MedStar Health DocTalk
Comprehensive, relevant and insightful conversations about health and medicine happen here… on MedStar Health Doc Talk. Join us for real conversations with physician experts from around the largest healthcare system in the Maryland-DC region.
MedStar Health DocTalk
Gastroesophageal Reflux Disease aka GERD
Are you one of the many who experience heartburn or acid reflux? In our latest episode, host Debra Schindler separates fact from fiction about gastroesophageal reflux disease -or GERD- with MedStar Health gastroenterologist Vinshi Khan, MD. Learn why long term complications from GERD make treatment so important.
If you would like to provide feedback on this podcast, or get more information on hand tumors, send Debra an email: debra.schindler@medstar.net.
For more episodes of MedStar Health DocTalk, go to medstarhealth.org/doctalk.
Comprehensive, relevant and insightful conversations about health and medicine happen here on MedStar Health Doc Talk. These are real conversations with physician experts from around the largest healthcare system in the Maryland D.C. region. By the time we reach adulthood, most of us have experienced a little heartburn, right? That unpleasant burning sensation in the chest might wake us up after eating spicy foods, for example. It'treatable and goes away. But for about 20 out of every 100Americans, heartburn is actually a symptom of a chronic condition called gastroesophageal reflux disease, or gerd. Persistent heartburn, difficulty swallowing, a chronic cough, even chest pain can all be symptoms of GERD that impact your quality of life. But recent studies now link GERD to other conditions like tinnitus, asthma, even cancer. MedStar Health gastroenterologist Dr. Vinci Khan is here today to talk about GERD and the importance of treating it. I'm your host, Debra Schindler. Dr. Khan, thanks for being with us today on MedStar Health doct talk.
>> Dr. Vinshi Khan:Thank you, Debra. thank you for having me, Dr. Cond.
>> Debra Schindler:The symptoms of gastroesophageal reflux disease could be dismissed for heartburn or even acid reflux disease. The terms seem to be interchangeable with gerd. How are they different? Are the symptoms different?
>> Dr. Vinshi Khan:So GERD is like the pathological entity, which is a chronic GI condition, where it is characterized by the, retrograde flow of, stomach contents into the esophagus or the regurgitation of the stomach contents into the esophagus. So that's the pathological definition. It's the disease entity is called gastroesopphhageal reflux disease. And heartburn is the most common sign or the symptom of, this entity. So, yes, sometimes patients use it interchangeular, but it is not the only, symptom of this disease and should not be, used interchangeably.
>> Debra Schindler:Acid reflux disease is actually the same thing as gerd. It's the process of the regurgitation.
>> Dr. Vinshi Khan:Yes.
>> Debra Schindler:And then the heartburn is a symptom.
>> Dr. Vinshi Khan:Is a symptom, is the most common symptom. And there are other symptoms that can be seen with this condition, like chest pain, difficulty swallowing, cough, and so on. So it is one of, like, heartburn is the most common symptom of it, and sometimes it's used as a layman in terms of, like, describing this disease.
>> Debra Schindler:Now, I guess that heartburn is the most predominant symptom of gerd. Do you have to wait to have it a certain amount of days? A week to experience frequency, to be able to say hey I think I have gerd.
>> Dr. Vinshi Khan:Like the rule of thumb is when anything is occurring to a point that it is affecting your quality of life where you have to like take a step back or maybe look for over the counter medications. Quite often I would say thats the time to seek expert care or at least discuss it with your primary care doctor. It is a physiological response to eating. the reflux. If I were to have a ah, late dinner I would have some acid reflux so I can expect that. But when despite like in my regular day to day in life, if Im am having it more so often and it is affecting my quality of life then that is something that needs to be addressed.
>> Debra Schindler:Why would a late dinner be more of a problem for gerd?
>> Dr. Vinshi Khan:So like no, it depends on the fact that the gastric emptying, like the stomach has to empty before, ideally should be empty before you go to bed to avoid the risk of acid reflux. So people who have late dinner tend to not have that enough time for the stomach to empty properly and before going to bed. And right now you and me sitting upright, the gravity is helping us in terms of preventing reflux. But when we eliminate the gravity and we go to bed and if our stomach is full that increases our chance of reflux. I ideally tell my patients to have a gap of at least three hours, ideally four hours before between the supper and the bedtime, a whole meal.
