Gastroesophageal reflux disease, or GERD, is a digestive disorder that affects the lower esophageal sphincter, the ring of muscle between the esophagus and stomach.
Heartburn, also called acid indigestion, is the most common symptom of GERD and usually feels like a burning chest pain beginning behind the breastbone and moving upward to the neck and throat.
Doctors recommend lifestyle and dietary changes for most people needing treatment for GERD.
Treatment aims at decreasing the amount of reflux or reducing damage to the lining of the esophagus from refluxed materials.
Jatinder Pruthi, MD., is here to help you with your symptoms of GERD and give lifestyle advice to reduce the damage that undiagnosed GERD can cause.
Do You Suffer from Heartburn or GERD?
Featured Speaker:
Learn more about Jatinder Pruthi, MD
Jatinder Pruthi, MD
Jatinder Pruthi, MD, is board certified in Gastroenterology and a member of the medical staff at Palmdale Regional Medical Center.Learn more about Jatinder Pruthi, MD
Transcription:
Do You Suffer from Heartburn or GERD?
Melanie Cole (Host): Sometimes many of us feel a burning in the chest or throat known as heartburn. If you have these symptoms more often, however, you may have GERD. My guest today is Dr. Jay Pruthi. He is an astroenterologist and a member of the medical staff at Palmdale Regional Medical Center. Welcome to the show, Dr. Pruthi. Tell us a little bit about the difference between heartburn and GERD.
Dr. Jay Pruthi (Guest): Thank you for inviting me to the show. Heartburn or GERD is gastroesophageal reflux disease it’s also called “acid reflux”. When we eat food it goes from the mouth and the esophagus – that’s the food pipe – then, it goes into the stomach. Normally, the stomach has acid. When that acid, or any other contents from the stomach, back up in the esophagus, then we call it “acid reflux disease”. When the acid backs up, it gives the burning sensation in the esophagus and patients come and report that they have heartburn.
Melanie: Sometimes we don’t necessarily feel that heartburn, Dr. Pruthi. Can GERD, or gastroesophageal reflux, disease also be silent?
Dr. Pruthi: Yes, it could be. Most common symptoms of acid reflux disease are heartburn but some patients may not have heartburn. They may just have chest pain or trouble swallowing or may have raspy voice or sore throat or unexplained cough and some of them may not have any heartburn symptoms. They may just have the esophageal symptoms that we just described.
Melanie: Are there certain risk factors that would contribute and make someone predisposed to suffering from acid reflux?
Dr. Pruthi: Yes, the risk factors for acid reflux are obesity – people who are overweight; smoking, these are the risk factors and eating certain fatty, fried foods which release pressure in the esophageal sphincter and the acid backs up. These are the risk factors for acid reflux disease.
Melanie: If someone does come to you with some of these symptoms that you’ve described, how do you diagnose it? Are you also checking, if you do endoscopy, are you checking for Barrett’s or some complications from undiagnosed GERD?
Dr. Pruthi: When the patients have heartburn symptoms or other symptoms that we described which suggest acid reflux disease, they generally go to their primary doctors. If they have symptoms less than twice a week, we tell them, “This is simple acid reflux disease,” and they can take over the counter antacids. If the symptoms are more than twice a week, then they need medical attention. They should see the doctor or the provider. The diagnosis for acid reflux is generally by history. If they have acid reflux and everything fits together, this is reflux and they take antacids or acid-reducing medicines over the counter, the symptoms come under control that takes care of it. If the over the counter medications do not work and the symptoms continue to progress, then we do endoscopy. Endoscopy means the patient has to be on an empty stomach overnight, they come to the endoscopy center and we make them sleepy and put the camera through the mouth and esophagus and take a look and see if there is any damage going on in the esophagus from the acid reflux. Everybody does not need endoscopy. Patients who have some alarm symptoms, like they have difficulty swallowing, they have anemia, they have some bleeding or they’re losing weight or they have vomiting or they have persistent symptoms despite the treatment, they need endoscopy right away. People who are above 50 years of age, particularly males, and have chronic reflux symptoms for more than five years, they have symptoms at night time, they have history of hiatal hernia, they have obesity, body mass index is high, they’re smokers, they have abdominal obesity. Those are the people who also should have endoscopy right away. All people who have atypical reflux symptoms, they should also come for an endoscopy and that gives us a correct diagnosis. When we do endoscopy, we look at the lining of the esophagus in the lower esophagus and see what changes are going on. As the acid backs up, it can erode the lining of the esophagus and cause erosions and ulcerations. The lining can change into Barrett’s esophagus lining, as you mentioned. Barrett’s esophagus lining is a lining of the lower esophagus which has changed into something different. That is Barrett’s. The significance of Barrett’s esophagus is that it increases the risk of esophageal cancer. That’s very important to get a correct diagnosis and develop a treatment plan.
