GERD FAQS

It’s natural to have questions if you’ve been diagnosed with gastroesophageal reflux disease (GERD) or if your doctor suspects that you may have this condition. We’ve gathered answers to some of the questions our team commonly receives about GERD.

Do I actually have GERD?

Before we can say that your condition is GERD, we’ll need to consider other possibilities. For example, the following problems can have symptoms similar to GERD:

• Biliary tract disease (any condition that affects the pathway of bile from the liver to the gallbladder and small intestine, including bile duct stones and primary sclerosing cholangitis.
• Coronary artery disease
• Gastritis (inflammation of the stomach lining)
• Dyspepsia (recurring pain or discomfort centered in the upper abdomen)
• Esophageal motor disorders, also known as swallowing disorders
• Infectious esophagitis (an inflammation of the lining of the esophagus)
• Peptic ulcer disease (a condition in which sores develop in the lining of the stomach or small intestine)
• Pill esophagitis (also called drug-induced esophagitis, which can occur when medications dissolve in the esophagus instead of the stomach)

If your symptoms are severe, your doctor may recommend that you talk to our GERD team. If necessary, we can perform an endoscopy, which uses a thin, flexible tube called an endoscope to evaluate your upper gastrointestinal tract (consisting of the esophagus, the stomach and the first portion of small bowel).

If this is negative, you may need an ultrasound of the abdomen to evaluate the biliary tract. A gastroenterologist may recommend further studies.

How can I manage my GERD symptoms?

You can manage GERD symptoms by using:

• H2 blockers (Tagamet or Pepcid)
• Acid suppressors (Prilosec or Prevacid)
• Prokinetic agents (Propulsid)
• Other medicines used to relieve less-common symptoms (Rectiv and Procardia)

There are other measures that you can initiate to reduce the symptoms of GERD:

• Elevate the head of your bed 10 to 15 degrees to prevent stomach contents from refluxing (going backward) into the esophagus
• Avoid eating at least two hours before going to bed
• Avoid foods that may worsen symptoms, such as alcohol, caffeine, chocolate and mint products

Is coughing a common symptom of GERD?

Coughing can be a symptom of GERD, but it is not necessarily a common symptom. There may be several reasons for it:

• Acid may be refluxing into the mouth, where you are inhaling it into the lungs.
• There may be a nerve reflex started by acid refluxing into the esophagus. The acid causes a spasm of the air tubes, which can lead to a dry cough.
• If you have had chronic reflux, you may develop a stricture (a narrowing of the esophagus). Food may regurgitate and be aspirated (breathed in), causing a coughing/choking sensation.
• If you smoke, your reflux can get worse, and cigarettes could be responsible for your cough.
  
  

How can I best prepare for a GERD attack?

Symptomatic esophageal reflux is a reoccurring problem. Once the symptoms come back (known as a GERD attack), there is nothing to do but wait for the antacids to stop acid production so that the esophagus can heal. There are lifestyle modifications that can help control these symptoms:

• Avoid coffee, alcohol, cigarettes and fatty foods
• Avoid lying down for three hours after eating
• Eat three meals a day
• Use antacids or over-the-counter H2 blockers like Tagamet, Pepcid AC, etc., when you have symptoms

To prevent GERD attacks, you may need prescription-strength doses of H2 blockers or proton-pump inhibitors such as Prevacid or Prilosec. Your doctor may prescribe prokinetic agents, such as Propulsid, to prevent reflux symptoms.

Are there any symptoms of cancer that are not present with ordinary GERD?

Cough is not a usual symptom of GERD. It may be associated with hoarseness or dental problems if it’s caused by GERD. Having a cough does not necessarily imply that you have Barrett’s esophagus or esophageal cancer.

I think I may have esophageal cancer. What’s a good indicator?

Especially if you’re over 45, the following symptoms may be warning signs of esophageal cancer if you have long-term GERD:

• Difficulty swallowing
• Evidence of gastrointestinal bleeding
• Weight loss

Researchers have noted a relationship between chronic hoarseness, GERD, vocal cord polyps and throat cancer.

What is intestinal metaplasia?

Intestinal metaplasia is a change in the lining of the lower esophagus, making it more consistent with the lining of the small intestine.

What testing do I need if I think I have significant gastrointestinal bleeding?

You should have a rectal examination to test for microscopic blood in your stool, especially if you use more than one adult-strength aspirin a day on a regular basis (or nonsteroidal anti-inflammatory drugs, such as Advil, Motrin, Aleve, etc.). Aspirin products can cause irritation of the stomach lining and even ulcers that can result in bleeding.

What are the long-term effects of using PPIs?

Proton-pump inhibitors (PPIs) include omeprazole (Prilosec) and lansoprazole (Prevacid). When first introduced, Prilosec was only approved for short periods because of the possibility of developing rare stomach tumors called carcinoids due to prolonged suppression of stomach acid.

However, Prilosec has since been used in Europe on patients with ulcers and GERD for several years at a time without adverse effects. Therefore, doctors in the United States currently prescribe it for prolonged periods.

In clinical practice, we try to use the lowest dose of Prilosec or Prevacid necessary to control symptoms and try to wean patients off the drugs whenever possible. On the other hand, we will prescribe these medications for longer periods if necessary.

When should I consider surgery?

If Prevacid doesn’t relieve your symptoms, you may want to consider surgery. You should undergo further testing prior to surgery to confirm the diagnosis of GERD and to rule out other esophageal motility (swallowing) disorders. You should also be aware that any surgical procedure has associated risks. It is important to consider the risks, benefits and alternatives of any procedure prior to proceeding with surgery.

What is the long-term prognosis with reflux esophagitis?

Reflux esophagitis (inflammation of the esophagus due to acid entering the esophagus) is a chronic condition. The severity of symptoms can vary, but most people will have intermittent discomfort or ongoing problems. It is unusual to have only one episode of symptoms.

If you have any other questions or concerns, please consult one of our gastroenterologists.