The holidays are approaching and all those great treats can sometimes cause discomfort.
GERD (Gastroesophageal Reflux Disease), affects millions of people every year.
Reflux means that stomach acid and juices flow from the stomach back up into the tube that leads from the throat to the stomach (esophagus).
This causes heartburn. When you have heartburn that bothers you often, it is called gastroesophageal reflux disease, or GERD.
Having heartburn from time to time doesn't mean that you have GERD. With GERD, the reflux and heartburn last longer and come more often.
Though GERD can be uncomfortable, it is treatable.
Mick Meiselman, MD, is here to discuss the symptoms and treatment options available at NorthShore University HealthSystem.
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Healthy Strategies To Help Those With GERD
Featured Speaker:
Learn more about Dr. Mick Meiselman
Mick Meiselman, MD
Dr. Mick Meiselman is a board certified gastroenterologist and section chief of the Advanced Therapeutic Endoscopy Program at NorthShore University HealthSystem. The program provides care for patients with advanced esophageal, biliary tract and pancreatic disease. Dr. Meiselman also holds an academic appointment at the University of Chicago Pritzker School of Medicine, which is the principal teaching affiliate of NorthShore.Learn more about Dr. Mick Meiselman
Transcription:
Healthy Strategies To Help Those With GERD
Melanie Cole (Host): If you’ve ever suffered with GERD, gastroesophageal reflux disease, you know how uncomfortable if can be. Is GERD really what you have and is there something you can do about it? My guest today is Dr. Mick Meiselman. He is a board certified gastroenterologist and section chief of the Advanced Therapeutic Endoscopy program at NorthShore University HealthSystem. Welcome to the show, Dr. Meiselman. GERD, what is it? Are there certain causes we can nail down, triggers, and what can we do about it?
Dr. Mick Meiselman (Guest): Well, thanks, Melanie. First of all, gastroesophageal reflux disease can be fairly simple in its presentation. It could be as simple as heartburn. This is one thing that many patients will complain of and they can manage on their own. Other symptoms, however, can occur and are not as classic. In terms of this type of syndrome, it’s not so simple. You can have reflux where you actually bring up fluid into your chest, but then reflux can also present as chest pain. It can present with several ENT type findings—ear, nose, and throat type findings—where patients complain of fullness in the throat, sore throat, and point of fact, the really alarm findings that we have when people have GERD are either trouble swallowing or painful swallowing or weight loss. Those three symptoms are something that you’re definitely going to want to see your physician sooner rather than later – the so-called alarm signs of difficulty swallowing and painful swallowing and associated weight loss.
Melanie: If somebody is suffering with GERD, the way to diagnose is what, endoscopy? You have an endoscopy and you can see what goes on or if it’s causing any kind of esophagitis, or even worse problems. Then what?
Dr. Meiselman: Well, sure, endoscopy is very helpful, but let me make it pretty clear. Reflux is common. If you really look at a population of adults greater than 50 and you tease out a history, you can get a history of reflux in 50% to 75% of cases. For uncomplicated GERD, it’s acceptable to treat those patients with lifestyle modifications and some medications, which we may or may not get into later in the talk. We don’t have to jump to make a definitive diagnosis. However, in general, if we have associated alarm signs that we talked about, painful swallowing or difficulty swallowing, where if patients don’t really promptly respond to therapy, then endoscopy, which is a lighted tube that we can have the patient swallow under some light anesthesia, we go in, take a look and we can determine whether or not there is reflux, whether or not there is damage from the reflux, which can then predicate how we’re going to approach that from the standpoint of therapy. Is it just four weeks or is it long-term therapy? Endoscopy also helps us to make sure that in patients greater than 50 years of age, that there’s not a precancerous change caused by the reflux or so called Barrett’s esophagus.
Melanie: I’ve had an endoscopy and been checked for Barrett’s myself and I can tell the listeners it is very easy. You are put out and it goes very quickly. You wake up, it’s done. You didn’t even know what happened and you don’t have to do all the prep that goes along with a colonoscopy. Now, as we talk about treatments, if it’s a simple reflux, and there are so many antacids, Dr. Meiselman, on the market, do you recommend the over-the-counter, or do you want to start with the medications to reduce that acid production?
Dr. Meiselman: To be upfront with you, I’d rather see lifestyle modifications first. I think if one wants to take antacids, over-the-counter famotidine or over-the-counter Mylanta, Maalox, those are all appropriate, but realistically, you have to ask yourself why am I getting reflux? Is it something that I’m doing? We get it with age, but there’s lots of factors that precipitated, that you need to consider in terms of modifying your life. If you like, I’d go through those with you.
Melanie: I would love for you to do that because lifestyle modification would be the best first line of defense. Go for it.
