Treating Reflux
Heartburn can be more than just an annoyance. Here’s how to know when to seek treatment.
Dr. Shaheer Siddiqui is a gastroenterologist with Memorial Hermann Medical Group Southwest GI and Memorial Hermann Medical Group Sugar Land Multi-Specialty.
Many people get heartburn every now and then, especially after a heavy meal. If it goes away with an over-the-counter acid reducer — and you avoid overindulging in acid triggers such as alcohol and fried foods — then it’s probably nothing to worry about, says gastroenterologist Shaheer Siddiqui, MD. But, if chewable antacids aren’t cutting it, or if the symptoms keep coming back, you could have chronic reflux — known medically as gastroesophageal reflux disease (GERD). GERD affects about 20% of Americans, according to the National Institutes of Health, and it can lead to more serious problems if left untreated. Dr. Siddiqui discusses when you should seek treatment, and what that might entail.
Q. What is the difference between GERD and heartburn?
Dr. Siddiqui: Heartburn is a symptom; GERD is a disease that can cause heartburn. People who have acid reflux might complain of burning or pain in the chest, trouble swallowing, regurgitation, food getting stuck in the throat — these are all symptoms of the disease we call GERD. Most of the time, it’s caused by acid from the stomach that gets into your esophagus.
Q. When should someone see a doctor about reflux symptoms?
Dr. Siddiqui: All of us have some amount of reflux occasionally. Some people never feel it, but if you do have symptoms, most people go to a drugstore and pick up over-thecounter acid reducers. If your symptoms improve and don’t come back, then you’re probably fine. If your symptoms don’t get better, or they keep coming back, I’d recommend seeing a doctor. The problem with chronic reflux is that if it goes untreated, it can permanently damage the lower part of the esophagus, and it can develop into a condition called Barrett’s esophagus, which can be a precursor to cancer of the esophagus.
People over 50 who develop reflux symptoms for the first time should get evaluated by a gastroenterologist. Those symptoms can be signs of other things that might be going wrong, including ulcers, inflammation or possibly even cancer.
Q. How is GERD diagnosed?
Dr. Siddiqui: Most of the time, in younger patients, it’s diagnosed based on clinical symptoms. Initially, patients are prescribed a very mild medication like famotidine. If they don’t improve, a stronger medication will be recommended. If that doesn’t make the symptoms improve, the next step is usually an endoscopy. There’s a wireless esophageal pH test that measures how much acid is flowing backward from the stomach. A small capsule is placed in the esophagus during the endoscopy that monitors all the acid that comes up and gives us a detailed report.
Most of the time, it’s acid that causes these symptoms, but there’s a small subgroup of people that have non-acid reflux. Those patients can have similar symptoms. They can feel stomach fluids or gases that aren’t actually acid, but their brains perceive it as acid reflux.
Q. What are the treatment options for GERD?
Dr. Siddiqui: The first step is always medical treatment, and the most important medications typically used are acid-suppressing medications. The main purpose is to decrease the amount of acid in the stomach, so patients don’t have the symptoms of acid reflux. Patients have to do lifestyle modifications as well. Because even with the medication, if you’re still doing things that trigger reflux, it won’t improve.
If you’re overweight or obese, losing weight can help. If you’re a smoker, or you’re around secondhand smoke, limiting your exposure can help.
Alcohol triggers an excessive amount of acid in the stomach, so not drinking can make a huge difference.
But if symptoms don’t resolve with medication and lifestyle modifications, or if patients don’t want to take medication, surgical options are considered. Some patients with reflux have a hiatal hernia, which is when a part of the stomach goes up above the diaphragm, and that can be corrected by a surgical procedure. In some cases, people with reflux have a loose valve between the stomach and the esophagus that allows acid to creep up into the esophagus.
To treat that, we can wrap part of the stomach around the lower part of the esophagus to tighten the opening. Another procedure uses magnetic beads that are placed on the lower part of the esophagus to keep it closed.
Most of the time, these procedures are all very well tolerated. The expectation is that the reflux will go away afterward, and for the vast majority of people, it does.
At Memorial Hermann, we take a comprehensive approach to treating GERD.
For more information, visit memorialhermann.org/GERD