Ending Acid Reflux Doctor Interview

Who are the ideal candidates for the new procedure for GERD?

Dr. Melvin: Most people with reflux are treating with antacid pills and they work quite well for a lot of patients, but some patients can’t continue to take the medication — either they can’t afford it, they have side effects or they just don’t want to be on a pill every day. Other patients don’t have good symptom relief with the medication alone. Those are really the two groups of patients that do quite well with the procedure that rebuilds the bottom of the esophagus and stops acid reflux.

How does the procedure work?

Dr. Melvin: For most patients with reflux disease who need some kind of procedure, they used to get surgery; that could be laparoscopic surgery. People did get quite well with it and bounced back. Now, there’s a new procedure where we use an instrument called Esophyx that goes down the mouth, without any incisions, and rebuilds the bottom of the esophagus where it enters the stomach by placing fasteners into the area, creating a valve there that prevents acid reflux.

What causes acid reflux?

Dr. Melvin: Most patients with symptoms of heartburn or reflux get those symptoms because acid that’s supposed to stay in the stomach gets into the esophagus. In normal people, there’s a valve in the bottom of the esophagus that keeps that acid there. When that doesn’t work anymore, people can get heartburn and they get burning in the inside the esophagus, which can actually cause damage that can lead to cancer.

How are you rebuilding the valve?

Dr. Melvin: The Esophyx device is a mechanical device that allows the surgery. It is actually inserted into the mouth. It goes into the stomach and is able to rebuild that valve of the esophagus where it goes into the stomach. With a scope that goes through it, you can see it happen and we can individually tailor the valve as needed for different patients.

Why is this procedure considered an advancement?

Dr. Melvin: A patient with reflux has the option of having traditional surgery, which, while done laparoscopically, can still cause some disability. This is done down the mouth so it’s less invasive than even traditional surgery. It’s still a reasonable step and it’s not for everybody, but it’s very effective for patients who either require medication everyday or don’t get good relief.

What patients is the procedure recommended for?

Dr. Melvin: Many patients with reflux have a hiatal hernia — a large opening in the diaphragm muscle. Those patients — if they don’t get good relief — probably need the traditional laparoscopic surgery to rebuild that whole area. The Esophyx instrument works well on patients who don’t have big anatomical problems or need a major reconstruction.

What kind of results have you seen?

Dr. Melvin: The device results are relatively early. It’s only been around for a couple of years, but hundreds of patients have had it done and we know that most patients will get very good to excellent relief of symptoms over the follow-up course. That follow-up is relatively short — still in a period of a year or so — but most patients do quite well and are able to get off medication.

How does the procedure affect patients long-term?

Dr. Melvin: The results of Esophyx are still early so we don’t know what happens five, and ten years down the road, but in at least at one year most patients are able to be off medication and are relatively symptom free.

Is it an outpatient procedure?

Dr. Melvin: Currently it’s an outpatient procedure. It does require a general anesthesia so patients need to be put to sleep for the procedure, but most patients are able to go home later that night or certainly the next day and bounce back pretty quickly.

How high is the risk of esophageal cancer in these patients?

Dr. Melvin: Patients with chronic reflux can have changes in the bottom of their esophagus that can increase their risk of cancer, so anybody with longstanding reflux should get screened to help prevent cancer. The changes can be very early and we can know about them or they can be late; however, if you identify esophageal cancer early, it can be prevented.

How serious of a problem is acid reflux?

Dr. Melvin: About 15 percent of the American population has heartburn that bothers them from time to time. The people that need to have surgery usually have pretty severe symptoms that bother them everyday or keep them awake at night. The other thing reflux can do is cause problems in the esophagus — both changes that can lead to cancer and changes in their lungs. Sometimes we see patients who are even adults who develop asthma or choking as a result of their reflux.

Herbal Supplements

Cordyceps
Cordyceps is a mushroom that has long been used, particularly in traditional Chinese medicine, for ailments ranging from asthma to coughs to female hormonal problems. Its use has since extended to include treating bronchitis, hepatitis B, and hepatic cirrhosis, and acting as a replacement to certain immunosuppressive medications. Some studies have also found that cordyceps provides increased energy levels and improved lung capacity. For that reason, this herbal supplement is popular among athletes.

