When it’s more than just Heartburn

What You Need to Know about GERD—Gastro Esophageal Reflux Disease

How did I end up here?
The question kept running through my mind as I was wheeled into the operating room to have a piece of chicken lodged in my esophagus removed. Fearful of hospitals, I was also angry with myself for being lax about my own well-being. As a 42-year-old health and fitness fanatic, I had no idea that dismissing heartburn symptoms could lead to anything more serious. But, in researching this story, I found I wasn’t alone.

Chris Mooney, a 47-year-old fitness instructor from East Meadow ignored early stomach cramps and mild heartburn. That was until, she says, “I started thinking I was having a heart attack. It felt like someone was sitting on my chest.”

Many adults at one time or another have felt it—a burning or pressure in their chest after eating. In fact, according to the American College of Gastroenterology, nearly 40 percent of Americans experience heartburn at least once a month. But what if the problem isn’t just heartburn? Heartburn can be a symptom of something more serious: Gastro Esophageal Reflux Disease or GERD, which left untreated, can become a real health issue down the road.

What is GERD?

Perry Gould M.D., FACG, a gastroenterologist in private practice in Garden City explains, “GERD occurs when the sphincter muscle at the bottom of the esophagus is weak or relaxes too often allowing gastric (acidic) contents access to the esophagus. The esophagus normally has a different cellular lining than the stomach which is less resistant to the effects of acid.”

According to Robert E. Tepper, M.D., FACP, FACG of Nassau Gastroenterology Associates, P.C., and Long Island Clinical Research Associates, LLP, “heartburn” is a symptom that a patient describes. The diagnosis of GERD is rendered by a doctor based on a patient’s symptoms, response to appropriate therapy, and, if indicated, endoscopic findings.

Jill Secord, 66, of Long Beach says, “I was suffering with quite a lot of heartburn.” Recurring symptoms motivated Secord to visit her doctor. She says, “My primary care doctor suggested I have an endoscopy done. It showed a mild reflux.”

What is an endoscopy?

“An upper endoscopy or gastrocopy, as it is commonly referred to is a short inspection with a flexible tube of the surfaces of the esophagus, stomach, and initial part of the small intestine,” Gould explains. “It is safely performed in both hospitals and offices with the use of sedation/anesthesia.” There is generally no pain with the exam however, the gag reflex makes this examination difficult to tolerate without administration of sedation. “Recovery is prompt,” Gould adds, “and depending on the medications used it is not unusual for patients to be discharged within 1/2 hour of the exam. Post examination discomfort is very uncommon.”

When to see the doctor

Mooney noticed a number of seemingly unrelated symptoms before her GERD was diagnosed. “I would lose my voice,” she says. She also began having coughing fits. Until seeing a doctor she didn’t realize either symptom could have anything to do with GERD.

Barry Glanzman, M.D.,
Former Chief of Gastroenterology at Huntington Hospital, now in private practice in Huntington, isn’t surprised. He says possible complications stemming from untreated GERD can include:
• Sore throat
• Hoarseness of voice
• Asthma like symptoms
• Lung complaints and coughing
• Ulcerations of the esophagus and scarring or strictures, which can cause narrowing of the esophagus.

It turns out, a dangerous narrowing of the esophagus caused by my untreated GERD was exactly what landed me in the hospital. It was the culprit that made my ability to swallow food difficult, and as time progressed (as with the piece of chicken that fateful night) at times impossible. In fact, Glanzman says two symptoms that warrant a trip to your doctor are difficulty swallowing and food getting stuck. Other symptoms he says include: “awakened at night with heartburn symptoms, weight loss, or loss of appetite, or if symptoms are resistant to over the counter medications.”

Physicians also strongly caution patients to rule out other more serious causes of heartburn or heartburn-like symptoms that could require immediate attention. Glanzman says, “It can be very hard to distinguish a heart attack, angina, or acute coronary syndrome from heartburn.” Gould stresses, “As serious consequences may result from undiagnosed heart disease it is always prudent to have a thorough cardiac evaluation first in cases where the diagnosis is in doubt.” Glanzman adds that gall bladder disease, gall bladder stones and ulcer disease also have symptoms that might masquerade as heartburn.

Treatment

Fortunately, for those who are diagnosed with GERD much can now be done to control symptoms and help avoid complications. Most doctors will prescribe medication. Mooney, whose condition had at one time progressed to the more severe erosive esophagitis, says her symptoms are now well under control. “I take my pills regularly. I’m more conscious of what I’m eating. My diet has changed a lot.” Secord too says her symptoms are under control while on medication. She also does her best to avoid what seem to be her trigger foods—tomatoes and chocolate. Fortunately, my erosive esophagitis, like Mooney’s, is also responding well to drug treatment and lifestyle changes. Swallowing food is no longer an issue.

To treat GERD, Glanzman recommends avoiding caffeine, alcohol, fatty foods and acidic foods. If overweight, lose weight, stop smoking and eat a light meal for supper. Do not go to bed within three hours of eating and try elevating the head of the bed 30 degrees. Patients should also be aware that some drugs, such as aspirin and NSAIDs (Non-steroidalanti-inflammation drugs) could cause reflux symptoms. Tepper adds, “Avoid exercising, wearing restrictive clothing, or bending forward immediately after meals. Other foods to avoid: citrus juice, spicy foods, onions, garlic, pepper, tomato sauce, red wine and peppermint.”

A small percentage of patients opt for a surgical correction of GERD called fundoplication. It is, according to Gould, “essentially wrapping a portion of the stomach around the lower end of the esophagus to tighten muscle tone. It is increasingly being done laparoscopically, avoiding an open incision.

Stress is also associated with GERD. Mooney, like many patients, noticed her symptoms felt worse when she was stressed. Shirley Johnson-Hall, M.D., of Gastroenterology Associates of Suffolk says that stress does play a role. But surprisingly, not how one may think. Johnson-Hall says, “It’s stress that causes heightened sensitivity to normal acid levels.” She adds, “Based on studies there hasn’t been a direct correlation between the amount of acid and stress.” So while a patient may be more conscious of his or her symptoms while experiencing anxiety, it is a case of the stress making the patient more apt to feel the acid present—not an actual increase in acid production. It’s important for patients to understand that if they are diagnosed with GERD, they should not assume if they just learned to relax they would not be suffering from what is in fact a real medical condition.

Medications for gerd

Barry Glanzman, M.D., notes that there are many drug choices available to doctors and their patients.

• Antacids such as Maalox, Mylanta and Tums neutralize acid already there, decreasing contact time with the esophagus. The advantage: they work quickly. The disadvantage: by the time one feels heartburn symptoms and takes these drugs the initial damage of the acid reflux is already done.

• H2 Blockers such as Zantac, Pepcid, Axid and Tagamet. These drugs reduce the secretion of acid in the stomach causing whatever secretions coming up from the stomach into the esophagus to be less acidic. The advantage: they work well, are available over the counter; are preventative and have a low incidence of side effects. The disadvantage: not all patients experience 100 percent relief.

• Proton Pump Inhibitors such as Prilosec, Prevacid, Protonix, Nexium. These drugs provide more acid suppression. The advantage: they are more effective for GERD, are stronger, last longer, are usually taken once a day, and are usually well tolerated. The disadvantages: mild side effects might include headache, diarrhea, and abdominal pain. These drugs are expensive. They are not to be used as an antacid. “If symptoms require daily over the counter therapy for longer than two weeks then the patient should consult a physician to clarify the correct diagnosis and to assess for complications of reflux including erosive esophagitis and esophageal cancer,” says Robert Tepper, M.D.

—Delmonico Prussen

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