>> Debra Schindler:What about snack? Because I'm good for having snacks before I go to bed.
>> Dr. Vinshi Khan:That's another like you know snacking. Late night snacking will also cause acid reflux. That's like I'm going to be honest, lot of my patients tell that hey, I take my dinner at this time but then when I dig into it they fess up and say that oh I do like you know, have late night snacks and that is the reason and the trigger for their acid reflux.
>> Debra Schindler:I mean I admit that we have dinner late very often because we get home late from work.
>> Dr. Vinshi Khan:Yep. Yeah. Sometimes like people are on night schedules and different schedules, sometimes life is busy. So yes, it is a difficult thing to maintain. But that's one of the recommendations that helps if followed consistently does help your reflux symptoms.
>> Debra Schindler:Well how does it not stay down in the stomach? Is something happening, something changing in the body for it to come up like.
>> Dr. Vinshi Khan:You know, it is a process of accommodation. Like you know, when you eat you're obviously taking into air as well and There has to be, some relaxation, like, like some way of venting the air out. Some people belch, some like, you know. So, it is more of a way of like, removing extra air from the stomach.
>> Debra Schindler:I think I was expecting some explanation about that sphincter. Isnt there a sphincter muscle that doesnt stay close?
>> Dr. Vinshi Khan:So, yes, there is. Like, we have some protective mechanisms naturally in our body to help protect us from reflux. We have what is called an upper esophageal sphincter and a lower esophageal sphincter. Lower esophageal sphincter is the sphincter between the esophagus, the footpipe and the stomach. That helps against these episodes of reflux. But sometimes the stomach has to, what is called gastric accommodation. It has to release the pressure. And sometimes in doing so, in releasing the air, there is a reflux of gastric contents as well. And sometimes some patients have their obese or they are pregnant. There is more abdominal pressure on the stomach. So the esophageal sphincter kind of gives away or like, is weak in those cases and, is overwhelmed. And also, like, if you are old, like older patients, there is a disruption of the muscle integrity, so they are more prone to have acid reflux. So these are some of the factors that kind of may overwhelm the esophageal sphincter. Sometimes you have what is called hiatal hernia, where a part of the stomach kind of goes up and down into the chest and that also disrupts your esophageal sphincter. So these are few things. We do have some, like, natural mechanisms of protection, but then we also have conditions that can overwhelm it.
>> Debra Schindler:So some of the risk factors then are diet, obesity. You mentioned the hiatal hernia. Smoking, Certain medications can cause gerd.
>> Dr. Vinshi Khan:Yes. So like I always say that, I kind of divide the risk factors into, like, lifestyle, medical conditions, medications, old age and then other environmental factors. Lifestyle would be obesity, if you are obese, if the way you'eating habits, if you have late dinners or if you have, like, more fatty, greasy foods, especially in dinner, that or you are a smoker. So these are lifestyle, risk factors for acid reflux. Or you drink alcohol quite heavily, especially in the evenings and stuff. So those are the lifestyle risk factors in terms of medical conditions. Pregnancy. Pregnancy causes it. Hia tal hernia, as I mentioned that it is, the part of the stomach that goes up into the chest from the abdomen that also increases Your risk of acid reflux then are there are conditions called gastroparesis, which is mostly seen in diabetic patients where the stomach is paralyzed and it doesn't move so well. So like the food sits in the stomach longer than the usual periods of time and that causes more acid reflux. So those are certain medical conditions. Then it comes to like medications. Certain medications especially the ones that we take for like aches and pains like aleve, motrin, ibuprofen, EEDN, which come under what is called NSAIDs, which is non steroidal anti inflammatory medications. They also increase your risk of acid reflux. Certain blood pressure medications like calcium channel blockers like amlodipine and so on. They can also increase your risk, by relaxing the esophageal sphincter. Then it comes to old age. Old age, just by the virtue of aging, you kind of lose the muscle integrity or like the esophageal, there is some age related disruption of the esophageal sphincter. So that can happen. Other factors being stress, sleep deprivation, anxiety, those are also factors that are, that puts you at risk of acid reflux.
>> Debra Schindler:Should someone see a gastroenterologist specifically for gerd or can they see their primary care physician and expect appropriate treatment? Or would they just be referred then to a GI doctor?
