Health Chats
Barrett’s Esophagus and GERD
Tuesday Aug 25, 2009, 12:00PM - 01:00PM (EST)
972628?1247864868
Cleveland Clinic
, Cleveland, OH
The Cleveland Clinic Digestive Disease Institute has been ranked second in the nation by U.S. News & World Report’s Best Hospitals Survey since 2003, and first in Ohio since 1990. <br><br> Cleveland Clinic Digestive Disease Institute (DDI) is the first of its kind to unite all specialists within one unique, fully integrated model of care - aimed at optimizing patient experience. At DDI we offer patients the most advanced, safest and proven medical and surgical treatments primarily focused on the gastrointestinal tract. Our departments include: <ul> <li>Gastroenterology & Hepatology <li>Colorectal Surgery <li>Hepato-pancreto-biliary and Transplant Surgery <li>Center for Human Nutrition </ul> Gary W. Falk, MD is currently a Professor of Medicine at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. He is also Director of the Center for Esophageal and Swallowing Disorders and has previously been Director of the GI Fellowship Training Program at Cleveland Clinic. He is currently an Associate Editor of the American Journal of Gastroenterology and a contributor to the Selected Summaries section of Gastroenterology. He is past President of the American Society for Gastrointestinal Endoscopy.<br><br> The focus of this Health Chat will be on Gastroesophageal Reflux Disease (GERD) and Barrett’s Esophagus.<br><br> <b>GERD</b> is also known as Acid Reflux, Gastric Reflux and Heartburn. GERD is a burning sensation in the center of the chest that often occurs after eating, bending over, with exercise, and sometimes at night when lying down. Approximately one in 10 adults has heartburn at least once a week and one in three monthly. Some pregnant women experience heartburn almost daily as a result of increased pressure on the abdomen and hormonal changes. Although its name implies otherwise, heartburn has nothing to do with your heart. Rather, these symptoms indicate a condition called gastroesophageal reflux disease, or GERD. <br><br> <b>Barrett's esophagus</b> is an irritation in the lining of the esophagus caused by chronic reflux of the contents from the stomach and small intestine into the esophagus. There are a number of risk factors for the development of Barrett's esophagus. Patients at greatest risk of developing Barrett's are Caucasian males over age 50 who have a history of chronic heartburn. <form name="signup_form2" method="post" action="/health_chats/register/16"><br/> <div class="actions float_fix"> <a onclick="return false;" id="signup_form2_submit" class="big_gr_btn" href="#"><img src="/RoR/images/blank.gif" class="btn_l_img pos_rel"/><span style="padding-top: 2px;" class="btn_r_txt pos_rel"><span class="btn_r_txt_w">Register</span></span></a> <span><input type="submit" value="signup_form_h_submit" name="commit" class="hidden_submit"/></span> <script> Event.observe(document.signup_form2, 'submit', function(e) { if (true) { $('signup_form2_submit').replace('<b>Submitting</b> <img src="/RoR/images/wait_arrows.gif">'); } else { Event.stop(e); } } ); Event.observe($('signup_form2_submit'), 'click', function(e) { if (true) { document.signup_form2.submit();$('signup_form2_submit').replace('<b>Submitting</b> <img src="/RoR/images/wait_arrows.gif">'); } }); </script> </div> </form> <br/>
Pam:
My brother-in-law has a terrible problem with GERD. What are the treatments?  He lives on antacids but I wondered if there is anything else that might help
Gary W Falk, MD:
If the patient has GERD defined as heartburn or acid regurgitation stronger acid reducing medicines are warranted such as H2 blockers (Pepcid, Zantac) or proton pump inhibitors (Omeprazole, Nexium, Prilosec, Aciphex, Prevacid, Protonix).
trtlhanmer:
I am 32 and had a Nissenfunduplication three years ago for Barret's Esophogus, and am having some symptoms I do not understand... first there is the gas, next I cannot belch and lastly I cannot vomit.  I am terrified of getting a stomach flu or food poisoning more so for fear of forced vomiting.  Do I need to have the surgery lossened?
Gary W Falk, MD:
These are well recognized side effects of surgery.  The sphincter valve has been tightened and as such belching is much harder to do as is vomiting.  Persistent problems warrant a repeat visit with your surgeon.
ladypar:
i had endo 8 mo ago, have imflamation of esophagus,will i have to be checked again? also ulcer, cured now ,gasteritis moderate hiatal hernia small and stricture dialated now i have spasms as well take omerole 2x a day. should i be re checked by endocopy. can this lead to barretts?
Gary W Falk, MD:
If you did not have Barrett's then and there were no erosions or ulcers of the esophagus then redo endoscopy not needed.  The ulcer is a different story.  You need to be checked for H. pylori infection and also if it is in the stomach adequate biopsies are needed.
Tiredofstressing:
Hello Dr. Falk, I have been on Nexium on and off for the last 5 years or so. I say on and off beause I would stop taking it during my two pregnancies. I am now back on it and the heartburn problems have been taken care of but now I am experiencing something new. I have a dry cough that I have on and off throughout the day but I notice that it gets worse when I eat. I also feel like I have to chase alot of my food with liquid to get it down. And I also feel like there is sometimes a lump in my throat. I have had the cough for about two monthsit started while I was off the nexium. My question is, are these symptoms of gerd or maybe something more and is there anything to do about the cough?
Gary W Falk, MD:
Cough may be related to many problems including  reflux, sinusitis, asthma, smoking, envrionmental exposures etc.  In the absence of heartburn or acid regurgitation, it is unlikely to be due to reflux.  
