Joey Wahler (Host): It's a common digestive condition, so we're discussing acid reflux. Our guests from Silver Cross Hospital are Dr. Kamran Ayub, MD. He's Medical Director of the Advanced Endoscopy Center. Amy Liss, who's a Certified Physician's Assistant, and Jessica  Dakhoul, who's also a Certified Physician's Assistant. This is Silver Cross Hospital's I Matter Health Podcast, where medical experts bring you the latest information on health topics that matter most to you and your family.

Thanks so much for joining us. I'm Joey Wahler. Doctor, ladies welcome.

Kamran Ayub, MD: Thank you.

Jessica Dakhoul, PA-C, MMS: Thank you for having us.

Amy Liss, Pa-C, MMS, RD: Thank you.

Host: Yeah, great to have you aboard. So, first, doctor, what's the difference in a nutshell between occasional heartburn and acid reflux?

Kamran Ayub, MD: So acid reflux is the disease. Heartburn is a symptom of acid reflux disease. Occasional heartburn is common, almost universal. Any of us can get heartburn if we eat spicy food or deep dish pizza or something. Acid reflux disease is when you have recurrent heartburn or reflux of acid content into the esophagus, the food pipe, with or without heartburn even.

Host: And doctor, just how common is acid reflux because the numbers are pretty eye-opening, right?

Kamran Ayub, MD: Yep. Uh, so Gastroesophageal Reflux Disease is a very common digestive health problem. It's a major public health hazard. About 20 to 25% of adult population in most studies, appear to have gastroesophageal reflux disease.

Host: So Jessica, what's actually happening inside the body when someone experiences acid reflux?

Jessica Dakhoul, PA-C, MMS: So when acid reflux is occurring, usually it's when the stomach acids or the gastric acids are entering into the esophagus where they really don't belong. So the stomach acid is obviously quite acidic and irritating to the lining of the esophagus. So, heartburn occurs when the stomach acid enters the esophagus.

Host: So Amy, many think heartburn is just from spicy food, right? But what are some common myths or misunderstandings you see that you can clear up for us here?

Amy Liss, Pa-C, MMS, RD: Good question. I think when people describe heartburn or symptoms of heartburn, oftentimes they're looking for that very traditional, like, ow, you know, I have this, this burning sensation in my chest. But we like to remind patient's that it's not always that way. Sometimes it's cough, sometimes it's chest pain, sometimes it's flare up of asthma or pneumonia. There's a lot of symptoms that can be related to heartburn that may not be obvious.

Host: Dr. Ayub, how about some practical lifestyle changes that can really make a difference for someone dealing with reflux.

Kamran Ayub, MD: So reflux is, as I mentioned, a common condition. One of the major causes is obesity. And of course the symptoms typically occur when you eat fatty meals or rich meals, spicy food, et cetera. So very spicy meals, fatty meals like deep dish pizza or deep fried foods, desserts especially chocolate based desserts, alcohol, smoking. All these factors lead to reflux of gastric contents into the esophagus. Or as one of my friends says, anything that you enjoy eating can cause reflux. So try and eat healthy meals, low fat, low in spices and calories, and that helps prevent reflux.

Host: Gotcha. Amy, as you well know, many rely on antacids or acid reducers. So how do you know when those are sufficient or when it's time to see a doctor?

Amy Liss, Pa-C, MMS, RD: That kind of depends on the patient, what kind of antacids they're using and, to what frequency. In general, we like to tell patient's if you've experienced acid reflux for five years or more, you really should see a gastroenterologist to consider having an upper endoscopy done. But certainly those patients who are relying on antacids more days outta the week than they're not, those patient's we'd like to see as well.

Host: Jessica, how about some warning signs that reflux might be something more serious? For instance, when would someone be diagnosed with Barrett's esophagus, and what exactly is that? Simply put.

Jessica Dakhoul, PA-C, MMS: Yeah, so kind of like Amy said, I think if you're requiring frequent antacids like daily or almost every day, that would be a warning sign that this acid reflux might be something more of concern. The other thing to look out for would be what Amy mentioned earlier, a cough or asthma that's kind of refractory or not responding to the usual treatments, or if you start noticing difficulty swallowing or chest pain. Any of those things can indicate complications from acid reflux.

And Barrett's esophagus is a complication of acid reflux, but it often is kind of a silent condition. It doesn't typically present with any symptoms. What Barrett's esophagus is is when the cells that line the esophagus change to resemble more like intestinal type cells, and that's a precancerous condition.

So, you know, whether or not you really have a warning sign, if you're requiring frequent antacids and dependent on that medication, you should come in and get an endoscopy because that's the best way to look for Barrett's esophagus.

Host: Absolutely. And, uh, maybe tell people for us what an endoscopy is for those unfamiliar.

Jessica Dakhoul, PA-C, MMS: So an endoscopy is a procedure that we do in the hospital or in our outpatient endoscopy lab. This is a procedure where we put the patient to sleep and we pass the scope through the mouth down into the esophagus to look at the esophagus and the stomach. We usually take biopsies at that time, which is really how we can see Barrett's esophagus, but we can see other problems of the upper digestive system with that procedure as well.

Host: Switching gears a little bit. Doctor, how has technology changed the way reflux disease is diagnosed nowadays?

