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This program is a community service and is not intended to be a substitute for medical advice. Listeners having questions about their health should make an appointment to see their personal physician. Any opinions or statements made during the program are those of the individuals are physicians making the statements and are not the opinions or statements of the hospital.

Prakash Chandran: We've all experienced that burning sensation in our chest that usually comes from indulging in spicy food or alcohol, but is that heartburn, acid reflux or something else entirely? And what if that burn doesn't go away? We're going to talk about it today with Dr. Neal Moller, a gastroenterologist at Tenet Health.

This is Healthy Conversations podcast from Tenet Health Central Coast. I'm Prakash Chandran. And this episode is part of November where we're bringing awareness to men's health issues. Dr. Moller, it is great to have you here today. So we're talking about those chest pains I was mentioning, can you tell us a little bit more about what they are?

Neal Moller: When you're dealing with heartburn, it's part of the total package of what we call gastroesophageal reflux disease. And since we're coming into the holiday period, a lot of people are going to be experiencing it. In fact, it is said that about 70% of the population will experience some form of heartburn.

Heartburn includes the classic symptoms, which is a burning or feeling of indigestion in the lower part of the chest. The other classic symptom is what we call regurgitation and regurgitation is where fluid comes up from the stomach and can go to the top of the esophagus or even into the mouth. There's also what we call atypical symptoms, things like chest pains or cough or a sore throat or change in your voice.

Prakash Chandran: Okay. So you talked about heartburn and you talked about some of that reflux and you also mentioned gastroesophageal reflux disease, which I know is GERD. Can you talk to us a little bit about how those three things relate to each other?

Neal Moller: GERD is basically two different things that are both part of what we call gastroesophageal reflux disease. One is the symptoms which we typically call heartburn. The other is the amount of damage that it's done to the esophagus. We grade it from A to D. Don't ask me why they do that instead of one to four, but that's the way it's been.

And not always do the symptoms correlate entirely with the amount of damage that is being done. So gastroesophageal reflux disease includes both the symptoms that people have, the typical or the atypical, as well as the damage done to the esophagus from the acid that comes up into the esophagus.

Prakash Chandran: Okay, thanks for that clarification. And just expanding on what you said earlier. I'm assuming because the holiday season is upon us, that people are going to be eating more and they're going to be drinking more and therefore experiencing more of these symptoms. Isn't that correct?

Neal Moller: Absolutely correct. You know, you're at the dinner with Grandma Julia. She makes a big turkey, a lot of fatty foods that causes the valve between the stomach and the esophagus to open inappropriately. It comes up. The next thing you know that cousin Doug is sitting there complaining that he's had chest pains.

Those are common scenarios that we see during the holidays. Other factors include drinking too much, being overweight, smoking is not good for this, and certain types of foods, like the spicy foods or the fatty foods or things like peppermint, which you see a lot during the holidays. They all can increase our risk of reflux.

Prakash Chandran: So when does it become a problem? Like for example, my father-in-law when he, you know, drinks or eats a heaty meal, he'll complain that he can't fall asleep, but he feels a hundred percent in the morning, but I'm wondering about the damage part of it and when people should be concerned and potentially go to get it diagnosed.

Neal Moller: As I said, 70% of the population will experience heartburn at some time. Thirty percent will see their doctors for it and another 10% of that we'll end up seeing the gastroenterologist. When do you see a gastroenterologist would be someone who has tried over-the-counter medications usually for two weeks. If the symptoms don't go away and are prolonged, that's one. Symptoms that start after the age of 50 and don't seem to get better, that's another indication for going to see your doctor.

Finally, there's what we call the dangerous symptoms. People who have trouble swallowing. All of a sudden, they're eating the Turkey and it gets stuck. That's an absolute reason to see your doctor. Weight loss, black stool, which can sometimes indicate bleeding. Those are all reasons. But if you've taken medicine for at least two weeks and you're not getting better and it's persistent, and those are the people that should be seeing a specialist.

Prakash Chandran: That's helpful. And what about people-- because I know that there are these people out there that just potentially take Tums or Rolaids and that's their cure for it, but they ignore the fact that it's been persistent for quite some time. Is there any consequence for leaving GERD untreated for a long period of time?

Neal Moller: Biggest issue for untreated GERD is, as I mentioned, the damage that can be done by the acid. People with severe acid reflux, they can get a change in the lining of the esophagus. And unfortunately, it starts looking more like the stomach or the intestine. We call that a Barrett's esophagus. The problem with Barrett's esophagus is that it is a premalignant condition and, in this country, it's the number one cause of the esophagus cancer. Esophageal cancer still is a rare condition, but it is one of the cancers that we're seeing the greatest rise over the last 10 to 20 years. So people who don't seek medical care and just try to treat it with over-the-counter for long periods of time are putting themselves at some risk and they do need to be seen.

