Transcription:

Scott Webb (Host): Most of us have been there and you meet with friends or family and overdo it a bit. Maybe it was that last drink or the extra scoop of Buffalo cheese dip. But the end result is predictable. You get home and snuggle up in bed only to have that unpleasant feeling of burning in your chest and that bitter taste in your mouth. Yeah, it's heartburn, also known as reflux. And though it may have been the cheese dip, it might also be GERD, gastrointestinal reflux disease. And joining me today to explain GERD and tell us about our options for dealing with it, including diet modification and surgery is Dr. Tyler Bedford. He's a Physician specializing in Advanced Laparoscopic Surgery at Summa Health.

This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. So, Dr. Bedford, thanks so much for being on today. We're talking about GERD. Most of us know what heartburn is, but many people may not realize that that heartburn is caused by GERD. So, let's start with maybe the most obvious one here. What exactly is GERD?

Tyler Bedford, MD (Guest): GERD actually stands for gastroesophageal reflux disease. It's an acronym and the D there is the big thing, the disease part. So, reflux is normal, you know, to have occasionally have some reflux, but it becomes an issue when it actually transitions over into a disease where you're having daily symptoms, you're getting bleeding, you're having strictures from it or something other than just the occasional reflux. And that's when it crosses over into actually being called GERD.

Host: And that's probably when we should, you know, seek treatment or see a doctor and find out exactly what's going on. What are the causes? What we could do about it? But, many people maybe just don't even realize exactly you say reflux, but we probably more commonly referred to it as heartburn. So, what really causes reflux or heartburn?

Dr. Bedford: Yeah. It's, there's a connection from the esophagus, which is the swallowing tube from your mouth down to your stomach. That's called the esophagus and there's a connection from the esophagus and the stomach. And there's normally acid in the stomach. And what happens when you have reflux or GERD or heartburn, which are essentially, those three terms are synonymous. When you have that, the acid from the stomach actually makes its way up into the esophagus. And it should normally mostly be contained within the stomach, but reflux occurs when that valve there between the esophagus and the stomach is actually dysfunctional.

Host: And I'm really jealous of people who don't suffer from reflux or GERD because I'm definitely, as we were talking about before we got started, I'm somebody who lives with this. I know what some of the triggers are, what some of the causes are, whether it's a pasta sauce or chocolate or coffee. So, a lot of it I do to myself and I know that. And so, I'm really envious of people who can just eat anything and never get heartburn. But for those folks, could they still be at risk?

Dr. Bedford: Really, I kind of break it down into, your you're right on the money. You want to normally, if you have a little bit of heartburn, you take a couple of TUMS, maybe you have it once or twice a week, at most, then you don't really have to go run in and see your doctor, that's not too uncommon. If it becomes more frequent where two, three, four times a week, you're having heartburn and you're taking medication more frequently, over the counter medication more frequently. That's the time where you really want to start thinking about, asking either your medical doctor or a gastroenterologist or a surgeon if it's something that you should be concerned about or look into more.

Host: Yeah. And I had a friend whose dad sadly, when I was younger, his dad thought he had heartburn and he went to bed and didn't do anything about it. And it turned out he was having a heart attack and he passed away. And I know that that can be a thing, right. That people can often sort of conflate or confuse those symptoms. They think that heartburn is just heartburn or they were having a heart attack when they're really having heartburn. So, how do we on our own at home, how do we distinguish between the two and when should we call 9-1-1?

Dr. Bedford: That's difficult. Especially in someone that has heartburn, and knows they have heartburn and then they have something similar, and it could actually be a heart attack, like you said. I guess the main things you want to watch out for number one, are your symptoms different? If you have normal heartburn, do you know what that feels like? And if it feels different than I would encourage you to seek some attention. If it's associated with racing, it feels like your heart's racing, feels like there's an elephant sitting on your chest. If you have right-sided pain, shoulder pain, down your jaw, things like that. Obviously, if you pass out or lose consciousness, those are concerning things. But really, like you mentioned, it can be, it can be pretty devastating to think it's heartburn and then obviously it's a heart attack and it goes untreated. So, I really encourage anyone to think, if they think it's something abnormal to call and seek some help.

Host: Yeah. That sounds right. You know, when in doubt, call your doctor, call 9-1-1, obviously, even during COVID-19 we want people to do that. And you mentioned, taking a couple of TUMS for people who just have kind of the run of the mill heartburn or reflux, is something that they probably did to themselves. They had a bunch of pasta and they get a little heartburn. So, what are the options? The nonsurgical options besides TUMS? What else can we take to prevent and treat heartburn or reflux?

Dr. Bedford: Kind of the algorithm is you start with like you said, diet modification, lifestyle modifications, that's where you start. So, if you can control it with the foods that you eat, then obviously you avoid those foods. We used to tell people with heartburn to avoid a whole list of foods, mint, coffee, caffeine, chocolates, alcohol, a huge list of things.