>> Dr. Vinshi Khan:So I believe for most of the patients, almost all of the patients, the first point of contact to express these concerns and discuss would be their primary care doctor and the primary care doctors. Most of the treatment is for acid reflux is a trial of like antacid. Okay. So that can very well be addressed by the primary care doctor. And if at that point it all depends on the comfort level of the primary care doctor. If they feel like, okay, this is happening so often you'having other symptoms like trouble swallowing or stuff, you need to be referred. Or sometimes they say that, hey, it improved with this trial of this medicine. You just need to do these lifestyle changes and let us see if it worsens or keeps on happening. At that point they would refer. But yes, most of the times I think the primary care doctors can address it to certain, like the mild cases of it and any, any point that they don't feel comfortable, they are happy to refer it to us.
>> Debra Schindler:What are some of those medications like Mylanta, Tums, Peptoismol.
>> Dr. Vinshi Khan:So they are like different categories. they all kind of come under antacids. Okay. So the usual antacids are like the neutralizing, medications like Tums, Mylanta. So those are milk of magnesia and things like that. Those are the antacids, which are actually just literally neutralizing agent. They neutralize the acid. Then there are other medications which are Ah, H2 blockers, which femmotidine pepsid, which are over the counter. They are those. And then the ones that are most commonly used are proton pump inhibitors like omipprraazole or Nexium, those common ones which are now even available over the counter. And then we have a new class of medications which are called PCAPs, which are potassium competitive acid blockers, which was only in 2023, approved to be used in the U.S. we have only one drug that's available. So that's also one of the new upcoming options for treatment.
>> Debra Schindler:And you wouldn't prescribe any of those without an actual diagnosis. So let's get to that part. I feel like we might have jumped ahead a little bit, but a patient comes to you and they've laid out all of their symptoms and you start to suspect that they have gastroesophageal reflux disease. What's the first step in getting a proper diagnosis?
>> Dr. Vinshi Khan:So the first step is to like, listen to the patient, see what they have to say and how they present their symptoms and know how frequent are the symptoms. Are there any associated symptoms? Trouble swallowing, nausea, vomiting, epigastric pain or upper abdominal pain and cough. Like, you know, they may have gone to a lung doctor or their other doctors for cough that was like, or an ENT, even Dr. To see for their cough. But then they were referred to us because of cough. So, anything, anytime, it depends on the frequency of their, symptoms. And then if there are any red flag signs like trouble swallowing and so on. At that point we we have to like, you know, at least start them on the treatment like medications. Sometimes for the mild cases we can just start them on medication and see how things are going. usually, when it has, it has been a chronic issue and there are some other red flag signs we would want to proceed, especially if they are older. We would want to proceed with an upper endoscopy, which is esophagal gastroudnoscopy, which is a, flexible tube with a camera at the end. We go down your mouth and look inside the stomach and eopphagus to look for any changes from these reflux symptoms.
>> Debra Schindler:Are the patients at that point, under general sedation or are they in.
>> Dr. Vinshi Khan:A twilight, for EGD or Upper endoscopy we usually use twilight or a conscious sedation, which is a, twilight sleep. And they are still breathing on their own, but they are just comfortable, they are not gagging and they can tolerate the procedure.
>> Debra Schindler:Whats an esophageal manometry?
>> Dr. Vinshi Khan:Esophageal manometry for patients who have trouble swallowing, which is called dysphagia, whether it is to solids or liquids or both. We do a procedure called manometry, which is basically they put a probe down your nose and then they ask you to swallow different consistency foods like liquid, like water, nectar, thin nectar, thick solids. And then, they see how the esophagus, is contracting. And then they generate a report, send it to the doctor for interpretation. And that helps us identify whether what is the cause for the trouble swallowing. So manometry is usually for trouble swallowing. Sometimes we can couple it with what is called PH monitoring to help also identify acid reflux symptoms during these episodes. So those are slightly two different kind of test manometries to see the muscle contraction of the esophagus. And Bravo study or ph monitoring is to see how much correlation are we having with your symptoms versus an actual reflux event at that time. So those are the things when someone, I would say when someone has had acid reflux. We have tried them with the regular medications and they have not had good relief with it. And we have increased the doses and they are still not having much relief as expected. And the upper endoscopy has not been, like, doesnt show severe changes or any like Hiaal hernia or any factors that may increase their risk of having persistent acid reflux. So at those points we do what is called ph monitoring or a Bravo study, to look for these reflux events in real time. And see how much of the reflux, actual reflux event correlates with their symptoms.
