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Acid Reflux / GERD
Occasional heartburn is quite common, especially after a heavy meal. However if you experience symptoms on a regular basis, it may be indicative of something more severe. Dr. Murali Perumal discusses heartburn, acid reflux, and GERD, their differences, possible ways to treat them, and more.
Featured Speaker:
Murali Perumal, MD
Murali Perumal, MD is a Gastroenterologist at Montefiore St. Luke's Cornwall. Transcription:
Acid Reflux / GERD
Evo Terra: Occasional heartburn is quite common, especially after a heavy meal. But if you experience symptoms on a regular basis, it might be indicative of something more severe.
Welcome to Doc Talk, presented by Montefiore St. Luke's Cornwall. I'm Evo Terra. My guest today is Dr. Murali Perumal, a gastroenterologist at Montefiore St. Luke's Cornwall. Welcome to the show, doctor.
Dr. Murali Perumal: Hello. How are you?
Evo Terra: Good, good. Listen, I think a lot of us have experienced heartburn in our lives. So why don't we start there? We're going to talk about GERD and acid reflux. Are those the same thing when we think we're experiencing heartburn? Do we have GERD or acid reflux?
Dr. Murali Perumal: Well, yes, heartburn is the most common symptom of acid reflux. There are other symptoms you can have as well, and GERD refers to gastroesophageal reflux disease when there's actually inflammation noted associated with the heartburn and reflux, which we often see on endoscopy with biopsies.
Evo Terra: So, they're not all the same. Could you kind of break down like severity levels between all three?
Dr. Murali Perumal: So, yeah, we have heartburn. Heartburn's a very common symptom. We see that with people if they have certain kind of foods, if they have, you know, red sauces, it's possible people will complain about, well, having this burning sensation and the chest, a bitter sour taste in the back of the throat. And if it happens on occasion, that would just be labeled heartburn. If it's happening on a more regular basis or associated with any other symptoms, then it becomes something more significant. And certainly, the first thing we call it is GERD, even though there can be other things as well.
Evo Terra: You say there's another thing as well. What's worse than GERD?
Dr. Murali Perumal: Well, a lot of things. Well, it's one of the things with heartburn and reflux symptoms, it may not necessarily be acid reflux, gallbladder pathology can sometimes be involved and give these atypical symptoms. As always, of course, there's chest pain. The first thing to rule out is cardiac source. But if that is all ruled out then, then we think of GERD and acid reflux disease.
Evo Terra: Okay. Well, let's talk about treating said symptoms. How effective would you say are the over-the-counter medications for GERD and acid reflux disease?
Dr. Murali Perumal: They are. Agents such as Tums are good for transient relief and certainly for the occasional rare episodes of heartburn, those are fine. Using over-the-counter H2 blockers like Pepcid, Pepsi AC, famotidine, these provide some transient relief as well, and some people use proton pump inhibitors. But the concern is to make sure there's no other significant underlying pathology and to make sure those are addressed.
Evo Terra: Right. And so, let's talk about that. To make sure that we don't have that underlying pathology, what should I do if I'm experiencing heartburn on a more than infrequent basis? What should my next steps be?
Dr. Murali Perumal: Well, that's concerning. If it's happening several times a week or associated with any of what we call concerning or alarm symptoms, difficulty swallowing, food hanging up in the chest, then we would want to have further investigation of this and, you know, they should seek their primary care doctor and/or a gastroenterologist such as myself.
Evo Terra: And what is that examination going to consist of?
Dr. Murali Perumal: So, the examination that we would do if referred to us by a primary care or we would want to, of course, go over the anti-reflux diet, which is very, very important to follow. And by that point, conservative measures may have been tried, so we may want to do an upper endoscopy to evaluate the area better.
Evo Terra: Great. So I'm assuming there's a variety of treatment options. We talked over-the-counter. Let's talk about prescription medication. What are common prescriptions? What would be prescribed by a doctor for a patient suffering from GERD?