Dr. Meiselman: They really are. And in point of fact, even if you go on medication, really, you need to do lifestyle modifications to really minimize the damage and make yourself the most comfortable. Lifestyle modifications, all right. First of all, you want to try to avoid overeating. The corollary there is one eats at least three meals per day, okay? Generally, fats tend to delay the stomach’s emptying and they also open up the sphincter between the esophagus and the stomach, so they really can provoke reflux. You want to have a low-fat diet, three meals per day. You want to minimize coffee. Coffee can cause reflux. Now, we used to think it was just the caffeine, but then some good work by a gentleman named [Sydney Cohn] out of Temple in Philadelphia showed that even decaffeinated coffee provokes reflux. One drink at night is fine, but excessive alcohol promotes reflux and it promotes damage. Then another important factor is to not eat before lying down. There’s a lot of gravity in this. When you eat and then lie down within an hour or two, your stomach is full and you tend to relax. The sphincter, again that muscle between the esophagus and stomach, relaxes, and then sure enough, you’ll have reflux. You want to go to bed on an empty stomach. I tell patients, no solids three hours before bed, have water up until one hour before bed, and then nothing until the next morning. Finally, everybody has got to kind of look at themselves and say, how about weight? If you gain just 10 pounds, that can precipitate the onset of reflux. Reflux is very weight-related. You got to work on keeping your weight down.
Melanie: If you exercise, if you are an exerciser later in the day, does that affect how that meal is digested? Obviously, we want to do it to keep our weight in control, but is there any effect from exercise?
Dr. Meiselman: Yeah, I think that exercise is critical. In general, I think it’s great to exercise before you eat dinner, but the point that I see a lot of my patients come to, is they say, “Well, I can’t exercise before dinner and then get my dinner done and then wait three hours to go to bed.” I tell you. I’m willing to work around the exercise. There are people where exercise precipitates the reflux, but I think it’s so important to a healthy lifestyle, I say exercise and we worry about working your diet around it.
Melanie: Now, is there something that would signal that it is getting worse and someone should come to see you? Like if it is getting to be Barrett’s esophagus or any of those, the trouble swallowing, those kinds of things would signal a little red flag?
Dr. Meiselman: Yes, truly. You get painful swallowing, trouble swallowing. The other thing, we know that there are some specific risk factors for Barrett’s esophagus. Tobacco and alcohol are risk factors, and even Caucasian males greater than 50 tend to have a high incidence of Barrett’s. In some states, it’s up to 10% to 15% of the population. We have a lower threshold to put a scope down somebody who is smoking, drinks some alcohol. they can be greater than 50 years old and Caucasian and male greater than female. These are the risk factors that we look at. But, yes, pain with swallowing and trouble swallowing are clearly key or just a lack of complete response to medication and lifestyle.
Melanie: Now, Dr. Meiselman, holidays are coming up, not too far away, and people overeat. They eat and get tired and fall asleep. They eat too much and so it takes a while to digest all of that food. What advice do you have for people to try and keep their meals smaller through the day? That’s hard to do on the holidays.
Dr. Meiselman: Holiday heartburn is a real entity. We see people on the other end after the holidays, January or February, they’ve picked up 10 to 15 pounds. You got to try to keep your weight down. I don’t think you need to plan for tomorrow. I think you plan for today and you keep your meals down. You try to keep the fats down. Chocolate, desserts are going to be factors. Not only will they put weight on you, but again, chocolate actually in itself is refluxogenic. Meat is refluxogenic, and so are fatty foods. The best I can tell you is plan ahead. Sure, if you want to splurge a little bit on the holidays, you’ve got to be careful and you got to keep your free eating through the holidays.
Melanie: Dr. Meiselman, we only have a couple of minutes left. Before I ask you the last question, I’d like to know what you think about something like some alternative like vinegar. Does that help regulate the pH and help with that acid production for reflux?
Dr. Meiselman: I think there’s a role for vinegar, but keep in mind, that the stomach is a reservoir; it has intense acid in it. The effect of vinegar is likely to be relatively transient. Certainly, vinegar isn’t going to help you heal the inflammatory change. The other thing about reflux is it’s not all about acid. There’s also bile, pepsin. There’s different enzymes in the stomach fluid and that’s why we’re trying to do the lifestyle to prevent the reflux of not only acid, but bile, pepsin, enzymes up into your esophagus is important. I don’t have any problem with utilizing vinegar, but it won’t really provoke a healing response. It’s more of a temporizing approach.
Melanie: Dr. Meiselman, in just the last minute, tell the listeners why they should come to NorthShore University HealthSystem for their gastrointestinal care.