>> Debra Schindler:Did you call it a Bravo? Okay. And how do you do the ph monitoring? How is that performed?
>> Dr. Vinshi Khan:So it'with a Bravo capsule, which is like earlier they were different. Like earlier there were probes that would stay inside the patient, through the nose. They would go home with the machine and bring back the machine with instructions that, hey, when you'eating, you need to put like, you know, cl, click the buttons. And when you have, an event of acid reflux, you click the buttons and so on to record your events. It'better now in a sense that we do an upper endoscopy and we deploy the capsule, the Browo capsule, into like about 5 to 6 centimeters above the stomach. We kind of deploy the capsule and it gets fixed to the esophagus. And then we sent home we send them with a wireless device and tell them the instructions how to use it and say hey, you need to record when you're eating and then when you are re sleeping and then whenever you have symptoms. And then they bring out the machine back to us in like 48/ars and then we like generate a report and then we see how much of how much correlation is there between their symptoms versus an actual reflux event that was recorded by the machine.
>> Debra Schindler:Can they feel that when its in there for two days?
>> Dr. Vinshi Khan:So its a very tiny capsule receptor kind of device. And they dont feel it, it doesnt cause any trouble swallowing most like we have had practically no one complain of any pain or any trouble swallowing and it kind of like sloughs off by itself in a few days. And sometimes people may see in their poop, sometimes they may not even notice it. So they don't have to bring back the device that in the esophagus they just have to bring the wireless device that they go home with.
>> Debra Schindler:And how does that device get the information from the capsule? I'm, I'm a little confused about that.
>> Dr. Vinshi Khan:So it's a wireless device and it's programmed to connect Wii? Yeah, it's like yeah, WI fi and it kind of communicates. It has to be within a certain vicinity of that device so you have to keep it close to you. the device which is in the esophagus is monitoring for reflux and the device, what you're using, you are manually putting in your eating time.
>> Debra Schindler: 4:00. I'm having dinner.
>> Dr. Vinshi Khan: Yeahinner 4:00. O soeah. So you'manually putting your sleeping time, your eating time and your reflux like you know, your heartburn or reflux symptoms in there. But the device in your esophagus is monitoring the actual reflux events.
>> Debra Schindler:I should have said 10pm eating a sub that would be more proestedra. So the treatment varieties, let's go through the current treatment options. We talked about the lifestyle modifications, we talked about medications and I do know, I do understand that you're not the surgeon in a case you would refer a patient who needed surgery. To a surgeon. When would a patient need surgery? What would you find? What would be the results of their screenings or your tests?
>> Dr. Vinshi Khan:So all of those patients where we are at the point that we may Consider surgery, have had an upper endoscopy and we kind of know their anatomy. So patients who have had chronic symptoms, chronic debilitating symptoms, which is affecting their quality of life, they have been on maxed out medical, you know, they have been medically optimized to the max in the sense that they have been on twice a day and medications and sometimes we may even have to add another. Like know they're on omipprazole twice a day and then we also have to add like famotidine or something at bedtime. So they are still not well controlled on max medical management. It's affecting their quality of life. And then when, if they have any anatomical, conditions like htal hernia, those are the conditions that help us. At that point we have to like, if they have a large hiatal hernia, it'affecting them to a point that they are willing to like, ask about the next steps. That's when we address and say that, hey, there are other options like endoscopic and other surgical options that we have.
>> Debra Schindler:Know, I won't ask you to explain them, but I would like for you to name them. There are four surgical options or procedural options. Any listener who thinks that they may need that could ask about.
>> Dr. Vinshi Khan:So the ones that I feel are the ones that I would send my patients for. There are few. So there is one which is called Nissan fundoplication, which is usually in patients who have a highal hernia, which is usually like no greater than 3 or 4 centimeters. The surgeons have to do it and they basically create a wrap of the stomach around the esophagus to reinforce the sphincter. So that's that that's the Nissan fundoplication. Then there is a lyx procedure which I rarely use it or suggest it to my patients because, of the side effects that can happen or complications that can, it may lead to. It is basically they put the surgeon'place a magnetic ring, to reinforce the sphincter, or patients who have h tal herniaia reinforces the sphincter in those patients. I don't like it because some people there is migration of the ring and it can cause trouble swallowing or inflammation in the esophagus from the pressure. so. And then the other one which we can do like endoscopically, which is like less invasive than a surgery is called tif, which is transoral incision less fundoplication, which gastroenterologist can do it. But there are certain conditions to it that the Hiaal hernia has to be like 2 or 3 centimeter max and it's not a 360 wrap, it's a 270 degree wrap. So those are the things. But that's one thing that it doesn't require a cut or a major surgery.