Glucosamine
Glucosamine is an amino acid that occurs naturally in all tissues. It is vitally important to the preservation of cartilage, for two reasons: First, it is a main component of the connective tissue. Second, it is an aid in the process of transporting sulfur (another main component of cartilage) into the tissue.

As people age, they often gradually lose the ability to produce adequate levels of glucosamine. It is theorized that this is a main cause of osteoarthritis. Studying the effect of glucosamine supplements on arthritis sufferers, researchers have found that pain was relieved and mobility was improved. Although ti has not yet been proven, some people believe that this supplement can actually slow down the progression of the disease. Glucosamine sulfate is the form most highly recommended for relief from osteoarthritis.

Don’t’ take any form of glucosamine if you are allergic to shellfish. Consult use with your healthcare provider if you have diabetes, because glucosamine can alter blood sugar levels. Also, taking glucosamine with a diuretic reduces the effectiveness of this supplement, so you may need to increase the dosage to compensate.

Glycerophosphocholine
Glycerophosphocholine (GPC) is a compound related to phosphatidylcholine. It is only available with a prescription in Europe; it is available without a prescription in the United States. GPC stimulates the production of new acetylcholine, the neurotransmitter that helps maintain memory and allows learning. Ti also has an effect on nerve growth factor, a substance that regulates acetylcholine receptors. Studies have shown that this supplement can forestall, stabilize, and even reverse some memory loss that occurs in the early stages of dementia.

Ipriflavone
The synthetic ipriflavone is similar in structure to soy isoflavonoids. It is approved in some countries as a prescription drug for the treatment and prevent of osteoporosis, while it is available over the counter in the United States. Ipriflavone works by enhancing the effects of calcitonin (a thyroid hormone that regulates calcium) on calcium metabolism. The recommended dosage is 200 milligrams three times a day.

Malic Acid
Malic acid is found naturally in the body, but can also be consumed in apples, currants, and most tart fruits (as well as in some supplements). It is essential to life, as it is involved in several energy-producing reactions including the Krebs cycle and mitochondrial respiration. Despite its importance, healthy people do not usually need to take malic acid supplementation. However, a deficiency is associated with physical exhaustion, muscle pain, and fibromyalgia, and a malic acid supplementation program can help treat these conditions. Cisplatin, a chemotherapy medication, and certain other drugs can reduce the level of malic acid in the body.

Ornithine Alpha-Ketoglutarate
Ornithine alpha-ketoglutarate (OKG) is a combination of two amino acids, ornithine and glutamine. It increases the release of muscle-building hormones, prevents the breakdown of muscle, enhances muscle growth, and improves immune function. Clinical trials have shown that OKG supplementation also improves wound healing.

Policosanol
Policosanol is a mixture of fatty alcohols isolated from the wax of sugar cane and yams. Its main compound is octanosol. Studies have shown that policosanol lowers LDL (bad) cholesterol and raises HDL (good) cholesterol. It can also help prevent atherosclerosis. Policosanol reduces platelet aggregation of the blood and, therefore, its ability to clot, so consult use with your healthcare provider if you are taking a blood thinner.

Quercetin
Quercetin is a plant flavonoid. An anti-inflammatory, quercetin can be used to reduce arthritis pain. It can also help treat prostatitis and respiratory illnesses associated with inflammation such as asthma and bronchitis. Quercetin inhibits the release of histamine, which decreases the severity of allergic reactions, and is an antioxidant. Studies have also shown that men who intake more flavonoids, particularly quercetin, suffer fewer strokes and heart attacks than those who do not. In addition, quercetin has been found to protect the kidneys against the aging process. It can be found in apples and red onions as well as nutritional supplements.

Red Yeast Rice
Red yeast rice is the fermented product of rice on which red yeast has been grown. Red yeast is a natural statin drug. It forms naturally occurring HMG-CoA reductase inhibitors known as monacolins, which lower cholesterol. In fact, monacolin-K (which is also called lovastatin) is the ingredient in the cholesterol medication Mevacor. Red yeast rice also contains sterols (beta-sitosterol, campesterol, stigmasterol, sapogenin), isoflavones, and monounsaturated fatty acids, which also have a cholesterol-lowering effect on the body.

Similarly to a statin drug, rd yeast rice can deplete the body of coenzyme Q10. Therefore, after taking red yeast rice, the body’s supply of coenzyme Q10 must be replenished. Consult your healthcare practitioner regarding the recommended dosage of coenzyme Q10 for you.