Dr. Meiselman: Thank you very much. Well, we really do believe that we have an excellent system. We try to deliver extremely personalized care. We believe in trying to meet the patient’s expectations and we believe in looking at lifestyle rather than jumping to more aggressive therapies. We didn’t talk about medical therapies, but again, we try to treat the whole patient. A lot of times, patients will come to NorthShore with reflux as their problem, but we’ll diagnose other problems that are contributing, lifestyle issues. To sum it up, we try and treat the whole person. Reflux just may be the presenting symptom.
Melanie: Great information. Thank you so much. You are listening to NorthShore Health and Wellness. For more information, you can go to northshore.org. That’s northshore.org. This is Melanie Cole for NorthShore University HealthSystem. Thanks for listening.
Healthy Strategies To Help Those With GERD
Melanie Cole (Host): If you’ve ever suffered with GERD, gastroesophageal reflux disease, you know how uncomfortable if can be. Is GERD really what you have and is there something you can do about it? My guest today is Dr. Mick Meiselman. He is a board certified gastroenterologist and section chief of the Advanced Therapeutic Endoscopy program at NorthShore University HealthSystem. Welcome to the show, Dr. Meiselman. GERD, what is it? Are there certain causes we can nail down, triggers, and what can we do about it?
Dr. Mick Meiselman (Guest): Well, thanks, Melanie. First of all, gastroesophageal reflux disease can be fairly simple in its presentation. It could be as simple as heartburn. This is one thing that many patients will complain of and they can manage on their own. Other symptoms, however, can occur and are not as classic. In terms of this type of syndrome, it’s not so simple. You can have reflux where you actually bring up fluid into your chest, but then reflux can also present as chest pain. It can present with several ENT type findings—ear, nose, and throat type findings—where patients complain of fullness in the throat, sore throat, and point of fact, the really alarm findings that we have when people have GERD are either trouble swallowing or painful swallowing or weight loss. Those three symptoms are something that you’re definitely going to want to see your physician sooner rather than later – the so-called alarm signs of difficulty swallowing and painful swallowing and associated weight loss.
Melanie: If somebody is suffering with GERD, the way to diagnose is what, endoscopy? You have an endoscopy and you can see what goes on or if it’s causing any kind of esophagitis, or even worse problems. Then what?
Dr. Meiselman: Well, sure, endoscopy is very helpful, but let me make it pretty clear. Reflux is common. If you really look at a population of adults greater than 50 and you tease out a history, you can get a history of reflux in 50% to 75% of cases. For uncomplicated GERD, it’s acceptable to treat those patients with lifestyle modifications and some medications, which we may or may not get into later in the talk. We don’t have to jump to make a definitive diagnosis. However, in general, if we have associated alarm signs that we talked about, painful swallowing or difficulty swallowing, where if patients don’t really promptly respond to therapy, then endoscopy, which is a lighted tube that we can have the patient swallow under some light anesthesia, we go in, take a look and we can determine whether or not there is reflux, whether or not there is damage from the reflux, which can then predicate how we’re going to approach that from the standpoint of therapy. Is it just four weeks or is it long-term therapy? Endoscopy also helps us to make sure that in patients greater than 50 years of age, that there’s not a precancerous change caused by the reflux or so called Barrett’s esophagus.
Melanie: I’ve had an endoscopy and been checked for Barrett’s myself and I can tell the listeners it is very easy. You are put out and it goes very quickly. You wake up, it’s done. You didn’t even know what happened and you don’t have to do all the prep that goes along with a colonoscopy. Now, as we talk about treatments, if it’s a simple reflux, and there are so many antacids, Dr. Meiselman, on the market, do you recommend the over-the-counter, or do you want to start with the medications to reduce that acid production?
Dr. Meiselman: To be upfront with you, I’d rather see lifestyle modifications first. I think if one wants to take antacids, over-the-counter famotidine or over-the-counter Mylanta, Maalox, those are all appropriate, but realistically, you have to ask yourself why am I getting reflux? Is it something that I’m doing? We get it with age, but there’s lots of factors that precipitated, that you need to consider in terms of modifying your life. If you like, I’d go through those with you.
Melanie: I would love for you to do that because lifestyle modification would be the best first line of defense. Go for it.