>> Debra Schindler:What about tess? Transcutaneous electrical stimulation system. Is that performed routinely?
>> Dr. Vinshi Khan:I, you know I have never sent someone for it and I think it's really not used nowadays. It is it is to like you know, kind of reinforce the sphincter with the electrical stimulation. But I feel like it's really, maybe it's ph like phased out and obsolete.
>> Debra Schindler:But these are generally minimally invasive procedures.
>> Dr. Vinshi Khan:Minimally invasive outpatient. Like you know Nissason's fundoplication is the most invasive I would say. But it's still like done laparoscopically when they go home the same day usually. and if like depending on they may have to stay a day but like at least for the endoscopic procedures they go the same day. It's an outpatient procedure.
>> Debra Schindler:I found it interesting too when I was reading some material on GERD to research for this podcast. Some emerging treatment options and I'd like to get your thoughts on the research being done. Do you have any comment on drug developments targeting esophageal motility and acid secretion?
>> Dr. Vinshi Khan:So like I mentioned earlier, the most recent one is what is called pcap, which is potassium competitive acid blocker which is like in a prescription medicine. Vonopraone is the brand name and it has only approved in the US in 2023. That is one of the novel medications that is out there. We have not really started using it that much but I'm reserving it for patients who have not had good response to PPI or proton pump inhibitors like ommeprrazole or pantopraazole and or they have like contraindications to that like osteoporosis and kidney problems and so on. So those are those.
>> Debra Schindler:And it sounds to me though that that would not prevent the regurgitation. It would only stop it from being so actic. Or am I misunderstanding that?
>> Dr. Vinshi Khan:So in a way I would say that the reflux would happen especially if you're like going to sleep or things like that. But it helps protect the integrity of the stomach and the esophagus from the acidic contents of the stomach. So those like, you know it's not gonna reduce the reflux events but it may, it helps to Reduce the damage that it would produce.
>> Debra Schindler:Okay, True or false? Let's do a little myth busting. I'm going toa ask you a couple common perceptions and you can tell me if they're true or false. Milk soothes the symptoms of acid refox. Do you recommend milk for people who suffer no heartburn or gerd?
>> Dr. Vinshi Khan:You know if it was just a ah, low fat or like fat free milk, maybe it can act as a buffer. But usually the full fat milk is not going to help you. It may even worsen your gut symptoms.
>> Debra Schindler:Okay. High acid foods worsen the effects of gerd.
>> Dr. Vinshi Khan:Yes, true, true. That's why we ask you to like whenever we say about lifestyle and eating changes, we ask you to avoid highly acidic foods like citrus foods like orange, lemon and so on.
>> Debra Schindler:Mexican M that's pretty spicy the Mexican food.
>> Dr. Vinshi Khan:Spicy foods. Yes. kids love it M ye peppers and stuff.
>> Debra Schindler:Intermittent fasting is good for gut health and therefore helps those who suffer with gerd.
>> Dr. Vinshi Khan:Yes, Intermittent fasting. Is any of my person, of my patients who are obese or overweight and wanna start like something that would kickstart the weight loss. I suggest intermittent fasting. When you start the intermittent fasting it our body goes into what is called autoagi which is basically it kinds of devours anything that it's like a cleaning shop process in the, in the body. It destroys the damaged cells of the body. Anything that was probably mutated or something. So its research has shown that it has anti cancer properties in the sense that it helps prevent cancers or it may help reduce progression towards certain kind of cancers by causing autopagie. So intermittent fasting is good? Yes and no. Intermittent fasting helps in overall I would say it helps with acid reflux, it reduces acid reflux, but not so much in patients who have severe acid reflux symptoms or have anatomical conditions like a large hiaal hernia, they may not see much reduction in their acid reflux symptoms due to anatomical cases. Intermittent fasting increases what is called ghrelin, it's a hormone in our body. And ghrelin is inversely proportional like has an inverse relation with acid reflux. So intermittent fasting helps with that. The other thing is intermittent fasting reduces the insulin resistance in our body and insulin resistance causes weight loss. Decrease in the insulin resistance leads to weight loss and weight loss overall helps with reducing acid reflux. So I would say yes, intermittent fasting overall helps in reduction of acid refluxes.