Dr. Murali Perumal: Well, the common prescription medications would be H2 blockers, such as famotidine, you know, Pepcid is one of the common ones. Then, there's protein on pump inhibitors, omeprazole, Prilosec, Nexium, several other brands or some of the medications will often be prescribed this.
Evo Terra: And are there instances where someone might need something more than medication, something like a corrective surgery?
Dr. Murali Perumal: Well, if that's all determined anatomically, if there's a hernia involved, if there's, again, ulcers seen at the time of an endoscopy; then of course, it changes therapy. And perhaps even at a higher dose than what would normally be prescribed, but that would be usually by the specialist at that point.
Evo Terra: Got it. That's something that we determine once we are in and seeing a physician see what our next steps are, correct?
Dr. Murali Perumal: Correct.
Evo Terra: Is there anything that I have not asked you that you want to go down? You mentioned the acid reflux diet. Should we talk about that at all or is that a different conversation?
Dr. Murali Perumal: Before we get to that, I do want to mention one thing with reflux disease. You know, one of the things that's very concerning is the extent of as reflux disease we've been seeing and there is significant underlying pathology, and one of those is something called Barrett's esophagus, which is a pre-cancerous condition associated with acid reflux disease. So this is why it's important to get things checked out if you've had chronic persistent reflux symptoms or any of these alarm symptoms that I've already discussed.
Evo Terra: So, earlier, doctor, you mentioned something about the acid reflux diet. Can you briefly touch on that?
Dr. Murali Perumal: Yeah. There's some classic things to avoid, so to speak, for the anti-reflux diet. You want to avoid eating late in the evenings. We generally recommend not eating within two to three hours of bedtime, and small frequent meals. Of course, certain foods that are often associated with it. As I'd mentioned before, red sauces. Some people have onions. Some people have, you know, caffeine, caffeinated products, soda, coffee. These are all things to avoid with the diet. And lastly, high fat foods are associated with increased reflux as well.
Evo Terra: Dr. Perumal, thank you for all of the excellent information today.
Dr. Murali Perumal: Okay. Thank you.
Evo Terra: Thanks for listening to Doc Talk, presented by Montefiore St. Luke's Cornwall. For more information, please visit montefioreslc.org. That's M-O-N-T-E-F-I-O-R-E-S-L-C.O-R-G. I have been your host, Evo Terra. Thanks for listening.
Acid Reflux / GERD
Evo Terra: Occasional heartburn is quite common, especially after a heavy meal. But if you experience symptoms on a regular basis, it might be indicative of something more severe.
Welcome to Doc Talk, presented by Montefiore St. Luke's Cornwall. I'm Evo Terra. My guest today is Dr. Murali Perumal, a gastroenterologist at Montefiore St. Luke's Cornwall. Welcome to the show, doctor.
Dr. Murali Perumal: Hello. How are you?
Evo Terra: Good, good. Listen, I think a lot of us have experienced heartburn in our lives. So why don't we start there? We're going to talk about GERD and acid reflux. Are those the same thing when we think we're experiencing heartburn? Do we have GERD or acid reflux?
Dr. Murali Perumal: Well, yes, heartburn is the most common symptom of acid reflux. There are other symptoms you can have as well, and GERD refers to gastroesophageal reflux disease when there's actually inflammation noted associated with the heartburn and reflux, which we often see on endoscopy with biopsies.
Evo Terra: So, they're not all the same. Could you kind of break down like severity levels between all three?
Dr. Murali Perumal: So, yeah, we have heartburn. Heartburn's a very common symptom. We see that with people if they have certain kind of foods, if they have, you know, red sauces, it's possible people will complain about, well, having this burning sensation and the chest, a bitter sour taste in the back of the throat. And if it happens on occasion, that would just be labeled heartburn. If it's happening on a more regular basis or associated with any other symptoms, then it becomes something more significant. And certainly, the first thing we call it is GERD, even though there can be other things as well.
Evo Terra: You say there's another thing as well. What's worse than GERD?
