Health Chats
GERD/Heartburn: Advances in the Treatment of Severe GERD
Wednesday Apr 07, 2010, 05:00PM - 06:00PM (EST)
Elliot R Goodman, MDBlank
Chief of Bariatric Surgery Service
Beth Israel Medical Center
Surgery, New York, NY
GastroEsophageal Reflux Disease (GERD), also referred to as heartburn, is reflux and regurgitation of the contents of the stomach into the esophagus that is frequent and severe enough to impact daily life and may even damage the esophagus. Normally, after swallowing, a valve between the esophagus and stomach opens to allow food to pass into the stomach, then closes to prevent reflux of the food back into the esophagus. In GERD, this valve is weakened or absent, causing the acidic digestive juices from the stomach to flow back (or reflux) into the esophagus. <br><br> The esophagus is not designed to handle the acidic environment of the stomach. This reflux is not only painful and uncomfortable, but can burn the esophagus, cause chronic inflammation, and can lead to major damage and cancer of the esophagus. GERD is one of the most common diseases, with over 60 million Americans experiencing symptoms at least once a month. For many lifestyle modifications can significantly decrease the occurrence and severity of GERD and are usually the appropriate first step in the treatment process. <br><br> Drug therapies such as proton pump inhibitors (PPI) and H2 (H2RA) blockers reduce ‘typical' GERD symptoms caused by acid exposure, but they are not effective in treating non-acidic or alkaline reflux and ‘atypical symptoms' like asthma, or chronic cough. Even if drug therapy is effective, it may be needed for life, since symptoms and disease return as soon as medication is stopped. Surgery is sometimes indicated for patients with severe GERD who have failed less invasive treatments. Laparoscopic repair has been shown to be effective in 75-90% of patients in alleviating heartburn and 50-75% in alleviating cough, asthma, and laryngitis. Unfortunately, even laparoscopic surgical repair can be invasive and typically has a high incidence of side effects like gas bloat and difficulty swallowing. For this reason, less than 1% of GERD patients currently choose invasive surgical therapy to treat their condition. <br><br> Transoral Incision Free Fundoplication (TIF) is the third wave in the evolution of surgical procedures for the treatment of GERD and builds upon the principles of proven open and laparoscopic procedures used to effectively treat the disease. The key differences are that EsophyX TIF is performed through the mouth, does not require any incisions, and does not dissect any part of the natural internal anatomy. Benefits include reduced recovery time and discomfort and most patients are able to return to work and normal activities within a couple of days after the procedure. <br><br>
MedHelp:
Hello Everyone! The health chat is going to start at 5pm Eastern Standard Time and 2pm Pacific Standard Time.  Please feel free to start submitting your questions.
MedHelp:
Welcome to the GERD/Heartburn: Advances in the Treatment of Severe GERD Health Chat!
MedHelp:
Thank you to all members and to Dr. Goodman for joining us here today!
Dr. Elliot Goodman:
Hi everybody
Dr. Elliot Goodman:
Thxs for attending our chat
galden:
GERD, Hearburn, Acid Reflux. Those terms are often used interchangeably. What is REALLY the main differences between the 3? I ask because when people tell me what my health challenge is, I don't know what to answer, although all 3 seemingly do apply.
Dr. Elliot Goodman:
gerd and reflux same - acid coming back up from stomach to esophagus
Dr. Elliot Goodman:
heartburn - symptoms related to acid reflux
Dr. Elliot Goodman:
heartburn - chest pain and feeling of acid coming back up into chest
Jerseydevil:
Hello Dr. Goodman. I am a 40 year old male and have been suffering from acid reflux for about 10 years. I first tried products such as Tums however they were a short lived remedy. I started taking Prevacid and have been on it for about 5 years. I stopped taking it for about 6 months but needed to start again when the reflux returned. I don't like taking medication as it is and fear that I am doing more harm by continuing it for such a long time period. What are the potential health risks for staying on this medication for so long? Do you feel I should discontinue it again? Thank you for your reply. Shawn from New Jersey.
