If you suffer from chronic heartburn, you may actually have more serious condition called gastroesophageal reflux disease, or GERD, a very common disorder.
GERD causes a backflow of the stomach’s digestive “juices” into the esophagus.
This is unpleasant and also can cause substantial harm to the tissues of the esophagus, especially when the backflow contains harsh stomach acids.
Find out how to recognize the difference between simple heartburn and GERD—and what the latest GERD treatments are when you tune into SMG radio for an exclusive interview with from Summit Medical Group’s Dr. Raymond Kelly, a gastroenterologist and expert in GERD diagnosis and treatment.
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Chronic Heartburn? You May Have GERD
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Raymond Kenny,MD
Raymond P. Kenny, MD is a gastroenterologist, a physician specializing in diseases of the digestive system. He is the coauthor of articles and abstracts that are published in prestigious, peer-reviewed scientific journals, including the Journal of Laparoendoscopic Surgery, and the journal Gastroenterology. Dr. Kenny is Clinical Assistant Professor in the Department of Medicine at Rutgers New Jersey Medical School.Learn more about Raymond P. Kenny, MD
Learn more about The Gastroenterology Group of New Jersey at SMG
Transcription:
Chronic Heartburn? You May Have GERD
Melanie Cole (Host): If you suffer from chronic heartburn, you may actually have a more serious condition called Gastroesophageal Reflux Disease or GERD. My guest today is Dr. Raymond Kenny. He’s a Gastroenterologist and he specializes in diseases of the digestive system at Summit Medical Group. Welcome to the show, Dr. Kenny. Tell us, what is GERD? What happens in that situation?
Dr. Raymond Kenny (Guest): Well Gastroesophageal Reflux Disease implies that it’s an abnormality disease. By that, I mean we all have reflux. We all have acid which is produced in our stomach come back up into our esophagus normally. It’s what we call “physiologic reflux.” Two percent of the time in a 24-hour period, we have acid in our esophagus. That is mostly after eating meals with a stomach full of that digestive material, there is some bumping up of the food up into the distal esophagus and the pH or the acidity of the esophagus drops. That’s physiologic it doesn’t lead to any damage. It’s normal; it’s expected and it’s short lived after each meal. And then, for the rest of the day, particularly at night when you’re sleeping, there isn’t appreciable reflux or acid fluid coming back up into the esophagus from the stomach. So that the implication of word disease, Gastroesophageal Reflux Disease, is that there’s something abnormal here. That the hallmark symptom for that would be what we commonly experience as heartburn.
Melanie: People get heartburn all the time, Dr. Kenny. Is this a problem? If you get chronic heartburn is there any issue with leaving it untreated?
Dr. Kenny: The issues really come around to the fact of what you say is true. There’s a Gallup Poll that says that 40% of the population has reflux disease at least on a monthly basis. In practice, we generally say that if you’re having heartburn two to three times per week, particularly if you’re taking an over the counter medication whether that’s an antacid such as Tums or you’re taking some short-lived preparation like Pepcid or Zantac, which are available over the counter, there may be some other consequences to reflux disease. Reflux disease can cause erosion and irritation of the distal esophagus and, in certain people, a small minority of those patients, it can lead to a change in the lining of the esophagus which is called Barrett’s Esophagus named after Dr. Norman Barrett who originally described it. This change in the lining of the esophagus predisposes to the development of esophageal cancer. So, we would like to identify those people who have that condition, let alone the symptoms that you have. Why would someone have persistent heartburn on a daily basis when we have medications that can relieve that and there is this concern about an underlying pre-malignant condition?
Melanie: Do you think with colonoscopies now being covered as part of a well visit, a well/preventive care, that an endoscopy is the same? Do you think people should have a baseline endoscopy and have one every few years to see what’s going on?