>> Debra Schindler:Allgh one more true or false? Only overweight people get gerd.
>> Dr. Vinshi Khan:False. Anyone? Even a person thinner stick can get the reflexux because either they are pregnant or they are taking medications or they are stressed out or they dont have the best eating habit. So it not just, just not reservved for obese patients.
>> Debra Schindler:A very common misconception though.
>> Dr. Vinshi Khan:Yes.
>> Debra Schindler:Can you get stomach ulcers from having gerd? Are they related?
>> Dr. Vinshi Khan:No, not stomach. Stomach. You can get ulcers in the esophagus or what is called erosive esophhagitis, which is a severe case of gerd, acid reflux or gerd, but not so much stomach ulcer.
>> Debra Schindler:I was just going to ask you about erosiveus esophagitis. It sounds horrible. It sounds, that sounds like it would be really excruciating.
>> Dr. Vinshi Khan:Yes.
>> Debra Schindler:What is that exactly?
>> Dr. Vinshi Khan:So erosive esohagitis is the severe form of gerd. So GERD is an umbrella term and it includes what is called non erosive reflux disease, which is about 70%. of the patients where you do an endoscopy, they don'have. They do have the symptoms but they don't have like inflammation that we can see in the esophagus. So that's non erosive acid reflux or reflux disease. Then certain patients, I would say 20% or so, 20 to 30% can have what is called erosive esophagitis, which is basically disruption of the like epithelial integrity of, of the esophagus.
>> Debra Schindler:Mean the lining, the lin lining.
>> Dr. Vinshi Khan:The lining of the esophagus is disrupted, is ulcerated and is inflamed. And some people say Bart's esophagus is also a preancerous form of acid reflux or gerd, which is, which would.
>> Debra Schindler:Be a complication and a long, long.
>> Dr. Vinshi Khan:Term risk risk of acid reflux.
>> Debra Schindler:That is where we then enter into the risks of cancer. Yes, esophageal cancer.
>> Dr. Vinshi Khan:So the reason we want to be aggressive in treating acid reflux, because it does have it can cause long term SELA or complications. Like some of them are like a stricture, meaning there is a scar, there is a. Because of all these inflammation and so on over the years, there's a scarring in your esophagus and it has formed a stricture like a bottleneck in your esophagus where the food is getting stuck. So that requires like kind of multiple dilation, stretching of your esophagus and still may not be very effective. You may still get food stuck in your esophagus. Then what is another long term complications of acid reflux is parts which is a precancerous change in the lining of your esophagus from years and years of acid exposure. Stomach has a high acidic environment and the stomach wall is like designed in a way that it is equipped to handle that kind of acidic environment. But the esophagus has a different kind of lining which is not used to that kind of acidic environment. But over the years, if you have so much exposure of the acid, the esophagus is kind of forced to change to a stomach lining so that it can withstand that kind of acidic environment. So that change in the lining from the original lining of the esophagus is called barts. And there are certain steps like it'basically what is called metaplasia. I don't know if I can put it in a layman term, is basically or thell cells. The cells change from, you know, from a regular lining from a normal lining. So this is a normal lining. The next step is a metaplasia. The next step is a dysplasia and the last step is neoplasia. Neoplasia meaning cancer, malignancy. So these are the meta, the discs and the neo. So these are the steps before the cancer. So the BART is basically metaplasia, which is few steps before cancer.
>> Debra Schindler:Do you ever see that when you're doing an endoscopic screening on someone? Yes, just automatically. Wow.
>> Dr. Vinshi Khan:It's quite common, especially in men who are smokers.
>> Debra Schindler:It's common and they've just ignored the signs for a long time.
>> Dr. Vinshi Khan:Yes. Or maybe like, you know, some people, they don't have that degree of heartburn or symptoms, but then as they age they get more and more symptomatic is when they seek the care and at that point we see those changes already.