Dr. Elliot Goodman:
Proton Pump Inhibitors (PPI) were only designed to be taken in the short term and not for the long term.
Dr. Elliot Goodman:
Side effects include reduced absorption of calcium from your diet. Increased hip fractures in the elderly
Dr. Elliot Goodman:
and interactions with other medications such as cardiac medications.
Dr. Elliot Goodman:
There is an increased risk of gastric polyps with PPI's.
Dr. Elliot Goodman:
As a young patient you should consider other treatments for your Reflux since the medications are not attacking the underlying cause.
Dr. Elliot Goodman:
That being a faulty valve between the stomach and esophagus.
Dr. Elliot Goodman:
There are new procedures available to reconstruct the valve without incisions and with a very quick recovery time.  
Dr. Elliot Goodman:
You should consider a new technology Esophyx in this regard.
vprisco:
What is the best way to avoid heartburn at night?
Dr. Elliot Goodman:
Avoid eating the wrong sort of foods such as spicy foods, caffeine at nightime.  Don't go to bed on a full stomach.
Dr. Elliot Goodman:
If necessary, you can elevate the head of your bed.  In the old days, people would use the yellow-pages to lift their beds.
Dr. Elliot Goodman:
Some people with really bad heartburn often sleep in a recliner because of the reflux of food and acid at night.
jasonv11:
I Have  taken all the PPIs they make.  I feel  especially when I am on PPIs i get even more reflux.  I wonder if my proton pumps kick into overdrive when on PPIs and they cause more reflux.  Does anyone feel the same as I do? Better yet is there any proof that this can happen?  I am going to call my dentist this week and see if he will give me my dental records.  I had one real bad check up with 4 cavities when I was on a double dose of PPIs.  Thank you for reading this question
Dr. Elliot Goodman:
PPI's inhibit calcium absorption from your diet.
Dr. Elliot Goodman:
Therefore if you are on high doses, it can reduce the amount of calcium in your teeth and that will tend to lead to more cavities.
Dr. Elliot Goodman:
Again, I would stress that even though I don't think PPI's increase the amount of reflux, they are not getting to the underlying problem, that being the faulty valve.
Boobert:
I've been taking 40mg nexium for over 10 years for gerd. I have a hiatal hernia and what looks like barretts espophagus forming. What are long term effects of taking nexium and could it be a reason for chronic constipation and fatigue? Thank You.
Dr. Elliot Goodman:
We have already referred to the side-effects of PPI's, but they include Side effects include reduced absorption of calcium from your diet. Increased hip fractures in the elderly
Dr. Elliot Goodman:
and interactions with other medications such as cardiac medications. There is an increased risk of gastric polyps with PPI's. Constipation & fatigue are also side effects of PPI's.
Dr. Elliot Goodman:
Again, if you are sick & tired of being sick and tired, please consider other treatments such as Esophyx.
ikodimer:
I have recently been diagnosed with gastroparesis. Only about 17% test sample passed to duodenum after 90 minutes in gastric scan in nuclear med. The condition no doubt was caused by vagotomy and pyloroplasty when I was in my 20's. I am now 72. Question: Can this condition cause LPR...? a form of GERD ...great deal of sub laryngeal mucous most of the time, horseness of voice, nasal drip, intermittent cough. Have tried PPIs( Protonix 2/day...40mg total) and H2 blockers, to no effect. Have tried elevating head during sleep raising bed and using pillow wedge. Have seen 3 different ENT mds to no effect. Have adjusted diet to not eat several hours before bedtime. Some adjustment of diet during day also. Have lost some weight...about 15 over last year. Otherwise healthy and fit, work out 5-6X/week at gym. Any suggestions would be greatly appreciated. Thank you.
Dr. Elliot Goodman:
The LPR (laryngo-pharyngeal-reflux) may be related to your gastroparesis.  The stomach just doesn't empty properly and sync back up.