Jack615:
Hi thanks for taking questions today.  I have Barrett's Esophagus I gave up smoking but now my wife keeps telling me not to drink. Does drinking make this worse?
Gary W Falk, MD:
In moderation--no.  Congrats on stopping smoking.
carl_graf:
Hi, Dr. Falk.  I have stomach bloating/pain and have had upper GI, EGD and colonoscopy.  Motility is normal. I have been diagnosed with mild gastritis, small tongue of Barrett's, Schatki ring and sliding hiatal hernia but have no heartburn.   Can all these things add up to bloating/pain?  What is a recommended course of treatment?
Gary W Falk, MD:
All of these symptoms are highly unlikley to be related to what was found.  The most common causes of bloating are soda pop, dairy products, constipation and celiac disease.
SurgiMenopause:
I was definitely diagnosed with GERD by a Head & Neck Dr. who looked at my throat some time ago and he said I should definitely be taking my ranitidine twice a day. (A # of other meds give me bad h/a.)  Recently, the burning in my stomach had become much worse and I am now up to 150 mg t.i.d., which seems to help.  Should I be asking a GI doc for any testing to see if I have an ulcer?  Are there any digestive enzymes you could recommend that might help me?
Gary W Falk, MD:
Be wary of ENT doctors who diagnose GERD!  I would advise seeing a GI specialist.  
carl_graf:
I am a 37 yo male, healthy (resting HR in the 40's), active cycling/running, mostly eat right.  I have what my doc is calling dyspepsia or "stiff stomach".  I am bloated and it is painful sometimes.  There is no GERD but the EGD revealed a possible small tongue of Barrett's.  I also have small Schatzki ring & hiatal hernia but doc does not think these are bad enough to cause my symptoms.  Dispite these conditions, the only things that bring relief are belching after carbonated drinks and peppermint oil, not necessarily together.  These stomach aches do not respond to PPI's, antacids, Pepto, etc.  I have read about prokinetics and wonder if you could discuss "stiff stomach" and possible treatments including but not limited to prokinetics like metoclopramide.  
Gary W Falk, MD:
I do not know waht is meant by a stiff stomach.  Metoclopramide is a dangerous medicine which has resulted in warnings being issued by the FDA.  There are no other approved prokinetics on the market today.  
SurgiMenopause:
I had a grandparent with stomach cancer and a great grandparent with stomach cancer.  How likely is it that GERD might cause cancer?  I have had stomach acid problems and sore throat symptoms for a very long time now.
Gary W Falk, MD:
GERD does not cause stomach cancer.  The risk of esophageal cancer is increased in patients with GERD.  
Lyala:
Do you recommend new operations for GERd like Esophx?
Gary W Falk, MD:
No.  The entire endoscopic reflux field is strewn with problems including patient deaths.  
scopage:
Are there any promising molecular markers that may help determine a persons risk of Barrett's progression?
Gary W Falk, MD:
This is the holy grail.  Unfortunately, no markers of increased cancer risk are ready for prime time yet.  
lol4life:
Hello. i am currently suffering from GERD and chronic acid reflux, and also chronic nausea. i get it after almost every little thing. i had a chiari decompression surgery and my nuerologist thinks it could be damage to the vagus nerve but i dont know. if you could help in any way that would be fantastic. thank you so much for all you do!
Gary W Falk, MD:
There are many causes for all of these symptoms.  I think a visit with a gastroenterologist [GI] would be appropriate.  
FurballsMom:
I suspect my GERD may also include a hiatal hernia.  I feel the sensation of having a lump in my throat a lot.  I tend to swallow a lot of air when I'm taking my supplements or even when I'm just drinking a glass of water.  I also feel like someone has punched me in the gut right below my sternum.  I will be seeing my GI on Thursday.  Which tests should I ask my doctor about that would determine whether my GERD includes a hiatal hernia and what is the difference between a sliding hiatal hernia and a paraesophogeal hiatal hernia?  When does a doctor determine that the hernia needs to be operated on to correct the digestive symptoms?  What can I do if I've had a bad reaction to PPI's and Zantac isn't really effective?  Liquid antacids and antacid tablets actually aggravate my symptoms rather than helping them.  I am careful with my diet and avoid foods that I recognize cause my symptoms to worsen.
Gary W Falk, MD:
Excellent questions.  There is no single diagnostic perfect test for GERD.  Hiatla hernias only require repair if they are symptomatic.  Anitreflux surgery has risks and benefits and when not  done  in well selected patients by highly skilled surgeons may lead to big trouble
Lyala:
I have severe heratburn even siting up all nights  but Ph Test didn`t show acid reflux.Do you know why?
Gary W Falk, MD:
pH testing is imperfect.  There are also other causes of your symptoms besides GERD that need to be considered.  
Juana824:
Good morning, I have a quick question. I am 38weeks pregnant and have suffered from heartburn/acid reflux/GERD for most of my pregnancy. I was prescribed Protonix (sp?) and it helped for a short time. I now take a few teaspoons of Maalox to alleviate the pain , but that relief is short lived. My question is...With heartburn being a common pregnancy symptom, will there be a long term effect on my esophagas because of the acid reflux I have experienced during my pregnancy? It is sometimes unbearable and I am just a little concerned...I didn't have this problem prior to pregnancy.
Gary W Falk, MD:
Excellent question.  The bottom line is I do not know long term risks.  This is something to address after your delivery.  Good luck with your pregnancy.
scopage:
I've read that many patients with Barrett's overestimate their risk of progression to cancer. What does the latest data show as the lifetime risk for progression?
Gary W Falk, MD:
The risk is 0.5% per year.  Lifetime risk is low