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Daily Checkup: Weight, diet may cause frequent acid reflux

Dr. Gina Sam of Mount SinaiMount Sinai/Eugene Gologursky

Dr. Gina Sam of Mount Sinai

The Specialist:

An assistant professor of medicine at Mount Sinai Hospital, Dr. Gina Sam is a gastroenterologist who specializes in treating patients for GERD and acid reflux. She sees more than 1,000 patients with GERD a year.

Who’s at risk:

MORE THAN 60% of the adult population reports experiencing some kind of acid reflux during any one-year period, but for an estimated 7 million Americans, chronic reflux impacts their quality of life. “Gastroesophageal reflux disease, or GERD, occurs when contents from the stomach flow from up the esophagus,” says Sam. “Normally your lower esophageal sphincter acts as a barrier to stop contents from flowing up, but when that sphincter becomes weak or relaxes inappropriately, the stomach contents travel back up, causing symptoms like heartburn, regurgitation, and nausea.”

Not all acid reflux is GERD, which is a more serious and chronic form of acid reflux. “Most adults will experience acid reflux on occasion, while GERD patients might experience reflux as often as every week,” says Sam. “As yet, doctors aren’t quite sure exactly why GERD happens, or why one patient develops it when another patient doesn’t.”

While the cause of GERD remains unknown, doctors have identified a set of risk factors associated with the disease. “For some people, weight gain or even pregnancy can led them to develop GERD,” says Sam. “The main risk factors are gaining weight, being obese, eating a lot of fatty or spicy foods, eating close to bed time, and consuming large amounts of alcohol.” Ideally, you should give your stomach three hours to digest before you lie down.”

Just about anyone can develop GERD. “There’s no connection between gender and GERD, and it can occur at any age — even babies can have GERD if they have a specific anatomical problem,” says Sam. “But for the majority of patients, GERD begins when they start gaining a lot of weight.”

Signs and symptoms:

The symptoms of GERD can vary widely, so doctors cluster them into typical and atyical. “The typical warning signs include heart burn, chest pain, regurgitation, nausea, sore throat, and what we call globus — that sense that there’s something in the back of your throat you can’t get rid of,” says Sam. “Atypical symptoms can include coughing, (which means that the reflux is coming up from the stomach and going into the lungs), sinusitis, and in really bad cases, tooth decay and bad breath.”

Although symptoms range from person to person, most individual patients have a discernible pattern. “Most people find that their symptoms are pretty consistent,” says Sam. “If you have an anatomical problem like a hernia, you’re going to have reflux even if you are very careful with your diet. While other people find that when they lose thirty pounds their reflux goes away.”

Traditional treatment:

For most patients, the first line of attack is conservative treatment. “Weight loss and diet can be enough for some patients,” says Sam. “But if cutting out fatty foods and late meals isn’t enough, the doctor will call for an endoscopy to get a look at your esophagus.”

The second line of treatment are drugs called proton pump inhibitors. “These acid suppressing medications can be very effective, but you have to keep taking them for the rest of your life, and a lot of people don’t want to do that,” says Sam. “If your GERD symptoms continue or you want an alternative to medication, that’s the time to see a gastroenterologist who specializes in testing GERD patients.” Many other underlying diseases can cause similar symptoms, so you want to be sure that yours are due to acid breaching the esophagus.

There are also surgical and nonsurgical procedures for treating GERD. “One option is a surgery called Nissen fundoplication, which is when the surgeon uses the top of the stomach and wraps it around the esophagus to make it stronger,” says Sam. “Obviously, that’s an invasive surgery, but it can provide relief to patients with severe GERD.”

A nonsurgical option is called Stretta, a procedure that takes about 45 minutes and is done through the endoscope. “The doctor uses a small balloon with four needles on it that applies heat to the esophageal lining that causes the tissue to remodel itself and bulk up,” says Sam. “It takes about a month for the effects to be felt, and then patients can go off their medication. They do still have to be careful about their diet””

In addition to the unpleasantness of symptoms, it’s important to treat GERD because chronic reflux can increase your cancer risk. “Reflux causes damage to the end of the esophagus, which starts trying to heal itself and grows a form of abnormal tissue we call Barrett’s esophagus, which can develop into cancer,” says Sam. “So it’s important to know that while over-the-counter medications can provide symptom relief, they don’t address the damage that’s already been done to your esophagus-that’s where surgery or a Stretta procedure comes in.”

Research breakthroughs:

The results from the first longer-term studies of Stretta are just coming in now. “This procedure has been around for 10 years, but many of us were waiting for the data before we started recommending it more widely,” says Sam. “A recent study found that 10 years after the procedure, 72% of patients still had normalization of their symptoms — 41% didn’t need medication at all, and 64% took decreased medication. These are pretty impressive numbers — I expect we’ll see more and more patients option to get a Stretta procedure.”

Questions for your doctor:

To lead off, anyone who experiences even occasional reflux can ask, “What can I do decrease to my reflux?” And “how can I prevent damage to my esophagus?” If you have concerns that your reflux might be more serious, ask, “How can I know whether I have already damaged my esophagus?” And don’t hesitate to ask, “Should I see a specialist?” “Because of the connection between GERD and certain esophageal cancers, reflux is something you don’t want to brush off,” says Sam. “When symptoms persist, if medications don’t work, if food is getting stuck, if you’re losing weight, if you’re waking up at night coughing, make an appointment to be evaluated for GERD.”

What you can do:

Get informed.

Begin your on-line search with reliable sources like the American College of Gastroenterology’s patient site (patients.gi.org/) and Mount Sinai (mountsinai.org/patient-care/service-areas/digestive-disease/areas-of-care/acid-reflux-gerd).

Don’t eat right before bed.

Give your stomach three hours before lying down after a meal.

Cut down on alcohol.

The link between alcohol and GERD might not seem obvious, but alcohol’s high acidity contributes to reflux.

Cut your risk by eating smart.

Taking preventive steps can go a long way: losing weight, cutting down on fatty and spicy food, and limiting caffeine can all decrease your risk.

By the numbers: (from the doctor)

-about 7 million Americans report GERD symptoms

-over 60% of adults will experience some type of reflux in a 1 year period

-20-30% of GERD patients report weekly symptoms

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daily checkup

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