Dr. Kenny: The problem with that it is that has to do with what the frequency of this pre-malignant condition is, if that’s the aim of your endoscopy. The prevalence in the general population is relatively low. It’s only 2-4%. But, if you get middle age white males who come in with frequent heartburn, 13% of them have this. Those are the people that you focus on. So, I think an argument can be made that at the time of the screening colonoscopy that you do an upper endoscopy, particularly in a middle aged white male with heartburn 2-3 times a week.
Melanie: So, speak about the treatments. You mentioned Zantac and Pepcid and there’s antacids that you can get over the counter; then, there are the proton pump inhibitors that people are on, the little purple pill and then there are so many natural treatments for that. So, my first question to you, Dr. Kenny, is do we want to reduce the acid in our stomach or is that something our body needs to digest our good?
Dr. Kenny: Acid is there for a purpose. Contrary to what people might think, it’s not really a digestive purpose. It’s really there to sterilize the GI tract. It will kill bacteria that are ingested number one. Number two, it’s required to absorb certain elements – iron, calcium, magnesium. So, the concern with taking medication long-term for acid suppression is that you wouldn’t absorb iron, calcium, magnesium and, in the case of calcium, that could lead to osteoporosis, which obviously is a common problem. That lends the argument to defining that particular patient. What is the extent of their reflux disease? Is this something that, when we look down in the esophagus we see erosive esophagitis or we see Barrett’s Esophagus? In other words, a clear medical consequence of this disease which merits treatment on a long term or are they really just taking that medication for symptoms, in which case, as a general principle, we try to use the minimal amount of acid suppression that works. So, in that scale proton pump inhibitors are the most potent, an H2 blocker--less than that, an intermittent antacid use even less than that.
Melanie: Should we be looking at the cause? Is there a way to identify the cause and what about some of the things like apple cider vinegar that people claim help them with this?
Dr. Kenny: Apple cider vinegar is a common thing that people have talked about. Aloe is another thing that people have talked about – things that are helpful in the situation. I think those things are fine. They are certainly not going to affect your iron, magnesium and calcium absorption. The underlying mechanism, it’s sort of an intimate interplay of several things. There’s some anatomic things, the hiatal hernia and the lower esophageal sphincter both combine to create a barrier from acid moving back up from the stomach into the esophagus.
Melanie: Give us, in this last three or four minutes here, some of your best advice about dietary things that we can do or prevention--something that we can do. Also, if somebody burps a lot, does that mean that they are suffering from GERD?
Dr. Kenny: Certainly when they are burping, they’re bringing up not just air; there is certainly some regurgitation of fluid and acid at that time. It is not an indicator that you’re going to find significant reflux disease on that person. That’s what we would call in the most elegant way, the study of reflux disease is what we call a pH monitor test which are now easily done for 48 hours. It continuously monitors acid exposure for 48 hours. The person that you’re talking about there what we would call an “upright refluxer” or a belcher is someone who, through the day, is belching a lot of air and they do have increased acid exposure. Fortunately, that doesn’t have the same consequences to what we would call a supine refluxer--someone who lies down at night where there’s a continuous flow of acid coming back up. The latter is associated with the damage--the esophagitis, the Barrett’s Esophagus--not so much the person who has the belching and I san upright refluxer. They have symptoms but it doesn’t have the same consequences long term. As far as things that we can do to prevent the problem, the most important thing that I can recommend, and it’s an epidemic in the United States, is pursue a lean body mass through diet and exercise. Weight has an awful lot to do with increasing the abdominal pressure and making reflux disease worse.
Melanie: What about some foods that might aggravate it? Are there any of those? Chocolate or minty products? Do they help? What about foods?
Dr. Kenny: Well, in foods, there are several things that are recommended that you avoid. Spearmint, peppermint and caffeine. I think that those things, and the rationale for that is, that they stimulate acid secretion. It is probably less important than the other factors that we talked about like your weight. If you have significant reflux disease, dietary manipulation in of itself probably is not likely to give you complete relief. There are some lifestyle changes that you can have that may afford you some relief. Particularly for those people that are supine reflexers, elevation the head of the bed, avoiding of large meals. Like we talked about, there’s a physiological reflux after each meal and you’ll make it worse if you have a big meal. Don’t eat within two hours of recumbency. If you’re going to go to sleep at night at 10 o’clock, your evening meal should be at 6 so that your stomach is empty; there’s not a lot of pressure or reflux when you lie down at night.
