Cheryl Martin (Host): Do you get a burning sensation in your chest after eating certain foods? If so, you might have acid reflux. We welcome Dr. Brian Hodgens, a minimally invasive surgeon, to explain what causes acid reflux and what we can do to control it.

 This is Flourish, a podcast from Prisma Health. I'm Cheryl Martin. Dr. Hodgens, glad you're here to educate us on a problem that a lot of people experience.

Dr Brian Hodgens: Thank you very much for having me, Cheryl. I'm happy to be here today and I hope I can shed some light on a very common problem that a lot of people struggle with.

Host: Sounds great. So first, what is acid reflux?

Dr Brian Hodgens: Acid reflux is a condition where stomach acid goes backwards through the gastrointestinal tract and back up into the esophagus.

Host: Now, is it the same thing as heartburn and GERD?

Dr Brian Hodgens: Well, heartburn is a symptom of GERD. GERD stands for gastroesophageal reflux disease. So, many patients feel symptoms such as heartburn or chest pain or abdominal pain when they have the condition of GERD, which is acid reflux coming from the stomach and back into the esophagus.

Host: So then, is acid reflux one type of GERD or just within that category of GERD?

Dr Brian Hodgens: I would say GERD is kind of the technical jargon for acid reflux. There can be different kind of types of GERD or there are other kinds of reflux. Another one is called LPR, which is also called laryngopharyngeal reflux, essentially describing reflux coming up to a higher level of the esophagus.

Host: Doctor, talk more about just the whole category of symptoms then for acid reflux.

Dr Brian Hodgens: The typical acid reflux symptoms are probably described as heartburn, regurgitation, chest pain, sometimes feeling like things are coming back up into your mouth when you lay down at night, but they can also cover a broad range of symptoms like voice changes, throat clearing, sinus issues, abdominal pain, troubled swallowing or dysphagia as it is called. And really, there's a whole range of symptoms that kind of depend on the person and their degree of GERD or reflux, as well as other issues with their esophagus and stomach.

Host: You mentioned at night, why is the heart burn, why can it be worse at night?

Dr Brian Hodgens: There's a couple different ways that GERD becomes pathologic. So, just to back up a second, everybody has some degree of reflux of stomach contents back into their esophagus. As we eat, our stomachs produce stomach acid, our stomach fills up with food and fluid, and our esophagus eventually will feel some of these effects as these contents reflux back into the esophagus.

Now, in a normal person, having a small degree of reflux, especially after meals, would be considered normal. In other patients, sometimes there's more reflux of these contents, or they linger in the esophagus for longer periods of time, which can give patients these symptoms. At nighttime, oftentimes patients with a loose sphincter at the bottom of their esophagus or an anatomic abnormality called a hiatal hernia will feel more reflux or regurgitation because there is not a normal barrier between the stomach and the esophagus. When we lay down, gravity is no longer pulling these contents towards the stomach and small intestine, but it is allowing them to reflux back into the esophagus.

Host: So, what lifestyle changes can you make to prevent acid reflux?

Dr Brian Hodgens: Well, there are quite a few. Number one, we usually try and encourage patients to limit some of their dietary intake that typically causes reflux. The most common foods would be spicy foods, tomato-based foods, chocolate, red wine, typically all the things we like to have going into our stomach. We try and limit foods that may cause heartburn, and this is really patient-specific. Some people get it with fruit, some people get it with chocolate, so we try and identify triggers for heartburn or reflux and limit those.

Other lifestyle modifications include really trying to watch what you're eating, how much you're eating, and when you're eating. If you eat a big meal and then go lay down right away, you have a higher chance of having reflux. If you can eat a dinner a little bit earlier in the night before you're going to lay down, this can minimize symptoms. Also, sleeping with a couple pillows under your head so that you are somewhat upright can limit these symptoms as well. Finally, we do encourage patients to continue to eat well, exercise and overall keep themselves at a healthy weight, as higher weight or a higher BMI can predispose people to having reflux as well.

Host: Those are some great lifestyle changes. Now, for others, what are some home remedies, if there are, for acid reflux? For example, does apple cider vinegar work?

