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1 6 | PULSE S u m m e r 2 0 1 5 E veryone experiences heartburn once in a while, usually aer a large or spicy meal. Most people just pop a few antacids, but for some, over-the-counter medications aren't enough. If you continue to have heartburn symptoms even aer taking non-prescription drugs, you might have gastroesophageal reflux disease (GERD). Pulse recently spoke with gastroenterologist James A. Sattler, MD, medical director, Digestive Care Consultants, to learn more about it. WHAT IS GERD? Gastroesophageal reflux occurs when the muscle at the bottom of the esophagus weakens or relaxes when it should not, allowing stomach contents to flow back into the esophagus rather than passing through the stomach into the intestine. All people reflux to some degree. It's considered gastroesophageal reflux disease if symptoms are present more than twice a week for a few weeks. Some large hiatal hernias can also lead to increased amounts of reflux. WHAT ARE THE SYMPTOMS? Since stomach contents are acidic, the most common symptom of GERD is a burning sensation in the upper abdomen, which oen radiates to the area under the breast bone. is is commonly known as heartburn. A sour or bitter taste in the mouth may be present. Some of the less common symptoms occur when stomach contents reflux above the esophagus causing throat pain, hoarseness, chronic cough, the sensation of a lump in the throat, asthma, dental erosions, burning in the mouth, or recurrent sinusitis. HOW CAN YOU PREVENT GERD? Limit foods and habits that relax the lower esophageal sphincter such as caffeine, alcohol and tobacco. Don't excessively fill the stomach. Eat smaller portions, more frequent meals, limit carbonated beverages and fatty foods. Maintain a normal weight to decrease pressure from the abdominal wall on the stomach. Stop eating a few hours before bedtime so there is less food to reflux. HOW IS GERD DIAGNOSED? ere is no specific test. A diagnosis of GERD is generally made by the presence of symptoms that respond to lifestyle modifications or a short course of treatment with acid-reducing medications such as histamine 2 (H2) blockers or proton pump inhibitors (PPIs). Patients should first see their primary care physician. Referral to a gastroenterologist may be needed for further evaluation and possible endoscopy to evaluate the lining of the esophagus, stomach and duodenum. WHAT ARE THE RISKS OF UNTREATED GERD? Ulceration and possible narrowing of the esophagus leading to difficulty swallowing. Exacerbation of asthma, bronchitis, sinusitis and rarely pneumonia. A change in the lining of the esophagus (known as Barrett's esophagitis), has a small risk of developing into esophageal cancer. WHEN IS SURGERY RECOMMENDED? Generally, it's an individual personal decision for patients with symptoms that do not respond to or only partially respond to lifestyle modifications and medication. Oen patients with significant regurgitation of stomach contents don't adequately respond to medical treatment alone. Surgery is recommended to prevent irreversible damage to the lungs for patients whose GERD is unresponsive to treatment and continue to experience symptoms of asthma, bronchitis or pneumonia. WHAT'S NEW IN GERD TREATMENT? ere are new, state-of-the-art diagnostic tools now available at Torrance Memorial Medical Center. One of these enables us to treat some GERD patients endoscopically with a procedure known as a Transoral Incisionless Fundoplication (TIF), which repairs the gastroesophageal valve without incisions via the mouth, reducing the need for traditional surgery. Torrance Memorial has excellent specialists employing the latest minimally invasive surgical techniques. TELL US ABOUT THE COORDINATION OF CARE. For the majority of patients, coordination of care involves their primary care physician and gastroenterologist. e team approach for patients that have GERD symptoms affecting their throat, sinuses or lungs involves the primary care physician and gastroenterologist who collaborate and coordinate additional care with the ENT (ear nose and throat), pulmonary (lung), allergy and surgical specialists as needed. HOW CAN I TREAT GERD? WRITTEN BY CAROLE JAKUCS, RN, BSN, PHN A S K T H E D O C