Melanie: That’s great information and great advice. Thank you so much, Dr. Kenny. You’re listening to SMG Radio. For more information, you can go to SummitMedicalGroup.com. That’s SummitMedicalGroup.com. This is Melanie Cole. Thanks for listening.
Chronic Heartburn? You May Have GERD
Melanie Cole (Host): If you suffer from chronic heartburn, you may actually have a more serious condition called Gastroesophageal Reflux Disease or GERD. My guest today is Dr. Raymond Kenny. He’s a Gastroenterologist and he specializes in diseases of the digestive system at Summit Medical Group. Welcome to the show, Dr. Kenny. Tell us, what is GERD? What happens in that situation?
Dr. Raymond Kenny (Guest): Well Gastroesophageal Reflux Disease implies that it’s an abnormality disease. By that, I mean we all have reflux. We all have acid which is produced in our stomach come back up into our esophagus normally. It’s what we call “physiologic reflux.” Two percent of the time in a 24-hour period, we have acid in our esophagus. That is mostly after eating meals with a stomach full of that digestive material, there is some bumping up of the food up into the distal esophagus and the pH or the acidity of the esophagus drops. That’s physiologic it doesn’t lead to any damage. It’s normal; it’s expected and it’s short lived after each meal. And then, for the rest of the day, particularly at night when you’re sleeping, there isn’t appreciable reflux or acid fluid coming back up into the esophagus from the stomach. So that the implication of word disease, Gastroesophageal Reflux Disease, is that there’s something abnormal here. That the hallmark symptom for that would be what we commonly experience as heartburn.
Melanie: People get heartburn all the time, Dr. Kenny. Is this a problem? If you get chronic heartburn is there any issue with leaving it untreated?
Dr. Kenny: The issues really come around to the fact of what you say is true. There’s a Gallup Poll that says that 40% of the population has reflux disease at least on a monthly basis. In practice, we generally say that if you’re having heartburn two to three times per week, particularly if you’re taking an over the counter medication whether that’s an antacid such as Tums or you’re taking some short-lived preparation like Pepcid or Zantac, which are available over the counter, there may be some other consequences to reflux disease. Reflux disease can cause erosion and irritation of the distal esophagus and, in certain people, a small minority of those patients, it can lead to a change in the lining of the esophagus which is called Barrett’s Esophagus named after Dr. Norman Barrett who originally described it. This change in the lining of the esophagus predisposes to the development of esophageal cancer. So, we would like to identify those people who have that condition, let alone the symptoms that you have. Why would someone have persistent heartburn on a daily basis when we have medications that can relieve that and there is this concern about an underlying pre-malignant condition?
Melanie: Do you think with colonoscopies now being covered as part of a well visit, a well/preventive care, that an endoscopy is the same? Do you think people should have a baseline endoscopy and have one every few years to see what’s going on?
Dr. Kenny: The problem with that it is that has to do with what the frequency of this pre-malignant condition is, if that’s the aim of your endoscopy. The prevalence in the general population is relatively low. It’s only 2-4%. But, if you get middle age white males who come in with frequent heartburn, 13% of them have this. Those are the people that you focus on. So, I think an argument can be made that at the time of the screening colonoscopy that you do an upper endoscopy, particularly in a middle aged white male with heartburn 2-3 times a week.
Melanie: So, speak about the treatments. You mentioned Zantac and Pepcid and there’s antacids that you can get over the counter; then, there are the proton pump inhibitors that people are on, the little purple pill and then there are so many natural treatments for that. So, my first question to you, Dr. Kenny, is do we want to reduce the acid in our stomach or is that something our body needs to digest our good?
