Gastroesophageal reflux disease, or GERD, is a digestive disorder that affects the lower esophageal sphincter, the ring of muscle between the esophagus and stomach.
Many people, including pregnant women, suffer from heartburn or acid indigestion caused by GERD.
Dr. Ehrhardt will talk about GERD and how it can be treated.
Selected Podcast
There is Help for Your Gastroesophageal Reflux Disease (GERD)
Featured Speaker:
William M. Ehrhardt, MD
Dr. Ehrhardt is a gastroenterologist at the Stoughton Dean Clinic. Transcription:
There is Help for Your Gastroesophageal Reflux Disease (GERD)
Melanie Cole (Host): Do you suffer from heartburn? If you do, more often than not, what do you do about it? My guest today is Dr. William Ehrhardt. He’s a gastroenterologist at Stoughton Dean Clinic. Welcome to the show, Dr. Ehrhardt. So tell us a little bit about what GERD is. What do most people do when they’re suffering that heartburn and they realize they’ve got something going on?
Dr. William Ehrhardt (Guest): Thank you, Melanie. GERD is a disorder that’s experienced by probably 25 percent of the population or even more. It’s a disorder where stomach acid that’s supposed to stay down in your stomach and travel down to the small intestine instead reflexes back up into the esophagus, your swallowing tube. The esophagus is really not equipped to deal with stomach acid and so it causes a lot of pain and burning sensation when that happens. So what people generally experience is a lot of burning sensation and even regurgitation of stomach contents up into their chest and maybe even all the way up into their mouths at times.
Melanie: What do you recommend people do about it?
Dr. Ehrhardt: Well, for people that experience intermittent symptoms that are really infrequent, often taking a medication such as an H2 blocker like ranitidine can be quite effective. But when they start to experience symptoms several times a week or even several times a day, often they need medication to suppress that acid production in their stomach so that they’re comfortable. So many people often need to take medication every day to keep the problem under control. There are a few dietary modifications that people can consider as well. The things that seem to promote acid refluxing up from the stomach more than other things include caffeine, chocolate, smoking, tobacco or using tobacco products of any sort, and eating big, large meals, particularly before you go to bed at night. Unfortunately, chocolate is another one of those things. It seems to really rev heartburn symptoms up.
Melanie: Now, how do people have this actually diagnosed? With endoscopy, what does that show you, Dr. Ehrhardt?
Dr. Ehrhardt: Well, the diagnosis of GERD is really a clinical one as much as anything. So it’s really the symptoms that you tell your doctor about that tells us mainly whether you have GERD. An endoscopy can tell us whether the GERD is causing chronic damage in your esophagus. So the role of endoscopy is really at times to sort out whether there’s any stricturing or narrowing of the esophagus from GERD. So, if you develop problems with your swallowing or things don’t go down smoothly, it may be that you’ve developed some strictures or narrowing that we need to fix with an endoscopy. It also can tell us whether there has been the development of any type of precancerous condition in the esophagus called Barrett’s esophagus. If Barrett’s esophagus develops, that’s something we want to keep an eye on, on a routine basis with endoscopy, to make sure it’s not progressing into a more serious condition.
Melanie: Dr. Ehrhardt, I’m sure you know as I do people that just totally pop those antacids and they’re drinking Maalox and Mylanta or Tums and Rolaids. Is this counterproductive? Don’t they need their stomach acid to digest their food? How do you balance that for us?
Dr. Ehrhardt: There are really a few different classes of medications that people use to treat their heartburn symptoms with, and the most basic medications are the antacid medications. What those medications do is just briefly buffer the acid that’s refluxed up into the esophagus. They neutralize that acid so it’s not caustic and burning in nature. The problem with the antacids is they really don’t last very long and so you don’t get very long-term, sustained benefit from that. The next class of medications are called H2 blockers and those medications are much stronger than antacids and they last several hours after you take them and you get benefit from them usually within about 20 minutes or so of taking them. Then the last class of medications are PPI medications and those medications tend not to act quite as quickly as the H2 blockers but these medications have a much more sustained benefit, so they can last 24 hours or more after taking them.
So the question about whether you need your stomach acid for digestion, it turns out that even when we suppress our stomach acid with these medications, our digestion actually works just fine. In other words, we make more stomach acid than we ever really need for proper digestion. The real role of the stomach acid is to some extent probably to create an antibacterial mechanism in the stomach to prevent over-colonization of bacteria. But even the amount of acid we have on these medications is probably a fairly adequate amount of acid that we still make. Possibly when we get more elderly, some of these medications might cause a little higher risk of pneumonia because we don’t counteract the effects of bacteria in the upper aerodigestive tract as much at that point, but that’s probably a minimal effect so we really don’t worry too much about the effects of antacids on digestion ultimately.
Melanie: What role does maintaining a healthy weight play on our risk factor for GERD?
