Don’t Get Burned by Acid Reflux Disease

March 2, 2009 12:00 PM with Eli Ehrenpreis

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Nearly everyone gets heartburn occasionally but it could be something more serious. Eli Ehrenpreis, MD , Chief of Gastroenterology at Highland Park Hospital, discusses the signs, symptoms and treatments of gastroesophageal reflux disease (GERD).

Kristin Philbin (Moderator) - 11:51 AM:
Welcome! Today’s chat: Don’t Get Burned By Acid Reflux Disease will begin shortly. Please start submitting your questions and Dr. Eli Ehrenpreis will begin answering them as soon as we get started. While you are waiting for the chat to begin, feel free to visit the Gastroenterology Department to obtain more information about acid reflux.

Grant Gannon (Moderator) - 12:10 PM:
Just a quick update. Dr. Ehrenpreis has been delayed from starting the chat. Please stick with us and we'll update you soon.

Eli Ehrenpreis (NorthShore) - 12:12 PM:
Hello, this is Dr. Eli D. Ehrenpreis. I am a gastroenterologist and Chief of Gastroenterology at Highland Park Hospital. I am happy to answer your questions today about acid reflux disease.

  Jamie (Chicago, IL) - 12:12 PM:
My mother and father both suffer from acid reflux, and my grandfather has had an ulcer. Is acid reflux genetic?
Eli Ehrenpreis (NorthShore)
Great question, Jamie. There are some forms gastroesophageal reflux that are inherited. However, since the condition is so common, it is more likely that several of your family members are having symptoms of a common condition.

  James (Evanston, IL) - 12:14 PM:
I play basketball regularly. I also get intense heartburn periodically. I’m wondering if exercise or playing sports can exacerbate GERD?
Eli Ehrenpreis (NorthShore)
I used to be one of the physicians taking care of the Florida Panthers, the professional hockey team. Those players had terrible problems with reflux, probably because they are frequently bending forward after eating or drinking and they are contracting their abdominal muscles during play. This causes the contents of the stomach to literally regurgitate into the esophagus. I would assume that playing basketball may potentially cause the same problems. You should try to avoid eatintg for a couple of hours before you play.

  Steve (Highland Park) - 12:16 PM:
I recently awoke to an uncontrollable coughing fit in the middle of the night that left a sour taste in my throat. Is this a common GERD occurrence? Perhaps it was an isolated incident, but should I have it checked out?
Eli Ehrenpreis (NorthShore)
This symptom may indicate that you had nighttime GERD. If it is reoccurring, you should see your physician or a gastroenterologist. In the meantime, avoid eating within three hours of lying down; also avoid alcohol and caffeine at night.

  Rebecca (Skokie) - 12:18 PM:
Are there certain types of foods that can help mitigate heartburn or acid reflux disease?
Eli Ehrenpreis (NorthShore)
Another great question. Right now, licorice has bicarbonate in it. Some herbal preparations such as camomile and ginger may settle the stomach in general; However, they probably do not neutralize the acid in the stomach.

  Jamie (Chicago, IL) - 12:19 PM:
What kind of common condition would we be having?
Eli Ehrenpreis (NorthShore)
GERD is a very common condition. It has been estimated that up to 44 percent of people have a single GERD episode monthly.

  Kyle (Riverwoods, IL) - 12:20 PM:
Is heartburn the same as acid reflux?
Eli Ehrenpreis (NorthShore)
The terminology can be very confusing. Acid reflux means that the acid that normally resides in the stomach is moving upward into the esophagus. Heartburn is one of a number of symptoms that can occur when acid reflux is present.

  Danielle (Chicago, IL) - 12:21 PM:
Is it possible to reduce the effectiveness of over-the-counter medications by repeated use?
Eli Ehrenpreis (NorthShore)
In regard to acid-blocking medications, this phenomenon has not been described. In other words, the potency of the medication should not be reduced with ongoing usage.