Tea tree oil
Tea tree oil is made from the leaves of the Melaleuca alternifolia, a small tree that grows in Australia. With antiseptic and antifungal properties, tea tree oil can be applied topically to treat sunburn, sores, cuts, arthritis, bruises, insect bites, warts, acne, fungal infections, mouth ulcers, and dandruff. Do not take tea tree oil internally because it can cause nerve damage. It should also not be applied in the ears, eyes, or other mucous membrane.

GERD Linked to More Esophageal Cancers

New research suggests more cases of esophageal cancer may be attributed to gastroesophageal reflux disease than doctors previously thought.

Investigators who studied the link between GERD and different types of esophageal cancers found a more advanced form of the disease that occurs at the point where the esophagus meets the stomach may be caused by reflux.

The authors note doctors have long known GERD is responsible for cancers occurring along the tubular part of the esophagus. They also know some cancers occurring near the opening to the stomach are caused by reflux because they can see signs of a condition called Barrett mucosa, which indicates damage caused by GERD. However, they’ve typically attributed another form of cancer occurring in the same region to other causes because Barrett mucosa hasn’t been present.

This study compared 215 people whose cancerous tumors were located near the opening to the stomach. Results showed tumors linked to Barrett mucosa were generally smaller, identified earlier, and less likely to have spread than those not linked to Barrett mucosa. This led the researchers to conclude the latter were simply more advanced cancers that had already destroyed the underlying Barrett mucosa, rather than a separate form of the condition.

If these two types of cancer really are one disease, report the authors, it would nearly double the number of esophageal cancers caused by GERD every year.

Stopping Heartburn

It starts as a burning sensation in the chest, before slowly making its way up toward the neck and throat. At one time or another, nearly everyone experiences heartburn.

Occasional heartburn is normal. However, when heartburn occurs more than twice a week it can signal gastroesophageal reflux disease, or GERD.

An estimated 5 percent to 7 percent of the United States population is affected by GERD. Anyone, including men, women and children, can have GERD. The disease occurs when acid in the stomach flows backwards, into the esophagus. Under normal conditions, a muscle called the lower esophageal sphincter acts as a valve between the esophagus and stomach, helping to prevent acid reflux. When it fails to close properly, acid can leak back into the esophagus.

What are the Treatment Options for GERD?

There is no cure for GERD. It is a chronic disease, requiring long-term treatment. Most people with mild symptoms can ease their symptoms by making lifestyle changes. These may include losing weight; avoiding alcohol; eliminating foods and beverages such as chocolate, coffee, or greasy foods; and not eating late at night.

Prescription Medications

For many people, prescription medications may help. Over-the-counter antacids, such as Alka-Seltzer, Mylanta or Rolaids are often recommended to relieve mild symptoms. Antacids help neutralize stomach acid.

GERD sufferers also might benefit from proton pump inhibitors (PPI). These drugs, including Prilosec, Prevacid, Protonix, Aciphen and Nexium, provide long-term symptom relief and heal erosive esophagitis. Proton pump inhibitors provide the safest and most predictable treatment for GERD. Prilosec is available over-the-counter, cost isn’t an issue.

Proton pump inhibitors work by reducing the production of acid in the stomach, leaving little acid to back up into the esophagus. Studies have shown that proton pump inhibitors are more effective than other heartburn medications. However, new research suggests that taking proton pump inhibitors for prolonged periods may increase the risk of developing pneumonia. A Dutch study found the risk of pneumonia nearly doubled for people taking the drugs for prolonged periods.

“Despite the slight evidence of chronic pneumonia, proton pump inhibitors are safe,” says Dr. “Some drug companies have the attitude that once on a PPI, always on a PPI. There is a subset of people who may continually need PPI, but most don’t.” Dr. also suggests that PPI dose reduction may be appropriate for some patients.

Surgical and Endoscopic Options

Some patients may want to seek an alternative to taking medication for their symptoms. Surgical techniques to improve the barrier between the stomach and the esophagus can help. When performed by a skilled, high volume surgeon, laparoscopic antireflux surgery is very effective.

In recent years, endoscopic techniques have been introduced as promising treatments for GERD. These procedures are performed through a flexible tube inserted through the mouth and down the throat.

