Burning sensation? Sour stomach? Chest pain? You may have GERD
DAVID W. ROWE/PHOTO ILLUSTRATION
Do you have a burning sensation in your chest after you eat?
Does it feel like something sour is building up in your throat?
Do you have chest pain or find it difficult to swallow sometimes?
Have these symptoms caused restless days and sleepless nights and have lasted for weeks, months or even years?
If you answered yes to any of these questions, you may be one of millions who suffer from a problem known as gastroesophageal reflux disease.
More commonly known as GERD, gastroesophageal reflux disease is a chronic digestive disease that occurs when stomach acid backs up from the stomach and into the esophagus on numerous occasions throughout the day.
According to the Mayo Clinic, this backwash of acid causes irritation to the lining of the esophagus and creates a discomfort and feeling of burning in the chest area.
Glenn S. Freed, D.O., a community gastroenterologist in the area, said this problem has become more prominent over the last four decades. No definitive reasons as to why GERD occurs have been linked, but doctors like Freed, speculate that underlying causes could be from different types of foods a person eats; the esophageal sphincter relaxes abnormally or is weakened; a hiatal hernia; various diseases; pregnancy; or a person's weight.
He noted that there is no age range when a person could begin to have heartburn and GERD symptoms.
The history of reflux and relief
Freed explained that over the last few decades of his career, he has seen reflux become more prominent in the list of complaints patients had.
He noted that the major issue with reflux is that acid backs up from the stomach into the esophagus, when the stomach does not empty properly. This can cause more than just discomfort for a person. If it continues on a regular basis at least twice a week and is left untreated, it can cause a chronic irritation to the lining of the esophagus, which could lead to bleeding or breathing problems.
Through the years, doctors have tried a number of medications to alleviate patients' symptoms, including antacids, such as Mylanta or Maalox; Histamine H2 receptor blockers, like Tagamet; and proton pump inhibitors (PPIs), like Nexium or Prilosec.
In early studies, doctors found that antacids helped neutralize the acid in the stomach for a short time; but patients' symptoms later returned.
Problems with antacids, Freed explained, were that if a patient took too many antacids, other problems, such as diarrhea occurred.
Throughout the 1970s, pharmaceutical companies developed H2 blockers, which, Freed noted, were designed to attach to the outside of the parietal cells, which are responsible for the secretion of protons, such as hydrochloric acid, into the stomach.
Doctors found that H2 blockers helped relieve reflux in patients with stomach ulcer issues, but not others who only had reflux symptoms.
The problem with H2 blockers, Freed said, was that medication only stopped one of three receptors in the parietal cells and didn't suppress acid production all together.
As the issue with reflux and GERD continued to grow, a new type of medication in the form of PPIs was developed.
Like H2 Blockers, PPIs were designed to attach to the parietal cell, but rather than on the outside of the cell, PPIs penetrate and work on the inside of the cell. The medication then binds to the pumps in each cell and shuts down acid production.
"We found PPIs work really well with reflux disease," Freed said.
But, he continued, as the years went on, patients were beginning to have breakthrough symptoms throughout the day.
One pharmaceutical company then developed a PPI medication that, when taken once a day, actually works twice in the same day.
Freed explained that this medication provides relief within an hour, using fast acting capsules within the pill that dissolve in the stomach. A second wave of relief then occurs as slower-acting capsules are digested and dissolve while passing through the intestinal tract.
Determining if you have reflux
The hardest part about solving reflux and GERD is actually determining if the patient is experiencing chronic reflux or if it is caused by an underlying problem.
Freed explained that some patients have vague or nonclassic symptoms; while others have the classic symptoms associated with reflux disease.
Symptoms include heartburn at least twice a week; a burning sensation in the chest area that spreads to the throat, causing a sour taste in the mouth; chest pain; difficulty swallowing; dry cough; hoarseness or sore throat; regurgitation of food or sour liquid after eating or drinking; or a sensation of a lump in the throat area.
Freed said that after the initial visit, doctors have a few choices to determine if the person is experiencing true GERD symptoms.
He noted that he can increase the medication a person is taking for the problem and see how that works; take the person off the medication or change it; complete an endoscopy to look at the gastrointestinal tract; or he can conduct a minimally invasive test during the endoscopy using the Bravo pH monitoring system that lasts three to four days and provides a more accurate report on reflux occurrences.
Freed said he is the only doctor in the surrounding area currently using the Bravo probe to help determine if a patient is experiencing true GERD. He completes this test at least four to six times a month, based on the initial consultation with the patient.
"A lot of patients will come to me because their doctor wants them to get evaluated and I have the ability to do the (Bravo) probe during the endoscopy, which makes the endoscopy procedure that much better," he said. "I'll do the endoscopy, and possibly the Bravo probe, if the patient has had reflux symptoms, even if they are controlled with medication, for five years or more.
"I like to do a baseline endoscopy to look at gastroesophageal junction because if they have Barrett's (esophagus, which is changes to the esophagus lining), they may be predisposed to cancer of the esophagus and should be monitored with endoscopic procedures every three years with biopsies at that area," Freed continued.
He added that the Bravo probe, which is a little microchip secured inside a capsule that is then suctioned to the base of the esophagus during an endoscopy, makes getting to the root of the patient's problem much easier than years ago.
The other version for the pH monitoring test that doctors conduct is by inserting a tube down the patient's nose into the esophagus. The tube is then fastened in place and worn by the person for 24 hours. It is attached to a monitoring system that determines when a person experienced reflux symptoms.
Freed said that the downfall with the old test is that in addition to it being very uncomfortable for the patient; it only provides 24 hours of monitoring. Bravo now monitors for 48 hours, which provides a better baseline and more accurate results to study.
"I, personally, as a community gastroenterologist, find it helpful because it helps me definitively identify if the patient has reflux or not. If not, they could be having other issues," he said. "It helps me work with some of the medications associated with alleviating GERD as well.
"For example, you are on a PPI and say you are still having reflux for years, but the medications don't seem to work. You can either double their medication, change the medication, or see if they have reflux," Freed continued.
He added that there are two ways he does the testing. One includes keeping the patient on the medication they are taking; or do a scope and install the probe, which will pass through the person's system naturally within a week, and monitor the person's symptoms for 48 hours.
During the test, Freed monitors the instances of acid backing up in the esophagus while either having the person use the same medication or after having the person stop the medication one week prior. The patients also journals what they are eating when they had symptoms and when they are sleeping.
After 48 hours, he then downloads the data and resets the device to conduct a second test using a new medication to treat the person's symptoms.
"This is helpful because insurance companies sometimes say they don't cover a certain medication," Freed said. "This allows me to give them proof, saying that the medication you approve isn't working and this other one is."
The two tests then show through a pH graph if a person is really experiencing true reflux symptoms and which medicine is working best to alleviate the problem.
"Sometimes a patient is pressing the button (on the monitor), saying I am having symptoms but I when look on the graph there is no acid in the esophagus," Freed said, adding that when results like this occur, it could mean that the root of the problem is something other than reflux.
"This helps get to the underlying answer about if they are having reflux and it also helps to identify how well the medications are working."