Dr. Meiselman: They really are. And in point of fact, even if you go on medication, really, you need to do lifestyle modifications to really minimize the damage and make yourself the most comfortable. Lifestyle modifications, all right. First of all, you want to try to avoid overeating. The corollary there is one eats at least three meals per day, okay? Generally, fats tend to delay the stomach’s emptying and they also open up the sphincter between the esophagus and the stomach, so they really can provoke reflux. You want to have a low-fat diet, three meals per day. You want to minimize coffee. Coffee can cause reflux. Now, we used to think it was just the caffeine, but then some good work by a gentleman named [Sydney Cohn] out of Temple in Philadelphia showed that even decaffeinated coffee provokes reflux. One drink at night is fine, but excessive alcohol promotes reflux and it promotes damage. Then another important factor is to not eat before lying down. There’s a lot of gravity in this. When you eat and then lie down within an hour or two, your stomach is full and you tend to relax. The sphincter, again that muscle between the esophagus and stomach, relaxes, and then sure enough, you’ll have reflux. You want to go to bed on an empty stomach. I tell patients, no solids three hours before bed, have water up until one hour before bed, and then nothing until the next morning. Finally, everybody has got to kind of look at themselves and say, how about weight? If you gain just 10 pounds, that can precipitate the onset of reflux. Reflux is very weight-related. You got to work on keeping your weight down.
Melanie: If you exercise, if you are an exerciser later in the day, does that affect how that meal is digested? Obviously, we want to do it to keep our weight in control, but is there any effect from exercise?
Dr. Meiselman: Yeah, I think that exercise is critical. In general, I think it’s great to exercise before you eat dinner, but the point that I see a lot of my patients come to, is they say, “Well, I can’t exercise before dinner and then get my dinner done and then wait three hours to go to bed.” I tell you. I’m willing to work around the exercise. There are people where exercise precipitates the reflux, but I think it’s so important to a healthy lifestyle, I say exercise and we worry about working your diet around it.
Melanie: Now, is there something that would signal that it is getting worse and someone should come to see you? Like if it is getting to be Barrett’s esophagus or any of those, the trouble swallowing, those kinds of things would signal a little red flag?
Dr. Meiselman: Yes, truly. You get painful swallowing, trouble swallowing. The other thing, we know that there are some specific risk factors for Barrett’s esophagus. Tobacco and alcohol are risk factors, and even Caucasian males greater than 50 tend to have a high incidence of Barrett’s. In some states, it’s up to 10% to 15% of the population. We have a lower threshold to put a scope down somebody who is smoking, drinks some alcohol. they can be greater than 50 years old and Caucasian and male greater than female. These are the risk factors that we look at. But, yes, pain with swallowing and trouble swallowing are clearly key or just a lack of complete response to medication and lifestyle.
Melanie: Now, Dr. Meiselman, holidays are coming up, not too far away, and people overeat. They eat and get tired and fall asleep. They eat too much and so it takes a while to digest all of that food. What advice do you have for people to try and keep their meals smaller through the day? That’s hard to do on the holidays.
Dr. Meiselman: Holiday heartburn is a real entity. We see people on the other end after the holidays, January or February, they’ve picked up 10 to 15 pounds. You got to try to keep your weight down. I don’t think you need to plan for tomorrow. I think you plan for today and you keep your meals down. You try to keep the fats down. Chocolate, desserts are going to be factors. Not only will they put weight on you, but again, chocolate actually in itself is refluxogenic. Meat is refluxogenic, and so are fatty foods. The best I can tell you is plan ahead. Sure, if you want to splurge a little bit on the holidays, you’ve got to be careful and you got to keep your free eating through the holidays.
Melanie: Dr. Meiselman, we only have a couple of minutes left. Before I ask you the last question, I’d like to know what you think about something like some alternative like vinegar. Does that help regulate the pH and help with that acid production for reflux?
Dr. Meiselman: I think there’s a role for vinegar, but keep in mind, that the stomach is a reservoir; it has intense acid in it. The effect of vinegar is likely to be relatively transient. Certainly, vinegar isn’t going to help you heal the inflammatory change. The other thing about reflux is it’s not all about acid. There’s also bile, pepsin. There’s different enzymes in the stomach fluid and that’s why we’re trying to do the lifestyle to prevent the reflux of not only acid, but bile, pepsin, enzymes up into your esophagus is important. I don’t have any problem with utilizing vinegar, but it won’t really provoke a healing response. It’s more of a temporizing approach.
Melanie: Dr. Meiselman, in just the last minute, tell the listeners why they should come to NorthShore University HealthSystem for their gastrointestinal care.
Dr. Meiselman: Thank you very much. Well, we really do believe that we have an excellent system. We try to deliver extremely personalized care. We believe in trying to meet the patient’s expectations and we believe in looking at lifestyle rather than jumping to more aggressive therapies. We didn’t talk about medical therapies, but again, we try to treat the whole patient. A lot of times, patients will come to NorthShore with reflux as their problem, but we’ll diagnose other problems that are contributing, lifestyle issues. To sum it up, we try and treat the whole person. Reflux just may be the presenting symptom.
Melanie: Great information. Thank you so much. You are listening to NorthShore Health and Wellness. For more information, you can go to northshore.org. That’s northshore.org. This is Melanie Cole for NorthShore University HealthSystem. Thanks for listening.