophagus and that's what we call “acid reflux”. That's the symptom that you feel that you get that irritated and burning feeling in your chest that we call “heartburn”.
Melanie: So then, when is it you term "GERD" what we're feeling?
Dr. Ulbrich: Sure. When you have that symptoms along with the other ones that some people will have with GERD, such as difficulty swallowing or, sometimes patients will complain of a cough that won't go away, or the feeling that the food from your stomach is coming back up into your mouth or regurgitating. If you have those symptoms on a more regular basis--more that two or three times a week--then we'd call that “GERD” or “gastroesophageal reflux disease”.
Melanie: So then, if somebody is suffering from this, how often would they notice it or would they notice it? Can it be silent?
Dr. Ulbrich: It can be silent. Some patients will have no symptoms of the burning part of it at all. Rather, they'll come in and say that they noticed that they're getting a hoarse voice or that they're coughing more often than they usually were. So, it's not always just those heartburn type symptoms that people will have but sometimes the heartburn can be so severe that it causes chest pain that people think they're having a heart attack. That can cause them to go to the emergency room to find out that really it was just acid reflux causing the symptoms. So, it can be mild and silent or it can be pretty severe.
Melanie: Are there certain risk factors? People who are predisposed to suffering from GERD?
Dr. Ulbrich: The things that we commonly see in patients who have GERD are obesity. A lot of patients are overweight. That can cause more problems. People who are smokers can have issues more than people who are non-smokers. It's pretty common in patients who have asthma to have GERD. Certain medications can cause issues as well, and then, just dietary lifestyle factors, too, like drinking a lot of coffee or caffeine, drinking more alcohol, or carbonated drinks, or eating a lot of citrus or spicy foods. Those can contribute to it, as well.
Melanie: So, when does it require medical care?
Dr. Ulbrich: If patients are having symptoms more often than a few times a week and the usual things, like antacid you can buy over the counter or medications like Pepcid, if they're not helping, those would be reasons to come and see your doctor. Also, if you have some more serious side effects that we call “red flags”--things like weight loss that you can't explain, difficulty with swallowing, either liquids or solid food, blood in your stool or dark stools; that could be a sign that you have maybe an ulcer that could be bleeding. Those would be reasons to go to see your doctor more quickly.
Melanie: So, tell us, first of all, about the diagnosis. Do you take a history or is an endoscopy usually what's required? Are you looking for complications, maybe Barrett's Esophagus, from this?
Dr. Ulbrich: Sure. If patients come in and they don't have any of those warning signs, and a lot of times, we can take their history and find out what's going on and allow them to give medications a try first. If they've already tried the over-the-counter ones, we use medications like PPI or proton pump inhibitors, most commonly, people have heard of Omeprazole or the ones you can buy over-the-counter, but also have prescription versions, too. If they try those things and are given a good course of them and they're still having symptoms, then we do get concerned with more other possible complications such as esophagitis, or inflammation in the esophagus, which can lead to Barrett's Esophagus, which is changes in the lining of the esophagus which can lead to cancerous changes. So, that's a big one that we want to make sure we're not missing.
Melanie: So then, let's speak about some of the treatments, Dr. Ulbrich, because you mentioned proton pump inhibitors and some of those medications. If somebody is on these, is this a lifetime thing? Is this something that can be managed? Maybe go away? How does that work?
Dr. Ulbrich: A lot of it is dependent on the patient's willingness to adhere to the changes in the lifestyle that they have to make. Losing weight, stopping smoking, giving up coffee or alcohol, things that make it worse. Not eating around bedtime can help, too. And, if those things, you're able to do it--some patients are able to ward it off without having to stay on medicines long-term, but it's kind of up to the patient if they're willing to make those changes or sometimes, they end up do having to stay on medications. The other thing I forgot to mention, too, is people often take anti-inflammatory medications like Aleve and Ibuprofen. They don't realize that those medications can cause a lot of irritation to their stomach. They're taking them every day for aches and pains or headaches and if you've been on those for a while, they can certainly be another thing that can cause the reflux to worsen and then cause changes in the stomach that lead patients to come to the doctor for it, too.
Melanie: Are there some things you'd like people to do to possibly prevent GERD and/or to manage it at home? Some things that you really tell people every single day?
Dr. Ulbrich: Yes, the number one is quitting smoking would be the first thing that people can do along with maintaining a healthy weight. If they're overweight, we talk about ways to help them lose weight. The other things that we talk about are not overeating and then eating good foods. Not fatty, greasy foods, but more high-protein, low fat kind of meals. Avoiding excess alcohol can help, too. Then, other things that some patients will try are propping up the head of their bed a few inches so that when they sleep at night, they're more at an angle and that reflux is less likely to occur.
Melanie: What about some of the other kinds of things people hear about? Trying vinegar or regulating the pH? Is there anything to that?
Dr. Ulbrich: There are. I mean, it is a change in the pH and some of the further studies that if a family doctor needs to refer to a specialist for some reason, that can be some of the other testing they do. None of those treatments are well-studied and there's no scientific background to them being beneficial.
Melanie: So, in just the last few minutes, give us your best advice for people that think they may have heartburn and/or GERD. What do you really want them to know about it?
Dr. Ulbrich: The first things I would have them try are the things we've discussed for helping them manage it at home on their own as long as they're not having any of those warning signs of unexplained weight loss or difficulty swallowing, vomiting all the time. If they don't have those red flags, then trying the things at home, like changing their diet and exercising, being a healthy lifestyle; those things can all be the first steps to try followed by trying things like over-the-counter antacids if they're helpful, or even the H2 blocker medications like Ranitidine or Pepcid over-the counter. If they're still experiencing their symptoms two or three times a week despite trying all those things, then they need to come in and speak with their family physician about what they can try next and make sure that no other further testing is needed, or prescription medications that may help them. We don't want them to get any of the complications that come with it and those medications can help to prevent those.
Melanie: Tell the listeners why they should come to Hendricks Regional Health for their care.
Dr. Ulbrich: Here at Hendricks Regional Health we have a great group of doctors from all specialties, starting with the primary care physicians that can help you figure things out and, if we need to refer you on to a specialist, we have plenty of those here, too, that are well-qualified to help patients figure out what's going on when we can't.
Melanie: Thank you so much for being with us today, Dr. Ulbrich. It's such great information. You're listening to Health Talks with HRH. For more information, you can go to hendricks.org. That's hendricks.org. This is Melanie Cole, thanks so much for listening.