One of the more popular endoscopic procedures is Enteryx. Doctors inject a sponge-like material that thickens the valve at the base of the esophagus, stopping stomach acid from coming back up. Other endoscopic approaches include the EndoCinch system and Streta system.

Doctors advise caution for patients considering endoscopic techniques. “These therapies need to be carefully investigated. Complications have ranged from failure to correct the problem to death.”

There have been documented deaths from endoscopic procedures. People shouldn’t die from reflux disease. Federal agencies need to take a stronger look at these procedures, the studies are not going through close enough scrutiny.

The Consequences of Untreated GERD

Without proper treatment, GERD can cause serious complications. Years of exposure to stomach acid may cause cancer of the esophagus, or Barrett’s esophagus, a precancerous condition. Inflammation of the esophagus can cause bleeding or ulcers. Persistent symptoms of heartburn and reflux should not be ignored. The best way to prevent these conditions is by seeing a doctor early.

Further Hope Through Research

Despite treatment, there are still some individuals who continue to suffer persistent symptoms of GERD. Research is underway to investigate why.

Some researchers are focusing on nonerosive reflux disease. Individuals with nonerosive reflux disease present the same symptoms as others with GERD, although nonerosive reflux disease does not cause esophagitis. This does not mean that nonerosive reflux disease is less serious that erosive reflux. New therapies are needed for people with nonerosive GERD. They often do not respond to acid suppressants.

“Nonerosive disease is actually the most common presentation of GERD,” says Ronnie Fass, M.D., University of Arizona in Tucson. “The whole issue of nonerosive disease has really started to explode. These patients fall under the definition of GERD, but they really don’t have GERD, making them difficult to treat.”

Heartburn Surgery

More than 44-percent of all adults in the U.S. experience heartburn at least once a month. For most people, an over the counter drug will help, but for others the pain persists. Modern technology is making surgical relief much easier on the patient.

Twenty nine year old Jeff was plagued with persistent heartburn for seven months. “I felt like I was having a heart attack, and constantly burning, burning, nothing I could do…Rolaids, Mylanta and nothing could correct the pain.”

Surgery is the answer for patients like Jeff who suffer from severe, persistent heartburn or what’s called gastroesophageal reflux disease or GERD. New surgery methods are better than old ones. Normally GERD involves a huge abdominal scar. But with a fiber optics guide, a thin instrument is inserted into a patient’s stomach and there are only five tiny incisions.

Surgery used to mean eight to ten days in the hospital and six to eight weeks of recovery time, but laparoscopy means less time.

Dr. Said “The patient experiences minimal pain, if any. The recovery is much. much faster as compared with the traditional surgery.” This procedure has a cure rate of almost 100%. How do you know if your heartburn is serious enough to warrant surgery? Some signs include a burning sensation in the upper abdomen that will not go away, regurgitation, a sore throat, difficulty swallowing and hoarseness. Thanks to modern medicine, thousands are learning that they can do like Jeff: get freedom from pain, relatively quickly. Jeff was back to a normal lifestyle in about a week.

“I’ve been sleeping very good, right through the night. No pain, I don’t wake up with chest pains or burning. I don’t have to take a lot of Rolaids anymore.”

Studies show that more than ninety percent of the patients who undergo this procedure are symptom-free in ten years.

Pre-Walk Basics

Maximize the benefits of your walk before you take the first step — a proper warm-up revs your body for optimum performance and reduces risk for injury. Recent research suggests your body may respond better to dynamic stretching than static holds prior to physical activity. While the jury deliberates on whether toe touches are better before exercise or after, warming up with light cardio is recommended regardless. Heat up your muscles and joints first with a 5-minute slow walk… then try some of these range-of-motion generators:

To engage your hip flexors, hamstrings, and quadriceps, slowly swing one leg at a time back and forth starting with a knee raise in front and ending with your leg extended back behind you.

Lunges also simulate slower, yet exaggerated, actions of your walk — which helps prepare your legs for the real deal.

Circle both ankles clockwise and counter-clockwise; alternate between pointing and flexing your toes.

To stimulate blood flow to your back, twist your core from side to side. You can also rotate your entire upper body around your hips.

Dedicate 5-15 minutes to your warm-up, then you can impose light stretches — calves, hamstrings, and groin. Just remember, never bounce… ease into positions and breathe out slowly.