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Bill Klaproth (Host): Gastroesophageal reflux disease or GERD is common, easily treatable and is oftentimes misunderstood. Here to address reflux disease misconceptions is Dr. Borys Buniak, a gastroenterologist at St. Joseph’s Health. Dr. Buniak, thank you for your time. So, first off, what is GERD?

Dr. Borys Buniak (Guest): Well GERD or another word for it is heartburn is when you have a burning sensation in your chest, just behind the breastbone and usually worse after eating particularly spicy foods. People who drink a lot of coffee or people who have tomato juice or tomato products, chocolates, alcohol. Right after that you will feel this sensation in the back of your chest and it starts as a burning sensation and actually could give you some chronic cough, some hoarseness and even nausea.

Bill: So, what are some of the biggest misconceptions then of this condition?

Dr. Buniak: Most people think that heartburn is a benign condition when it actually could become something serious. With prolonged reflux disease, that means acid coming from your stomach into your chest can actually cause a burn in your esophagus and that can lead to ulceration, that can lead to strictures of the esophagus making it difficult to even swallow food sometimes. Sometimes if they have – taking pills, sometimes they can get stuck but with prolonged use what could actually happen is it can actually turn into cancer.

Bill: Okay so that’s good to know. So, how do you diagnose this then?

Dr. Buniak: The diagnosis is basically most of the time by physical exam. If someone has this burning sensation two or three times a week, that’s a condition where we think it’s something that should be looked at. And one way that we do make the diagnosis is we actually do an upper endoscopy where you put a camera down the throat and take a look at the food pipe to look for any ulcerations or any precancerous conditions. Sometimes we look for a hiatal hernia. So, an endoscopy is the way to make the diagnosis and it is also done under sedation, so no one has to worry about feeling that camera going done their throat.

Bill: So, what are the treatment options then if someone is diagnosed with GERD or heartburn as you say?

Dr. Buniak: A lot of people will initially start taking antacids over the counter. People will start chewing on Rolaids and Tums but if they take too much of those you can actually get kidney stones. But then there is over the counter Zantac and Prilosec and Pepcid and Nexium. And people sometimes will misuse this and if you read the back of the package they will say if you need to take it for more than a couple of weeks, you should contact your doctor, so we can take a look at it. Because those medications do eventually have some long-term side effects. Let’s say if you take Prilosec or Nexium for too long; some people can get osteoporosis from that. You may develop kidney disease from it, pancreatitis, so those are things that need to watch out for. Some people even get a magnesium deficiency which then will give you a lot of cramps in your arms and legs with prolonged use. But the medications are very effective and if monitored by a doctor; very effective in managing the symptoms.

Bill: So, those are over the counter medicines. What are some of the other treatment options available?

Dr. Buniak: Well treatment options besides watching what you eat and making sure you don’t eat three hours before you go to bed or don’t lay down or do some heavy lifting after meals; those are some lifestyle modifications. And tell people don’t drink before you go to bed, don’t smoke those are some of the modifications, but there are surgical options. Now someone who has a large hiatal hernia, they may need to have some type of surgical procedure to repair that. And some people have a very weak esophageal sphincter which is the sphincter that separates the esophagus from the stomach. If that’s weak, as soon as your stomach contracts, food will come up into your chest so there are devices now that we put into the lower part of the esophagus that can actually tighten up that sphincter, so you don’t get that regurgitation any longer.

Bill: So, can you explain the LINX implant procedure, since you are talking about these types of treatment options?

Dr. Buniak: LINX is like a little bracelet that we actually put in laparoscopically into the stomach. It is a surgery. It takes about a half an hour to do the procedure. But they put a little ring, a metallic ring that is magnetic and has these little beads on it attached on a titanium basically string and as you swallow, the magnetic beads separate so you can pass the food into the stomach, but then once the food bolus passes into the stomach, the rings come back together again and tighten that sphincter for you so regurgitation will no longer happen. So, the heartburn is very well-controlled.

Bill: And after the LINX implant procedure; how long does that operation hold? Does that work for lifetime then or is that something you just have to manage over time?

Dr. Buniak: The LINX procedure is a relatively new procedure. It’s only been around for three to four years, so we don’t have much data beyond four years. But as long as the magnets continue to work, it should work lifelong and that’s why we are using it. This allows us an opportunity to no longer use medications which a lot of people don’t want to do. A lot of people forget to take the medications, or they don’t want to use it because of long-term side effects but with this magnetic ring in there, it should provide long-term relief.

Bill: Well getting off medication very important. So, you’ve mentioned a couple times the hiatal hernia. Can you explain to us what that is?

Dr. Buniak: A hiatal hernia is when part of the stomach starts passing into the chest. When you take a deep breath, you cause a negative pressure in your chest and it basically sucks stomach contents up into your chest area. When you lift something you can do that, when you cough, you sneeze; all those things can pass part of the stomach up into your chest. We have actually had some cases where the whole stomach ends up in the chest, which obviously is very bad. But if you were to identify that early enough, that could be repaired by pulling the stomach back into the stomach and sort of sewing up the defect that happened in the diaphragm that allowed the stomach to pass into the chest.

Bill: And Dr. Buniak, what are some of the symptoms of the hiatal hernia?

Dr. Buniak: Well the hiatal hernia is you will just be eating something and then all of the sudden you will just have regurgitation, food will be coming up into your throat. We have had some people who complain of aspiration in the middle of the night. Let’s say they eat something heavy at dinner, they go to sleep and then all of the sudden you have all this food passing up into the back of the throat and you are almost choking on it. So, that’s part of the thing with the hiatal hernia. Now if the hiatal hernia is very large, then it takes up most of the chest people find it even difficult to take a deep breath or they will feel some pressure in their chest. So, you have like a big gas bubble in your chest making it difficult to take a deep breath. But those are very large hiatal hernias, but most people just have simple regurgitation and they call it water brash so if you have some gastric contents going into the distal part of your food pipe let’s say, you will have a lot of water in your mouth. That’s your body’s attempt to try to clear the acid from the esophagus back into the stomach. So, those are some of the symptoms of a hiatal hernia.

Bill: And Dr. Buniak the Heartburn Center at St. Joseph’s Health has a complete team of physicians and other experts to diagnose and treat people’s conditions. Can you tell us more about this team?

Dr. Buniak: Yes, we have two gastroenterologists, one being myself and then we also have two surgeons, both who have been trained very well in laparoscopic and also robotic surgery to place the LINX procedure and do the fundoplications which are the hiatal hernia repairs. We also have a nutritionist that will help people identify which foods they need to avoid to prevent reflux. We also have pulmonologists also or lung doctors who people who have a chronic cough or hoarseness from the reflex, they can help you with that. We also have behavioral scientists. Some people even get anxiety or even depression from having chronic reflux, so we have those people as well. We have a pretty good team and we meet twice a month, so we can talk about difficult cases, so we have an idea of how to help each individual that comes through our center. We also have a coordinator who arranges all of our procedures and we also have our nurse manager as well.

Bill: Great information Dr. Buniak and thank you so much for your time. And for more information about reflux disease and to hear more podcasts please visit www.sjhsyr.org, that’s www.sjhsyr.org. This is St. Joseph’s Health MedCast from St. Joseph’s Health. I’m Bill Klaproth. Thanks for listening.