Prakash Chandran: And I want to ask a more general question around when people start experiencing heartburn-like symptoms in their lifetime. Does that grow with age? Does it affect a certain demographic more than another? Maybe talk about that for a little bit.

Neal Moller: Again, we're going to go back to our holiday dinner there. You have cousin Mel and cousin Doug. Cousin Doug's gained about 20 pounds during this pandemic and he's been experiencing a lot of heartburn. Usually, it's males more than females. Number two, those that tend to be overweight definitely are at increased risk. Those that eat big meals. Eating one big meal a day is not the best for your digestive system and increases your risk of severe heartburn. Those that have shift work when they work at night, they are also at increased risk. And there's probably some family history component, although that's not been completely proven.

Prakash Chandran: Okay. So men are more susceptible than women and, certainly, your weight plays a factor. And if you're eating, for example, one big meal a day, all of those things contribute to you getting GERD. What are some preventative things that especially males can do to avoid this?

Neal Moller: When we see someone with GERD, the first thing we tell them is lifestyle changes. We tell them don't eat for three hours before you go to bed. Sometimes raising the head of the bed while you're sleeping like your family member, that may be helpful. We tell them to stay away from too much alcohol. We tell them to stay away from these fatty foods and the spicy foods, fatty foods even more. If they do smoke, you tell them to stop. But the most important thing is that if you can get people to lose weight, that is exceedingly helpful.

Prakash Chandran: So let's say that there is a severe case out there and the damage is at the D level that you're talking about, is there a fix for this individual?

Neal Moller: First of all, we'll go through the medications. Antacids for people who have very intermittent symptoms is fine. The next level is what we call the H2 blockers available over-the-counter. Things like cimetidine or famotidine known as Pepcid. They work a little longer, they are a little better. But again, after two or three weeks, they tend not to work as well. For more severe cases, we put them on what we call a proton-pump inhibitor, which is a stronger acid blocker. The proton-pump inhibitors are taken usually once, occasionally twice a day, usually in the morning before a meal, because food activates them. For people that you find damage to, the proton-pump inhibitors are the first thing that you would treat them with.

Now, as I mentioned that, you know, those people that have severe changes or if they have what we call a Barrett's esophagus or premalignant changes, those people need to be on a proton-pump inhibitor usually for life. Second thing that they need to do is to be followed up every two to three years to make sure there's no changes.

The severe changes that you can see, the premalignant changes are called dysplasia. And it goes from low-grade to high-grade, and that's the high grade that leads to cancer. In the old days, which is really only like less than five, ten years ago, that would require surgery to fix. Now, there are endoscopic approaches where you can actually remove the lining from the bottom of the esophagus, either endoscopically or do we call radiofrequency ablation where you use radio waves to get rid of the abnormal lining of the esophagus and allow it to heal. So we definitely have a lot more available to us over the last five years or so.

Prakash Chandran: And just as we close here, there are going to be people that are apprehensive about coming in to get help, even if they fall into that bucket of having these symptoms for more than two weeks. Is there anything that you'd like to say to them about the care that's being offered at Tenet Health during this time?

Neal Moller: The good news is that here in the Central Coast, we've developed a very strong GI team. The nursing staff and associated staff are all extremely well-trained. I would not hesitate to get my care from them.

Endoscopy, which is what people usually are scared of, is really not a big deal. There is no prep you have to take. We do the procedure under a little sedation, so no one really remembers having it. That people complain of gagging, which they really don't have. It's a 10-minute procedure and then they get to go home. Invariably, before, they may be anxious and, afterwards, everyone says, "That is the easiest thing I've ever done. I can't believe I was nervous about it."

Prakash Chandran: Yeah, that's really good to hear. And I also know that during COVID times, there's also been a lot of extra measures put in place to ensure that the patient is safe when they come in. Isn't that correct?

Neal Moller: We take every precaution. We've always taken every precaution, because there's been infectious diseases that have run rampant, whether it's the standard flu, HIV. So we've always had all of those precautions in place. Now, obviously we take even more precautions, extra PPE, making sure that the patients that we see are segregated from the rest of the hospital, so they're not exposed to anyone that may or may not have been exposed to COVID in the past. The staff gets checked, the patients all get checked. It's been as safe as any place. I would say that in a sense, it's almost safer than going to the grocery store.

Prakash Chandran: it definitely sounds like it. Dr. Moller, I really appreciate your time today. It was super informative. That's Dr. Neal Moller, a gastroenterologist at Tenet Health.

For referral to Dr. Moller or another provider. call the Tenet Health Central Coast physician referral line at (866) 966-3680. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library at tenethealthcentralcoast.com/about/ podcast.

This has been healthy conversations, the podcast from Tenet Health Central Coast. Thanks, and we'll talk next time.