Kamran Ayub, MD: We used to diagnose reflux based on symptoms, and in old days we would do x-ray called barium swallow, or barium meal where patient would drink contrast material and then do x-rays where we could see the reflux of stomach content into the esophagus on those live x-rays. Now we perform endoscopy and biopsies and biopsies give us exact severity, whether there is mild inflammation, ulceration, or complications of reflux called Barretts esophagus. We also do some special brushings where they can look for cells, progenitor cells for Barrett esophagus that can progress to Barretts and cancer down the road. So there is a lot more progression there.

At Silver Cross Hospital, I perform what we call confocal laser endo microscopy. We are, at the time of examination, we are able to see reflux, we are able to see Barrett's esophagus and any pre-malignant or malignant cells at the time of endoscopy, it's called optical biopsy. So a lot of changes happening.

A lot of exciting advancement. Moving one step further, we also have treatments available nowadays. There is a lot of endoscopic treatment option, which is incisionless, so we do a high volume of trans endoscopic incisionless fundoplication at Silver Cross Hospital, probably one of the highest volumes in state of Illinois.

We also do some other procedures, not offered elsewhere. So it's great. It is very satisfying to me when patients come back after these procedure and say they feel great, they don't feel heartburn. They're able to sleep at night without waking up coughing, getting heartburn.

And, unknowingly, the biggest advantage they have is it reduces progression to cancer of the esophagus, which is an extremely lethal type of cancer.

Host: Amy, how about some of the latest or most promising treatments available for people whose reflux does not improve with medication?

Amy Liss, Pa-C, MMS, RD: Right. So I think a lot of those types of procedures Dr. Ayub has touched on already. To be more specific, there's trans incisionless, fundoplication, that's the TIF for short. There's anti-reflux mucoectomy, AMRS, or we say arms for short. And there's also the Stretta procedure, which Dr. Ayub is currently the only one in the state of Illinois offering.

All three of these procedures are basically incisionless endoscopic procedures that are done in our endo units, not the OR. They're done between 30 to 45 minutes. The patient is asleep so they're relatively quick. And at most we might keep these patients overnight in the hospital one night for observation. Sometimes they go home right away, but they always seem to do exceptionally well, and that allows them to come off of their antacid medication.

Host: And so Doctor Ayub, as Amy just mentioned there's that one procedure there where you're the only one in the area that does it, so you are the man to see. Right?

Kamran Ayub, MD: Well, we at Silver Cross Hospital offer all sorts of treatment for reflux. I have had, uh, interest in reflux disease from the beginning, so my website is called refluxchicago.com. We at Silver Cross offer more variety of anti-reflux procedures than say, Northwestern or University of Chicago even.

So we offer anti-reflux mucoectomy resection, plication, Stretta, Tiff. Dr. Gamagami, my colleague surgeon offers robotic hiatal hernia repair when I do fundoplication, and he also offers a magnetic bead called links, that is placed in lower esophagus to prevent reflux. So we at Silver Cross consider ourselves at cutting-edge when it comes to treatment of reflux disease.

We have real passion for treating reflux, preventing its progression to carcinoma of esophagus.

Host: That's awesome. So, Jessica, how about for patients living with chronic reflux, what would you say the long-term outlook is today compared to say 10 or 20 years ago?

Jessica Dakhoul, PA-C, MMS: The outlook for these patient's now is much better than what it was 10 to 20 years ago. All these new procedures that we've been talking about were not available 20 plus years ago. So all of those, significantly reduce the risk of Barrett's development and then progression to esophageal cancer.

We also just more widely have available endoscopy and there's even some new medications that are prescribed for reflux. So a lot of really good options for these patients.

Joey Wahler (Host): Great to hear so. So Amy, cancer of the esophagus, however, is the fastest growing cancer in the United States, so that's certainly important to note. Why is that?

Amy Liss, Pa-C, MMS, RD: So Dr. Ayub alluded to this a little bit earlier and myself, I have a nutrition background. So I agree that we think being overweight and being obese is probably the number one risk factor for developing not only reflux, but then development of Barrett's and then the progression to esophageal cancer.

And so there are a lot of factors that play into this, but the one that we think is the most controllable and the most likely to lead to decreasing cancer risk is controlling the weight, you know, controlling the obesity epidemic. We are starting to do that in our own clinic in New Lennox. We are actually starting to offer another procedure called endoscopic sleeve gastroplasty, where we hope to help these patient's who have tried and failed other methods to lose weight as another means of treating their reflux and reducing the risk of cancer progression down the road.

Host: Gotcha. And in summary here, Dr. Ayub, if someone joining us is in fact struggling with reflux and or heartburn, what's the one thing you want them to know or do after hearing this conversation?

Kamran Ayub, MD: I think they should see a physician, if they have heartburn more than five years. The current American College of Gastroenterology guidelines are, they should have an endoscopy to look for Barrett's esophagus, screen for Barrett's esophagus, and if they have Barrett's esophagus further action. Many times we treat that to prevent progression to cancer.

So I think it's important to seek medical advice. It's not occasional heartburn. They are getting recurrent heartburn more than twice a week requiring medication, they should seek medical advice.

Host: Great advice indeed, especially considering as we covered that so many people are affected by this. Well folks, we trust you are now more familiar with acid reflux. Doctor, ladies, keep up all your great work and thanks so much again.

Kamran Ayub, MD: Thank you, Joey. Thank you for inviting us.

Jessica Dakhoul, PA-C, MMS: Thank you.

Joey Wahler (Host): And for more information, please do visit silvercross.org/heartburn. Now, if you found this podcast helpful, please do share it on your social media. Thanks so much again for being part of Silver Cross Hospital's I Matter Health Podcast.