Dr. Kenny: Acid is there for a purpose. Contrary to what people might think, it’s not really a digestive purpose. It’s really there to sterilize the GI tract. It will kill bacteria that are ingested number one. Number two, it’s required to absorb certain elements – iron, calcium, magnesium. So, the concern with taking medication long-term for acid suppression is that you wouldn’t absorb iron, calcium, magnesium and, in the case of calcium, that could lead to osteoporosis, which obviously is a common problem. That lends the argument to defining that particular patient. What is the extent of their reflux disease? Is this something that, when we look down in the esophagus we see erosive esophagitis or we see Barrett’s Esophagus? In other words, a clear medical consequence of this disease which merits treatment on a long term or are they really just taking that medication for symptoms, in which case, as a general principle, we try to use the minimal amount of acid suppression that works. So, in that scale proton pump inhibitors are the most potent, an H2 blocker--less than that, an intermittent antacid use even less than that.
Melanie: Should we be looking at the cause? Is there a way to identify the cause and what about some of the things like apple cider vinegar that people claim help them with this?
Dr. Kenny: Apple cider vinegar is a common thing that people have talked about. Aloe is another thing that people have talked about – things that are helpful in the situation. I think those things are fine. They are certainly not going to affect your iron, magnesium and calcium absorption. The underlying mechanism, it’s sort of an intimate interplay of several things. There’s some anatomic things, the hiatal hernia and the lower esophageal sphincter both combine to create a barrier from acid moving back up from the stomach into the esophagus.
Melanie: Give us, in this last three or four minutes here, some of your best advice about dietary things that we can do or prevention--something that we can do. Also, if somebody burps a lot, does that mean that they are suffering from GERD?
Dr. Kenny: Certainly when they are burping, they’re bringing up not just air; there is certainly some regurgitation of fluid and acid at that time. It is not an indicator that you’re going to find significant reflux disease on that person. That’s what we would call in the most elegant way, the study of reflux disease is what we call a pH monitor test which are now easily done for 48 hours. It continuously monitors acid exposure for 48 hours. The person that you’re talking about there what we would call an “upright refluxer” or a belcher is someone who, through the day, is belching a lot of air and they do have increased acid exposure. Fortunately, that doesn’t have the same consequences to what we would call a supine refluxer--someone who lies down at night where there’s a continuous flow of acid coming back up. The latter is associated with the damage--the esophagitis, the Barrett’s Esophagus--not so much the person who has the belching and I san upright refluxer. They have symptoms but it doesn’t have the same consequences long term. As far as things that we can do to prevent the problem, the most important thing that I can recommend, and it’s an epidemic in the United States, is pursue a lean body mass through diet and exercise. Weight has an awful lot to do with increasing the abdominal pressure and making reflux disease worse.
Melanie: What about some foods that might aggravate it? Are there any of those? Chocolate or minty products? Do they help? What about foods?
Dr. Kenny: Well, in foods, there are several things that are recommended that you avoid. Spearmint, peppermint and caffeine. I think that those things, and the rationale for that is, that they stimulate acid secretion. It is probably less important than the other factors that we talked about like your weight. If you have significant reflux disease, dietary manipulation in of itself probably is not likely to give you complete relief. There are some lifestyle changes that you can have that may afford you some relief. Particularly for those people that are supine reflexers, elevation the head of the bed, avoiding of large meals. Like we talked about, there’s a physiological reflux after each meal and you’ll make it worse if you have a big meal. Don’t eat within two hours of recumbency. If you’re going to go to sleep at night at 10 o’clock, your evening meal should be at 6 so that your stomach is empty; there’s not a lot of pressure or reflux when you lie down at night.
Melanie: That’s great information and great advice. Thank you so much, Dr. Kenny. You’re listening to SMG Radio. For more information, you can go to SummitMedicalGroup.com. That’s SummitMedicalGroup.com. This is Melanie Cole. Thanks for listening.