Melanie: Let’s talk about after diagnosis and the first line of defense. You mentioned over the counter medications but what about prescription medications – some of the proton pump inhibitors? We hear a lot about medications for reflux, Dr. Pruthi. Tell us about some of those.
Dr. Pruthi: The first line ideal plan is over the counter medications and if that works, very good; if not, then we use the prescription medications. Those are the H2 blockers like Ranitidine. The next line is proton pump inhibitor therapy which are Omeprazole, Esomeprazole, Pantoprazole, Rabeprazole. These are the medications which we can use to control their acid at the standard dose. We start with the standard dose and see how the effects are and then, if not, then we can go up at a higher dose and try those according to effects that control the symptoms and heal the erosions or, if there is any ulcer or something else going on, generally, the duration of the treatment is at least about 8-12 weeks. After that, we’ll see if the symptoms are under control. We can taper off these medications and generally people are good. If not, then we need to give them the medications for a longer period of time.
Melanie: What can they do at home and lifestyle changes to reduce their risk of having acid reflux and even to help themselves if they are on medication?
Dr. Pruthi: Lifestyle modifications are an important part of the management of reflux disease. First of all, if they’re overweight, try to lose weight. Avoid coffee, chocolate, peppermint, fatty foods – these are the foods which cause the esophagus to experience pressure and the acid backs up. The next step is alcohol. If they are drinking alcohol, they can cut back and stop alcohol. Stop smoking. Take smaller meals more frequently rather than having one large, big meal. At dinner time, avoid lying down for three hours after eating dinner. Eat your dinner at least three hours before you lie down. If still, the symptoms are bothersome then they can raise the head end of the bed by 6-8 inches by putting wooden blocks under the head end of the bed so the whole bed is tilted. Some people comment that they use the pillows but when we are sleeping the pillows slide off and those don’t work. Raise the head end of the bed by 6-8 inches with wooden blocks so that helps to control the symptoms.
Melanie: In just the last few minutes, Dr. Pruthi, what should people with GERD be thinking about when they are seeking care?
Dr. Pruthi: They are worried, most people, when they have reflux disease. They are worried what is going to happen, that this is a long term process, it is going to harm them or cause complications. Everybody hears about Barrett’s and esophageal cancer. In fact, reflux disease is quite common. We see that the prevalence is high and about 3-5% of patients develop long-term Barrett’s esophagus or short-term Barrett’s esophagus and those patients need surveillance because the annual cancer incidence in this situation is about .123%. The risk of developing esophageal cancer increases about 30 fold above the general population of patients that have higher body weight, long-term Barrett’s esophagus and older patients. Having said that, absolutely developing esophageal cancer in non-dysplastic Barrett’s is still very low. As long as we can treat them and provide a good management, control their symptoms, and do an endoscopy and keep their symptoms under control, we are good to go.
Melanie: Why should they come to Palmdale Regional Medical Center for their care? Tell us about your team.
Dr. Pruthi: We have a good team and we have good equipment. We have expert staff and we provide whatever we can do for them and help them diagnose the disease appropriately; suggest the lifestyle modifications; provide them the support and give them the appropriate medications, surveillance, treatments. If we find Barrett’s, we have several protocols. We bring them back every year for endoscopy and biopsy. If we detect a cancer or Barrett’s or we detect dysplasia, we have new equipment. We can ablate those segments of bad esophagus areas with radiofrequency ablation with that equipment that we have at Palmdale Hospital. We have been using it successfully over the last year and we have had good results. For all these reasons, they should come to us and we can take care of them.