Dr. Ehrhardt: That’s really a great point. In fact, many people who come to see me, the first thing we really have to address is the weight issue. When people are overweight, it really does promote acid reflux quite strongly and also puts you at higher risk for some of the effects of Barrett’s esophagus and potentially precancerous condition in the esophagus. So weight loss is one of the things we have to focus on the most and it’s one of the issues we have to address right off the bat with many people that come in overweight with a lot of reflux symptoms.
Melanie: Is there any truth to don’t lie down flat? If you’re someone who suffers from heartburn, keep your head elevated. Any of those kind of little tricks you can give people?
Dr. Ehrhardt: Absolutely. So it’s quite effective for many people, particularly if you have nighttime heartburn symptoms. So people who wake up in the middle of the night with a lot of regurgitation or heartburn can benefit quite a bit actually with elevating the head of their bed. Up to 30 degrees or so is usually adequate and that’s usually done with getting a foam wedge from a medical supply store. That seems to work the best. Some people will put blocks under their bed but then they often find they’re kind of migrating down their bed at night. So I think the foam wedge probably works the best.
Melanie: Are you aware of any alternative therapies you like to recommend people, like drinking apple cider vinegar or chewing various herbs? Is there anything that you know that can affect that stomach acid coming back up into your system?
Dr. Ehrhardt: Unfortunately, I’m really not aware of any of the kind of more alternative, if you will, therapies that work consistently for people. Anecdotally, I do have some people tell me that some of these therapies work for them from time to time, but I don’t find a consistent enough effect nor am I aware of any studies that really demonstrate any good, consistent effect from any of these therapies that I can really recommend them.
Melanie: And Dr. Ehrhardt, in just the last few minutes here, give patients listening your very best advice if they are someone who’s suffering from gastroesophageal reflux or they get this heartburn on occasion and why they should come to Stoughton Hospital for their care.
Dr. Ehrhardt: Well, if you’re suffering from these symptoms, there really is relief for you, first of all, by taking medications and making sure that we’ve given you good advice about lifestyle modifications that can help with these symptoms. So it’s really a very good idea to check in with your primary care doctor to begin with. If your symptoms continue to persist despite following those recommendations, seeing a gastroenterologist such as myself is a good idea so we can try to pick apart the history a little bit more and sort out whether there’s more we can do for you. Finally, people that have chronic heartburn symptoms who aren’t getting good results with medications may be a candidate for other treatments, possibly even a surgery called the Nissen fundoplication. In order to really kind of consider all of those options, you really need to sit down with a gastroenterologist to go over all those possibilities and what it means to go through all of that. So for those that are suffering with heartburn symptoms on a regular basis, it’s really a good idea to check in with your doctor and possibly a gastroenterologist ultimately to sort that all out.
Melanie: Thank you so much, Dr. Ehrhardt. You’re listening to Stoughton Hospital Health Talk. For more information, you can go to stoughtonhospital.com. That’s stoughtonhospital.com. This is Melanie Cole. Thanks so much for listening and have a great day.
There is Help for Your Gastroesophageal Reflux Disease (GERD)
Melanie Cole (Host): Do you suffer from heartburn? If you do, more often than not, what do you do about it? My guest today is Dr. William Ehrhardt. He’s a gastroenterologist at Stoughton Dean Clinic. Welcome to the show, Dr. Ehrhardt. So tell us a little bit about what GERD is. What do most people do when they’re suffering that heartburn and they realize they’ve got something going on?
Dr. William Ehrhardt (Guest): Thank you, Melanie. GERD is a disorder that’s experienced by probably 25 percent of the population or even more. It’s a disorder where stomach acid that’s supposed to stay down in your stomach and travel down to the small intestine instead reflexes back up into the esophagus, your swallowing tube. The esophagus is really not equipped to deal with stomach acid and so it causes a lot of pain and burning sensation when that happens. So what people generally experience is a lot of burning sensation and even regurgitation of stomach contents up into their chest and maybe even all the way up into their mouths at times.
Melanie: What do you recommend people do about it?
Dr. Ehrhardt: Well, for people that experience intermittent symptoms that are really infrequent, often taking a medication such as an H2 blocker like ranitidine can be quite effective. But when they start to experience symptoms several times a week or even several times a day, often they need medication to suppress that acid production in their stomach so that they’re comfortable. So many people often need to take medication every day to keep the problem under control. There are a few dietary modifications that people can consider as well. The things that seem to promote acid refluxing up from the stomach more than other things include caffeine, chocolate, smoking, tobacco or using tobacco products of any sort, and eating big, large meals, particularly before you go to bed at night. Unfortunately, chocolate is another one of those things. It seems to really rev heartburn symptoms up.
Melanie: Now, how do people have this actually diagnosed? With endoscopy, what does that show you, Dr. Ehrhardt?
Dr. Ehrhardt: Well, the diagnosis of GERD is really a clinical one as much as anything. So it’s really the symptoms that you tell your doctor about that tells us mainly whether you have GERD. An endoscopy can tell us whether the GERD is causing chronic damage in your esophagus. So the role of endoscopy is really at times to sort out whether there’s any stricturing or narrowing of the esophagus from GERD. So, if you develop problems with your swallowing or things don’t go down smoothly, it may be that you’ve developed some strictures or narrowing that we need to fix with an endoscopy. It also can tell us whether there has been the development of any type of precancerous condition in the esophagus called Barrett’s esophagus. If Barrett’s esophagus develops, that’s something we want to keep an eye on, on a routine basis with endoscopy, to make sure it’s not progressing into a more serious condition.