Dr. Murali Perumal: Well, a lot of things. Well, it's one of the things with heartburn and reflux symptoms, it may not necessarily be acid reflux, gallbladder pathology can sometimes be involved and give these atypical symptoms. As always, of course, there's chest pain. The first thing to rule out is cardiac source. But if that is all ruled out then, then we think of GERD and acid reflux disease.
Evo Terra: Okay. Well, let's talk about treating said symptoms. How effective would you say are the over-the-counter medications for GERD and acid reflux disease?
Dr. Murali Perumal: They are. Agents such as Tums are good for transient relief and certainly for the occasional rare episodes of heartburn, those are fine. Using over-the-counter H2 blockers like Pepcid, Pepsi AC, famotidine, these provide some transient relief as well, and some people use proton pump inhibitors. But the concern is to make sure there's no other significant underlying pathology and to make sure those are addressed.
Evo Terra: Right. And so, let's talk about that. To make sure that we don't have that underlying pathology, what should I do if I'm experiencing heartburn on a more than infrequent basis? What should my next steps be?
Dr. Murali Perumal: Well, that's concerning. If it's happening several times a week or associated with any of what we call concerning or alarm symptoms, difficulty swallowing, food hanging up in the chest, then we would want to have further investigation of this and, you know, they should seek their primary care doctor and/or a gastroenterologist such as myself.
Evo Terra: And what is that examination going to consist of?
Dr. Murali Perumal: So, the examination that we would do if referred to us by a primary care or we would want to, of course, go over the anti-reflux diet, which is very, very important to follow. And by that point, conservative measures may have been tried, so we may want to do an upper endoscopy to evaluate the area better.
Evo Terra: Great. So I'm assuming there's a variety of treatment options. We talked over-the-counter. Let's talk about prescription medication. What are common prescriptions? What would be prescribed by a doctor for a patient suffering from GERD?
Dr. Murali Perumal: Well, the common prescription medications would be H2 blockers, such as famotidine, you know, Pepcid is one of the common ones. Then, there's protein on pump inhibitors, omeprazole, Prilosec, Nexium, several other brands or some of the medications will often be prescribed this.
Evo Terra: And are there instances where someone might need something more than medication, something like a corrective surgery?
Dr. Murali Perumal: Well, if that's all determined anatomically, if there's a hernia involved, if there's, again, ulcers seen at the time of an endoscopy; then of course, it changes therapy. And perhaps even at a higher dose than what would normally be prescribed, but that would be usually by the specialist at that point.
Evo Terra: Got it. That's something that we determine once we are in and seeing a physician see what our next steps are, correct?
Dr. Murali Perumal: Correct.
Evo Terra: Is there anything that I have not asked you that you want to go down? You mentioned the acid reflux diet. Should we talk about that at all or is that a different conversation?
Dr. Murali Perumal: Before we get to that, I do want to mention one thing with reflux disease. You know, one of the things that's very concerning is the extent of as reflux disease we've been seeing and there is significant underlying pathology, and one of those is something called Barrett's esophagus, which is a pre-cancerous condition associated with acid reflux disease. So this is why it's important to get things checked out if you've had chronic persistent reflux symptoms or any of these alarm symptoms that I've already discussed.
Evo Terra: So, earlier, doctor, you mentioned something about the acid reflux diet. Can you briefly touch on that?
Dr. Murali Perumal: Yeah. There's some classic things to avoid, so to speak, for the anti-reflux diet. You want to avoid eating late in the evenings. We generally recommend not eating within two to three hours of bedtime, and small frequent meals. Of course, certain foods that are often associated with it. As I'd mentioned before, red sauces. Some people have onions. Some people have, you know, caffeine, caffeinated products, soda, coffee. These are all things to avoid with the diet. And lastly, high fat foods are associated with increased reflux as well.
Evo Terra: Dr. Perumal, thank you for all of the excellent information today.
Dr. Murali Perumal: Okay. Thank you.
Evo Terra: Thanks for listening to Doc Talk, presented by Montefiore St. Luke's Cornwall. For more information, please visit montefioreslc.org. That's M-O-N-T-E-F-I-O-R-E-S-L-C.O-R-G. I have been your host, Evo Terra. Thanks for listening.