>> Debra Schindler:In the intro I mentioned that there have been medical studies that have shown GERD to have an association to other conditions. Some I just didn't think would be associated with gerd, such as tinnitus. How do you explain that tinnitus? Let's explain what that is first.
>> Dr. Vinshi Khan:Tinnitus is like a ringing sensation in.
>> Debra Schindler:Your ear that never stops.
>> Dr. Vinshi Khan:That never stops. So I would say it is rather rare, like, you know, association with acid reflux. It is more so like when you have so much acid reflux that it'kind of into your throat, all the way into your ears and it has irritated your middle ear.
>> Debra Schindler:What about asthma? How does it cause or relate to Asthma and allergies.
>> Dr. Vinshi Khan:In terms of asthma, especially like patients who have had good regimen of asthma medications and they are still not well controlled or they have more like nighttime whzings and stuff like that. But in those patients we worry about them having underlying acid reflux that may be contributing towards the asthma and that may be the reason why the asthma is still not well controlled.
>> Debra Schindler:And cardiovascular risks.
>> Dr. Vinshi Khan:Many, patients come, especially women, they come in with heartburn symptoms and stuff like that. We have done all the workup and everything and we found that, okay, they actually like, you know, they have reduced blood supply in their heart and they are having more of atypical symptoms of rather than like a full blown chest pain sending you to the er. They have more of these acid reflux symptoms which later they found that, okay, there is a blockage in their coronaries or something like that.
>> Debra Schindler:Okay, so your final message for managing gerd, Give us the laundry list in making some lifestyle changes. That would be the first step. What's your advice?
>> Dr. Vinshi Khan:Lifestyle modifications and dietary modifications are the mainstay of treatment of acid reflux. Because we can try to put you on any medications, but if you don't follow that basic block of recommendations, you would still not have full relief. There's a lifestyle and then there's a diet chain component to it. And for lifestyle I say quit smoking, lose the weight, try not to like have heavy meals at night. Try to have a gap of at least three hours before the supper time and bedtime. Avoid late night snackings and so on. Like alcohol, especially at late night would be a problem as well. So those are the lifestyle part of it. In terms of dietary, I would say try to avoid fatty greasy foods. Chocolate, I know it's a big problem for many of my patients, but chocolate again, alcohol, caffeine, caffeine. Caffeine is the one. Energy drinks, carbonated drinks, soda pop, they are all a lot of problems. Some people even have a lot of trouble with garlic, peppermint and so on. So like everyone has like kind of, by the time they see us, they have identified their triggers and we tell them that hey, these are the usual triggers, but then you have certain unique triggers. You should avoid them.
>> Debra Schindler:And night eating. Thought that was a funny phrase. Even I never heard night eating. So if you do night eat, would it help people to prop up when they sleep?
>> Dr. Vinshi Khan:You know, yes, like elevation of bed, like head of the bed is, or like propping up, yourself with ah, two, two or three pillows is always helpful. But the best thing is to avoid a meal within three hours of eating, especially if you have a large hiatal hernia or so on. You may still want to prop yourself up at night, but I would still say elevating is one of the recommendations. The most important is to have a gap of 3R.
>> Debra Schindler:What's the worst case of reflux that you've ever seen?
>> Dr. Vinshi Khan:I'mnna be honest. The worst case of reflux can be different ways. Like you know there is what is called like issohagitis, erosso, esohagitis where there are different grades of esohagitis. Where I would say la, like Los Angeles grade D is the worst kind of esophhagitis. You can see it is basically the whole circumference of the esophagus is involved that the worst case can be that okay, there is is a phagitis and I also see a stricture. Worst case can be that the patient has had all these years of undiagnosed acid reflux. Now probably also had barret for years and now they have cancer. These are those like the sad scenarios we see.
>> Debra Schindler:So our final, our final word on that would be if you suspect that you have reflux disease, seek medical.
>> Dr. Vinshi Khan:Attention, talk to your primary care doctor and see if they want to send you to a GI doctor. And we here at MedStar Health would be happy to see you.
>> Debra Schindler:Thank you Dr. Kah, for sharing your valuable information with us about gastroesophageal reflux disease. That's Dr. Vinci Khan, board certified in gastroenterology and internal medicine with MedStar Health.
>> Dr. Vinshi Khan:Thank you Debra for having me. It was a pleasure.
>> Debra Schindler:Thank you through it. For more information about GERD, go to medstarhealth.org GERD D E R D.