Host: All the good stuff then, right?

Dr. Bedford: Exactly. Everything you want to eat, basically. And now we've changed to, if it gives you heartburn, try to avoid it, it makes sense. Cause those triggers may not cause heartburn in some people. So, that's number one and then weight is frequently associated with heartburn and not everyone that has heartburn is overweight and vice versa, but losing weight can help because it's pressure from your abdomen on your stomach and then pushes up into your chest so it can make heartburn worse. So, once you've exhausted those kinds of non-pharmacological things, you can move on to medications and they're almost all this stuff's over the counter now. You can get TUMS, over the counter. The medications, like they're called PPIs, which a lot of people now know what that is, cause it's so common. That's things like Protonix or he purple pill, omeprazole and there are also other medications like Zantac, which actually you want to avoid now, but that's a H, it's called an H2 blocker.

That's something you could take as well. Those medications, but I discourage people from doing that because if you need something more than TUMS, I think you should just reach out to your physician and have a conversation with them.

Host: What are the surgical options when it comes to dealing and living with GERD, when we talk about quality of life?

Dr. Bedford: There's quite a few tests that we have to do to make sure number one, it's reflux. Cause it could be other things that, that mimic reflux. So, we have to confirm that it's reflux. So, usually we'll do an upper endoscopy or an EGD. Sometimes we'll, at that time, we'll actually put a little probe that senses acid. We'll put a little probe there and see if that is elevated. Then there's another test where you have to see if the strength of the esophagus muscle is, is good enough to propel the food through. And then we also do usually an upper GI study where we have you drink contrast. And that's usually the first test we do. But that's, those four tests or any combination of those we usually do before thinking about surgery, because there are many surgical options and we want to pick the right one. A lot of times reflux is associated with what's called a hiatal hernia, which is a hernia in the diaphragm.

Surgical options always involve fixing that. And then we have to create some sort of a valve to keep you from having reflux. And then they're two broad classifications. There's the tissue valves, which involve taking the stomach and wrapping it around the bottom part of the esophagus. And there are variations of that. And then the nontissue valves or frequently the magnetic sphincter augmentation device or the Linx, which is a bead of magnets that goes around the bottom of the esophagus. And what that does is that it doesn't squeeze tightly, but it doesn't allow the esophagus to expand under low pressure. So, it doesn't allow reflux to occur, but allows you to eat. It allows food to go through.

Host: Yeah, it's good to know that a, there's obviously a battery of tests that people may go through and there are a lot of over the counter and now surgical options that we've discussed. A couple of last things here before we wrap up, what is Barrett's esophagus exactly?

Dr. Bedford: Barrett's esophagus is actually a change of the cells in the esophagus. So, normally they're a certain type of cell. And when they get exposed to acid over typically over long periods of time, they actually change the type of cell that they are in response to the acid. And that change again, over a long period of time can lead to what's called dysplasia and then eventually it can lead to esophageal cancer if it's long enough.

So, it's very important that if you have a diagnosed with Barrett's, that you get surveillance endoscopy's typically every two years and that's something you really don't want to skip out on cause that can turn into cancer. It's not very common to turn into cancer, but it can.

Host: Doctor, so good to have you on today and your expertise. Before we wrap up here, anything else you want to tell people about as we were joking a little bit, living with GERD. Heartburn and reflux is very common, but it's also highly treatable. So, what else do you want to want people to know today? What are the takeaways?

Dr. Bedford: Reach out to your doctor, it's very, like you said, it's very treatable. It's not, you shouldn't be taking medication every day. That's very important to reach out to your doctor, discuss it with him or her. And it's treatable with medication and the surgical options are excellent. Most of the time you can go home the same day as the surgery. It's done with laparoscopically or with small incisions. And it’s come a long way since we did them with big incisions and you spend five days in the hospital. That's just not the case anymore. Don't be afraid to reach out to your physician, and get some more information so that you're taking care of yourself.

Host: I think there's just so many things that people tend to live with because I don't know, they just maybe think it's easier to grab a couple of TUMS on a daily basis. But when we talk about quality of life, especially with something like GERD, reflux and heartburn, that is so highly treatable, we definitely want people to reach out, find out what their options are. And as you say, if you're having to do that kind of thing, you're having to take TUMS every day, it's probably worth speaking with your primary, possibly seeing a specialist. So, Doctor, thanks so much for your time today and your expertise and you stay well.

Dr. Bedford: Yeah, it's my pleasure, thanks Scott. You too.

Host: For more information, contact the Summa Health Medical Group Gastroenterology at (330) 253-1800. And if you found this podcast to be helpful and informative, please share it on your social channels and be sure to check out the entire podcast library for additional topics of interest. This is Healthy Vitals, the podcast from Summa Health. I'm Scott Webb. Stay well, and we'll talk again next time.

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