Dr Brian Hodgens: You know, again, everything is very patient specific. I have heard a lot of people come in with very different home remedies that work for them that don't always work for everybody else. Typically, reflux is treated with medications. The most common medication that is typically prescribed is called a proton pump inhibitor. It goes by the generic names of omeprazole or Pantoprazole, the brand names of Nexium or Prilosec. These medications help to reduce the amount of stomach acid that is produced so that when things do come back up into the esophagus, they are not acidic and they do not burn or they do not cause the symptoms that we typically associate with reflux.

On top of that, I have had patients do well taking antihistamine medications, such as Pepcid, alginate therapy or other medications such as Tums or Maalox, and even patients who think that baking soda helps them when they take it in small amounts with water.

Host: So really, it's for the patient to try different things to see what works for them.

Dr Brian Hodgens: Correct.

Host: Now, when would it be appropriate then to reach out to a doctor?

Dr Brian Hodgens: Well, I think in general, when patients are having any symptoms, it's always a good idea to reach out to your primary care provider and have them kind of initiate. What might need to be a workup or at least start medical therapy to see if this can help their symptoms. There are many other organs in the area of the esophagus and the stomach. So sometimes the pain or the heartburn or the indigestion sensation can be caused by other organs. So, I do think anytime patients are feeling these symptoms and they are uncomfortable and it is impacting their quality of life, it is a good idea to check with your primary care provider. and see if something needs to be done.

Cheryl Martin (Host): Now, you mentioned products like Prilosec and Nexium. Is it safe to take these every day?

Dr Brian Hodgens: These are good medications. They have been around for decades and they were initially developed to treat peptic ulcer disease or ulceration of the stomach, which used to be quite prevalent. Since the advent of these medications, gastric ulcers or stomach ulcers have gone way down, and we are seeing far fewer complications from that issue. These medications do work well for GERD or reflux disease as well, and many patients take these on a daily basis for many years. There have been some recent studies that have correlated certain long-term side effects of these medications, such as osteoporosis or kidney disease or dementia, but a lot of these studies have not shown a direct causal relationship with PPI therapy.

With that being said, some patients don't tolerate the medications. Some of these associations may cause some of these issues down the road. So, at this point, I would say the medications still work very well, but if there is a chance to get off of the medications, which would otherwise be for life, then perhaps it's worth exploring those options.

Host: I'm glad you brought this up, because aren't there some with acid reflux that it's really just a temporary, it's not a problem that goes for years? For some, it can be just for a couple of weeks or months after they have taken some of the antacids?

Dr Brian Hodgens: Yes, some people take medications for a short duration and their symptoms resolve. Other patients have mild disease and they just need to take as needed medications, or perhaps it's only after they go on vacation and eat and drink things they don't normally do.

Host: So if someone has tried all these and they don't work and they come to a physician, what treatments would be available for them for acid reflux?

Dr Brian Hodgens: While there tends to be an escalation of medical therapy first, most patients will see their primary care provider or a gastroenterologist, and sometimes increasing the dose of the medications or doubling the dose or changing the medications or adding medications is the first step towards treatment.

Once we have maxed out these medications or patients continue to have symptoms that are impacting their quality of life, then it typically moves on towards a workup where we really get a better look at the esophagus and the stomach. And this can include upper endoscopy, or imaging studies, or acid testing of the esophagus, which gives us a better idea of what is actually going on between the esophagus and the stomach. These workups are typically done by gastroenterologists and also surgeons at some places.

Host: Anything else you'd like to add, Dr. Hodgens?

Dr Brian Hodgens: I would like to say that this is a very common disease. Medications do work very well for a large majority of patients, and I do think they are safe to take, but there are a subset of patients who have other issues that require more intervention. Notably, when patients have a hiatal hernia, this is a situation where the stomach has begun to push through the diaphragm and move up into the chest. This decreases or sometimes eliminates the natural barrier our body has between the stomach and the esophagus. Patients with a hiatal hernia and ongoing symptoms despite medication can benefit from seeing a surgeon because we do have surgical ways to fix these hernias and also to augment or strengthen the sphincter between the esophagus and the stomach.

Host: Dr. Brian Hodgens, thank you so much for sharing your expertise and offering some great advice. Thank you.

Dr Brian Hodgens: Thank you very much for having me.

Cheryl Martin (Host): For more information, visit prismahealth.org/flourish. And if you found this podcast helpful, please share it on your social channels and check out the entire podcast library for other topics of interest to you. This is Flourish, a podcast from Prisma Health. Thanks for listening.