Melanie: Thank you so much, Dr. Pruthi, for being with us today. It’s great information. You’re listening to Palmdale Regional Radio. For more information please visit PalmdaleRegional.com. That’s PalmdaleRegional.com. Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.
Do You Suffer from Heartburn or GERD?
Melanie Cole (Host): Sometimes many of us feel a burning in the chest or throat known as heartburn. If you have these symptoms more often, however, you may have GERD. My guest today is Dr. Jay Pruthi. He is an astroenterologist and a member of the medical staff at Palmdale Regional Medical Center. Welcome to the show, Dr. Pruthi. Tell us a little bit about the difference between heartburn and GERD.
Dr. Jay Pruthi (Guest): Thank you for inviting me to the show. Heartburn or GERD is gastroesophageal reflux disease it’s also called “acid reflux”. When we eat food it goes from the mouth and the esophagus – that’s the food pipe – then, it goes into the stomach. Normally, the stomach has acid. When that acid, or any other contents from the stomach, back up in the esophagus, then we call it “acid reflux disease”. When the acid backs up, it gives the burning sensation in the esophagus and patients come and report that they have heartburn.
Melanie: Sometimes we don’t necessarily feel that heartburn, Dr. Pruthi. Can GERD, or gastroesophageal reflux, disease also be silent?
Dr. Pruthi: Yes, it could be. Most common symptoms of acid reflux disease are heartburn but some patients may not have heartburn. They may just have chest pain or trouble swallowing or may have raspy voice or sore throat or unexplained cough and some of them may not have any heartburn symptoms. They may just have the esophageal symptoms that we just described.
Melanie: Are there certain risk factors that would contribute and make someone predisposed to suffering from acid reflux?
Dr. Pruthi: Yes, the risk factors for acid reflux are obesity – people who are overweight; smoking, these are the risk factors and eating certain fatty, fried foods which release pressure in the esophageal sphincter and the acid backs up. These are the risk factors for acid reflux disease.
Melanie: If someone does come to you with some of these symptoms that you’ve described, how do you diagnose it? Are you also checking, if you do endoscopy, are you checking for Barrett’s or some complications from undiagnosed GERD?
Dr. Pruthi: When the patients have heartburn symptoms or other symptoms that we described which suggest acid reflux disease, they generally go to their primary doctors. If they have symptoms less than twice a week, we tell them, “This is simple acid reflux disease,” and they can take over the counter antacids. If the symptoms are more than twice a week, then they need medical attention. They should see the doctor or the provider. The diagnosis for acid reflux is generally by history. If they have acid reflux and everything fits together, this is reflux and they take antacids or acid-reducing medicines over the counter, the symptoms come under control that takes care of it. If the over the counter medications do not work and the symptoms continue to progress, then we do endoscopy. Endoscopy means the patient has to be on an empty stomach overnight, they come to the endoscopy center and we make them sleepy and put the camera through the mouth and esophagus and take a look and see if there is any damage going on in the esophagus from the acid reflux. Everybody does not need endoscopy. Patients who have some alarm symptoms, like they have difficulty swallowing, they have anemia, they have some bleeding or they’re losing weight or they have vomiting or they have persistent symptoms despite the treatment, they need endoscopy right away. People who are above 50 years of age, particularly males, and have chronic reflux symptoms for more than five years, they have symptoms at night time, they have history of hiatal hernia, they have obesity, body mass index is high, they’re smokers, they have abdominal obesity. Those are the people who also should have endoscopy right away. All people who have atypical reflux symptoms, they should also come for an endoscopy and that gives us a correct diagnosis. When we do endoscopy, we look at the lining of the esophagus in the lower esophagus and see what changes are going on. As the acid backs up, it can erode the lining of the esophagus and cause erosions and ulcerations. The lining can change into Barrett’s esophagus lining, as you mentioned. Barrett’s esophagus lining is a lining of the lower esophagus which has changed into something different. That is Barrett’s. The significance of Barrett’s esophagus is that it increases the risk of esophageal cancer. That’s very important to get a correct diagnosis and develop a treatment plan.
