Heartburn, Reflux and GERD

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Chronic heartburn and reflux disease a.k.a. gastroesophageal reflux disease (GERD) is a very common disorder. Tens of millions of Americans suffer from GERD. Below are some of the FAQs about GERD.

What is heartburn and reflux?

Heartburn is a sensation in the chest, frequently occurring due to reflux of stomach contents into the esophagus. However, heartburn is not always due to reflux and sometimes may on occasion even represent a life threatening heart attack.

Is It Leaky Gut or Leaky Gut Syndrome?

Reflux of the stomach contents into the esophagus is a normal phenomenon especially after meals. When it causes significant symptoms to affect quality of life , or causes complications, it is known as pathologic reflux or acid reflux or gastroesophageal reflux disease, or simply GERD.

I sometimes have heartburn. Do I need to see a doctor?

If you have heartburn two times or more per week, you should discuss it with your physician.

Can gastroesophageal reflux disease cause symptoms other than the heartburn?

Yes, GERD may cause chest pain resembling heart attack, asthma, chronic bronchitis, chronic cough, laryngitis, hoarseness, bad teeth, bad breath etc.

Can GERD occur in kids?

Yes, GERD can affect all ages. Healthy babies usually outgrow their reflux problems by the age of 1-2 years.

How is GERD diagnosed?

Gastroesophageal reflux disease is a clinical diagnosis based on symptoms. Tests are only needed in case of atypical manifestations,  if there are other problems like difficulty swallowing, bleeding, weight loss, or failure of treatment to resolve symtoms.  Commonly used tests include upper endoscopy, UGI series, 24 hour pH monitoring. Manometry is only useful as part of preoperative work-up prior to surgery.

Does everyone with reflux problems need medications?

No, lifestyle measures such as raising the head end of bed while asleep, avoiding large fatty meals, discontinuation of smoking and alcohol, not wearing tight clothes, and use of anatacid as needs intermittently may be all that’s needed in mild cases. However, for more severe cases H2 blockers or H2RAs (Zantac, Tagamet, Pepcid, Axid) are effective in about 50% of the cases.

Stronger acid blockers are called PPIs or proton pump inhibitors (Nexium, Prevacid, Protonix, Prilosec, Dexilant, Zegrid, Rapinex) and these are effective in 80-95% of the cases. PPIs are superior to H2RAs especially in complicated cases. PPIs are not risk free. Most but not all typical cases of GERD respond to treatment. Some of the emdications may be available in generic form and over the counter.

Is It Leaky Gut or Leaky Gut Syndrome?

Are there alternative therapies for GERD?

CAM (complimentary and alternative therapies) have been described for GERD and such treatments are frequently described in books e.g. Wall Street Journal Best Seller Dr. M's Seven-X Plan for Digestive Health. Their use is based on tradition in many cultures. Pharmaceutical companies are unlikely to sponsor expensive trials to study these since it is difficult to patent therapies known and used for hundreds of years.

Is surgery effective?

Surgery is an effective treatment for GERD. However, patients who have not responded to commonly used PPIs are less likely to have favorable response. In addition, surgery should not be undertaken on the belief that you won’t require medications. Our study (Madan and Minocha: Alimentary Pharma Thera 2005) found that about 2/3^rd of patients continue to take medications despite high level of satisfaction with surgery.

What about the role of endoscopic therapies?

Several endoscopic procedures based on devices have been approved for treatment of GERD in recent times. However, they have not withstood the test of time. Their mechanisms of preventing  gastroesophageal reflux vary from applying energy to applying surures etc in order to narrow the lower end of esophagus so it would prevent reflux. Good long term randomized controlled trials especially for GERD patients with moderate to severe esophagitis are lacking. In fact, some of the GERD devices/procedures have already been withdrawn from the market. At this juncture, I believe these should still be used in the context of trials for treatment of gastroesophageal reflux disease.

What is Barrett’s esophagus or BE?

Barrett's esophagus is a change in the lining of esophagus such that it resembles the lining of the intestinal wall. The significance of BE lies in the fact that it carries increased risk of cancer of esophagus. However, only a small fraction of people with GERD get Barrett’s. In addition, only a small fraction of patients Barrett’s esophagus go on to get cancer of esophagus.

Do I need upper GI scope (endoscopy) for screening for Barrett’s esophagus?

Screening endoscopy is recommended in patients with longstanding chronic heartburn or GERD (atleast 5-10 years). A repeat endoscopy for GERD is only recommended if Barrett’s is found on the initial exam.

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