Melanie: Dr. Ehrhardt, I’m sure you know as I do people that just totally pop those antacids and they’re drinking Maalox and Mylanta or Tums and Rolaids. Is this counterproductive? Don’t they need their stomach acid to digest their food? How do you balance that for us?
Dr. Ehrhardt: There are really a few different classes of medications that people use to treat their heartburn symptoms with, and the most basic medications are the antacid medications. What those medications do is just briefly buffer the acid that’s refluxed up into the esophagus. They neutralize that acid so it’s not caustic and burning in nature. The problem with the antacids is they really don’t last very long and so you don’t get very long-term, sustained benefit from that. The next class of medications are called H2 blockers and those medications are much stronger than antacids and they last several hours after you take them and you get benefit from them usually within about 20 minutes or so of taking them. Then the last class of medications are PPI medications and those medications tend not to act quite as quickly as the H2 blockers but these medications have a much more sustained benefit, so they can last 24 hours or more after taking them.
So the question about whether you need your stomach acid for digestion, it turns out that even when we suppress our stomach acid with these medications, our digestion actually works just fine. In other words, we make more stomach acid than we ever really need for proper digestion. The real role of the stomach acid is to some extent probably to create an antibacterial mechanism in the stomach to prevent over-colonization of bacteria. But even the amount of acid we have on these medications is probably a fairly adequate amount of acid that we still make. Possibly when we get more elderly, some of these medications might cause a little higher risk of pneumonia because we don’t counteract the effects of bacteria in the upper aerodigestive tract as much at that point, but that’s probably a minimal effect so we really don’t worry too much about the effects of antacids on digestion ultimately.
Melanie: What role does maintaining a healthy weight play on our risk factor for GERD?
Dr. Ehrhardt: That’s really a great point. In fact, many people who come to see me, the first thing we really have to address is the weight issue. When people are overweight, it really does promote acid reflux quite strongly and also puts you at higher risk for some of the effects of Barrett’s esophagus and potentially precancerous condition in the esophagus. So weight loss is one of the things we have to focus on the most and it’s one of the issues we have to address right off the bat with many people that come in overweight with a lot of reflux symptoms.
Melanie: Is there any truth to don’t lie down flat? If you’re someone who suffers from heartburn, keep your head elevated. Any of those kind of little tricks you can give people?
Dr. Ehrhardt: Absolutely. So it’s quite effective for many people, particularly if you have nighttime heartburn symptoms. So people who wake up in the middle of the night with a lot of regurgitation or heartburn can benefit quite a bit actually with elevating the head of their bed. Up to 30 degrees or so is usually adequate and that’s usually done with getting a foam wedge from a medical supply store. That seems to work the best. Some people will put blocks under their bed but then they often find they’re kind of migrating down their bed at night. So I think the foam wedge probably works the best.
Melanie: Are you aware of any alternative therapies you like to recommend people, like drinking apple cider vinegar or chewing various herbs? Is there anything that you know that can affect that stomach acid coming back up into your system?
Dr. Ehrhardt: Unfortunately, I’m really not aware of any of the kind of more alternative, if you will, therapies that work consistently for people. Anecdotally, I do have some people tell me that some of these therapies work for them from time to time, but I don’t find a consistent enough effect nor am I aware of any studies that really demonstrate any good, consistent effect from any of these therapies that I can really recommend them.
Melanie: And Dr. Ehrhardt, in just the last few minutes here, give patients listening your very best advice if they are someone who’s suffering from gastroesophageal reflux or they get this heartburn on occasion and why they should come to Stoughton Hospital for their care.
Dr. Ehrhardt: Well, if you’re suffering from these symptoms, there really is relief for you, first of all, by taking medications and making sure that we’ve given you good advice about lifestyle modifications that can help with these symptoms. So it’s really a very good idea to check in with your primary care doctor to begin with. If your symptoms continue to persist despite following those recommendations, seeing a gastroenterologist such as myself is a good idea so we can try to pick apart the history a little bit more and sort out whether there’s more we can do for you. Finally, people that have chronic heartburn symptoms who aren’t getting good results with medications may be a candidate for other treatments, possibly even a surgery called the Nissen fundoplication. In order to really kind of consider all of those options, you really need to sit down with a gastroenterologist to go over all those possibilities and what it means to go through all of that. So for those that are suffering with heartburn symptoms on a regular basis, it’s really a good idea to check in with your doctor and possibly a gastroenterologist ultimately to sort that all out.
Melanie: Thank you so much, Dr. Ehrhardt. You’re listening to Stoughton Hospital Health Talk. For more information, you can go to stoughtonhospital.com. That’s stoughtonhospital.com. This is Melanie Cole. Thanks so much for listening and have a great day.