Melanie: Let’s talk about after diagnosis and the first line of defense. You mentioned over the counter medications but what about prescription medications – some of the proton pump inhibitors? We hear a lot about medications for reflux, Dr. Pruthi. Tell us about some of those.
Dr. Pruthi: The first line ideal plan is over the counter medications and if that works, very good; if not, then we use the prescription medications. Those are the H2 blockers like Ranitidine. The next line is proton pump inhibitor therapy which are Omeprazole, Esomeprazole, Pantoprazole, Rabeprazole. These are the medications which we can use to control their acid at the standard dose. We start with the standard dose and see how the effects are and then, if not, then we can go up at a higher dose and try those according to effects that control the symptoms and heal the erosions or, if there is any ulcer or something else going on, generally, the duration of the treatment is at least about 8-12 weeks. After that, we’ll see if the symptoms are under control. We can taper off these medications and generally people are good. If not, then we need to give them the medications for a longer period of time.
Melanie: What can they do at home and lifestyle changes to reduce their risk of having acid reflux and even to help themselves if they are on medication?
Dr. Pruthi: Lifestyle modifications are an important part of the management of reflux disease. First of all, if they’re overweight, try to lose weight. Avoid coffee, chocolate, peppermint, fatty foods – these are the foods which cause the esophagus to experience pressure and the acid backs up. The next step is alcohol. If they are drinking alcohol, they can cut back and stop alcohol. Stop smoking. Take smaller meals more frequently rather than having one large, big meal. At dinner time, avoid lying down for three hours after eating dinner. Eat your dinner at least three hours before you lie down. If still, the symptoms are bothersome then they can raise the head end of the bed by 6-8 inches by putting wooden blocks under the head end of the bed so the whole bed is tilted. Some people comment that they use the pillows but when we are sleeping the pillows slide off and those don’t work. Raise the head end of the bed by 6-8 inches with wooden blocks so that helps to control the symptoms.
Melanie: In just the last few minutes, Dr. Pruthi, what should people with GERD be thinking about when they are seeking care?
Dr. Pruthi: They are worried, most people, when they have reflux disease. They are worried what is going to happen, that this is a long term process, it is going to harm them or cause complications. Everybody hears about Barrett’s and esophageal cancer. In fact, reflux disease is quite common. We see that the prevalence is high and about 3-5% of patients develop long-term Barrett’s esophagus or short-term Barrett’s esophagus and those patients need surveillance because the annual cancer incidence in this situation is about .123%. The risk of developing esophageal cancer increases about 30 fold above the general population of patients that have higher body weight, long-term Barrett’s esophagus and older patients. Having said that, absolutely developing esophageal cancer in non-dysplastic Barrett’s is still very low. As long as we can treat them and provide a good management, control their symptoms, and do an endoscopy and keep their symptoms under control, we are good to go.
Melanie: Why should they come to Palmdale Regional Medical Center for their care? Tell us about your team.
Dr. Pruthi: We have a good team and we have good equipment. We have expert staff and we provide whatever we can do for them and help them diagnose the disease appropriately; suggest the lifestyle modifications; provide them the support and give them the appropriate medications, surveillance, treatments. If we find Barrett’s, we have several protocols. We bring them back every year for endoscopy and biopsy. If we detect a cancer or Barrett’s or we detect dysplasia, we have new equipment. We can ablate those segments of bad esophagus areas with radiofrequency ablation with that equipment that we have at Palmdale Hospital. We have been using it successfully over the last year and we have had good results. For all these reasons, they should come to us and we can take care of them.
Melanie: Thank you so much, Dr. Pruthi, for being with us today. It’s great information. You’re listening to Palmdale Regional Radio. For more information please visit PalmdaleRegional.com. That’s PalmdaleRegional.com. Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.