  Greg (Rogers Park) - 12:23 PM:
When does it become necessary to consider surgery to stop acid reflux?
Eli Ehrenpreis (NorthShore)
We usually don't recommend surgery until a patient is unable to tolerate the excellent acid-blocking medications that are available for the treatment of gastroesophageal reflux disease (GERD) or at times, if the symptoms are persisting despite maximal treatment with these medications.

  Jamie (Chicago, IL) - 12:24 PM:
How do I know if I have acid reflux disease?
Eli Ehrenpreis (NorthShore)
In general, the presence of gastroesophageal reflux disease (GERD) is defined as "troublesome symptoms caused by the reflux of stomach contents" or "complications caused by reflux of stomach contents."

  Jamie (Chicago, IL) - 12:26 PM:
Similar to Rebecca's question, are there foods that provoke acid reflux? I've heard that this is the case for spicy foods and coffee. Is this true?
Eli Ehrenpreis (NorthShore)
There is fairly good evidence that caffeine containing foods such as coffee and tea, chocolate and peppermint can induce reflux of stomach contents. There is only minimal evidence to suggest that "acidy" foods such as oranges, other citrus fruits, and carbonated beverages can induce reflux. Lying down after eating a large meal can also induce reflux.

  Rich (Chicago) - 12:28 PM:
I use my voice professionally and I do have GERD. Can stomach acid do damage to my vocal cords? I experience irritation in my vocal box, almost like I can’t clear my throat regardless of how many times I try.
Eli Ehrenpreis (NorthShore)
Very good question. There are symptoms of reflux that can occur outside of the esophagus. These include cough, sore throat, and possibly even asthma. If these types of symptoms are occurring in conjunction with esophageal-related symptoms such as heartburn, it is possible that they are being aggravated by acid reflux.

  Steve (Palatine, IL) - 12:30 PM:
What are some prescription medications that help with acid reflux? Are some better than others?
Eli Ehrenpreis (NorthShore)
The proton pump inhibitors (PPIs) are the most potent acid-blocking medications available on the market. Most, but not all, are prescription drugs. Examples of prescription forms of PPIs include Nexium, Protonics, Acifex and Prevacid. Prilosec, which is now available over the counter, is another PPI. If you have erosive esophagitis, some of these may be better than others. If you have symptoms of GERD, these medicines should be relatively equal for treating the condition.

  Jamie (Chicago, IL) - 12:33 PM:
Are there lifestyle tips that can help me manage my acid reflux symptoms?
Eli Ehrenpreis (NorthShore)
Yes, but many don't great scientific evidence to back up their effectiveness. These include elevating the head of the bed, avoiding eating within three hours of going to sleep, and losing weight. Some of the dietary modifications that we discussed earlier are helpful for some patients.

  Jamie (Chicago, IL) - 12:35 PM:
Is heartburn really related to the heart, or just the stomach?
Eli Ehrenpreis (NorthShore)
It's a term for the most common symptom of gastroesophageal reflux disease (GERD). It has nothing to do with the heart.

  Kyle (Riverwoods, IL) - 12:36 PM:
How do you know when heartburn is serious enough to talk to a physician?
Eli Ehrenpreis (NorthShore)
In general, if it is "troublesome" (i.e., it is affecting your quality of life). Of course, any discomfort that occurs in the chest could represent heart disease rather than GERD. So it is important to make sure that the "heartburn" is in fact coming from your GI tract. Finally, if the "heartburn" is associated with food getting stuck when you swallow it, weight lose, fevers, unexplained anemia, etc., you should immediately consult your physician.

  Steve (Palatine, IL) - 12:38 PM:
How does a doctor diagnose someone with acid reflux?
Eli Ehrenpreis (NorthShore)
It's starts with a medical history and physical examination. Testing, such as endoscopy (putting a small tube with a light on it to look at the esophagus, stomach and a portion of the small intenstine) may follow. Other tests may also be recommended.

  Greg (Evanston, IL) - 12:40 PM:
I feel a burning sensation in my upper abdominal area as soon as I start eating. But the irritation does not linger after I eat. I’m not quite sure what’s going on. Please advise.
Eli Ehrenpreis (NorthShore)
Although this does not follow the typical pattern of GERD, your symptoms could represent gastroesophageal reflux. Other diagnoses are also possible. I would recommend you discuss this matter with your physician.

  Jamie (Chicago, IL) - 12:42 PM:
Why should I avoid eating before going to sleep? Should I also avoid eating before exercising?
Eli Ehrenpreis (NorthShore)
Eating just prior to lying down or before vigorous exercise can literally allow the contents of your stomach to travel toward your mouth. Acid might be included in these contents and thus, produce GERD.

  Kyle (Riverwoods, IL) - 12:43 PM:
Are there multiple kinds of GERD?
Eli Ehrenpreis (NorthShore)
Again, the terminology is potentially very confusing. The current definition of GERD (gastroesophageal reflux disease) requires the presence of troubling symptoms or complications from reflux of the contents of the stomach. Some patients with GERD can have actual inflammation, ulcers, narrowing and even cancer developing in the esophagus from the reflux. Other patients just have troubling symptoms.

  Danielle (Chicago, IL) - 12:46 PM:
I have heard that Tylenol and other Acetaminophen pain relievers can irritate this condition more - is that true? What would you recommend as an alternative?
Eli Ehrenpreis (NorthShore)
I am unaware of any problem from acetaminophen if you have GERD. It should be perfectly safe to take if you have GERD.

  Jamie (Chicago, IL) - 12:48 PM:
What are the complications of GERD?
Eli Ehrenpreis (NorthShore)
Complications include esophageal ulceration, stricture (narrowing), Barrett's esophagus (a precancerous condition), esophageal cancer, chronic cough, loss of dental enamel and laryngitis. Other possible complications include asthma and recurrent ear infections.

Kristin Philbin (Moderator) - 12:49 PM:
Thank you everyone for your great participation, the chat will be ending in approximately 10 minutes. Please submit any final questions you have.

  Elizabeth (Chicago) - 12:51 PM:
I read recently that there is a genetic test being developed to help predict who might be at risk for esophageal cancer as a result of having GERD. It does run in my family, but I didn’t realize there is genetic link to heartburn. Have you heard about this test?
Eli Ehrenpreis (NorthShore)
There is a study going on at Mayo Clinic that addresses this specific issue. But here at NorthShore University HealthSystem, we have a very well established Center for Medical Genetics. Our division of gastroenterology has been working very closely with the center. The Center for Medical Genetics should have access to further testing to assess your risk. You should consider making an appointment to see Dr. Wendy Rubinstein who heads up the genetics center.

  Steve (Palatine, IL) - 12:56 PM:
What is a reasonable approach to the management of GERD?
Eli Ehrenpreis (NorthShore)
Depending on your age and the length of time that you have had your symptoms, many gastroenterologist will start with a trial of PPI therapy. If you respond very well to this treatment, at times no further testing is required. If symptoms are persistent or the GERD has been going on for about five years or more, you need an upper endoscopy.

  Steve (Palatine, IL) - 12:58 PM:
What causes acid reflux?
Eli Ehrenpreis (NorthShore)
Stomach contents entering the esophagus.

Kristin Philbin (Moderator) - 12:59 PM:
Thank you again for participating in our chat today. For more information please visit our Gastroenterology pages.

Also, a transcript of this chat will be available shortly.

Eli Ehrenpreis (NorthShore) - 1:02 PM:
This has been a very lively discussion. Thank you all for your excellent questions. Please feel free to participate in the upcoming online chats featuring other members of our gastroenterology division. Have a nice afternoon, Dr. Eli D. Ehrenpreis

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Thank you very much for your participation.