GERD / Acid Reflux

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GERD / Acid Reflux

November 20, 2012
Noon – 1 p.m. (ET)

Tolga Erim, DO - Gastroenterologist

Cleveland_Clinic_Florida_Host: Today's Live Web Chat, "GERD / Acid Reflux" with Tolga Erim, MD will begin at 12 noon EST. Please submit your questions by typing them below and then clicking 'Ask'.

Jsweetie: Can acid from reflux aspirate into the lungs and cause pulmonary fibrosis?

Dr_Erim: Yes, severe reflux, chronic refluxing of gastric juices into the lungs can lead to pulmonary fibrosis and recurrence lung infections.

Cleveland_Clinic_Florida_Host: Welcome to our Online Health Chat "GERD / Acid Reflux" with Tolga Erim, MD. We are thrilled to have him here today for this chat. We have already gotten started with your questions.

Cleveland_Clinic_Florida_Host: We have already received some great questions! Dr. Erim is being as thorough as possible in her answers. Thank you in advance for your patience. We will get through as many questions as possible.

there4jsweetie: I am interested to know if there is any support for the use of DGL licorice to help problems such as Acid Reflux, GERD and IBS? If not, what supplement might you suggest?

Dr_Erim: Glycyrrhiza glabra (european licorice) uralensis (Chinese licorice) may have a potential for preventing or ameliorating gastric mucosal ulceration. Unfortunately there is no convincing scientific evidence that taking these as supplements may help reflux or GERD/IBS. I am hesitant to recommend a supplement as there is a real dearth of evidence regarding supplements to help with this. If you have a bloating/gas predominant IBS, I find a low fodmap diet to be very helpful.

Jsweetie: What is your opinion on slippery elm healing the digestive tract?

Dr_Erim: I am not aware of any scientific evidence that supports this claim.

Jsweetie: Are the wedges that runs the full length of mattress that you put under the mattress to elevate the head as good as raising the headboard only with bricks or a board?

Dr_Erim: I find that you may slip down more with a wedge. It probably won’t work as well.

Jsweetie: Does Fundoplication surgery have a good success rate?

Dr_Erim: Yes it does. Long term follow up of patients show about 95% satisfaction, however, it all depends on how severe your symptoms were before surgery and how well your pre-op evaluation was conducted.

sidepocket: I have GERD. The major problem is pronounced chest pain with food intake afterwards. I cannot tolerate NSAIDS due to gastritis. What are my medication options to treat chest pain? Other conditions include Atrial Fibrillation, Chads-2 score =0 Age 71 male.

Dr_Erim: I would suggest having an esophageal manometry to check for esophageal spasms, it is possible not all your symptoms are attributable to GERD. You may be able to use Nitroglycerin if it is related to esophageal spasms.

ralphallen: I take 30 Prevacid daily for 3 yrs. I have a hiatal hernia is it safe to take always I must or have severe acid attacks.

Dr_Erim: If you are not having frequent symptoms, 3 times a week or more, or if you do not have inflammation on your endoscopy, then you need only symptom control and an as needed Ranitidine may work just as well. You should definitely see your GI physician regarding this. It is not unsafe to be on Prevacid long term, however, should try to minimize if possible.

songcanary: In your opinion, how long is it considered safe to take a daily PPI long term? By that I mean longer than one year. And is it different for men and women? What are the known side effects?

Dr_Erim: Recently, there has been some controversy regarding bone fractures in elderly women who have been on PPIs long term. These studies are not the best studies to judge a relationship like this so we have been hesitant to limit use. PPIs have been used in millions of patients long term safely. They may cause increase in benign stomach polyps, diarrhea, and possibly increase risk of a hospital acquired colon infection but they are generally quite safe.

Cleveland_Clinic_Florida_Host: For those now joining us, we are currently chatting with Tolga Erim, MD, who is taking your questions about GERD / Acid Reflux. To ask a question, type in the box below and then click 'Ask'.

Cleveland_Clinic_Florida_Host: Dr. Erim will answer the questions in the order they are received. Thank you in advance for your patience.

ls0505: My daughter suffers from very High Acidity that sometimes prevents her to go to school. Is it always related also with reflux? Is it related to stress most of the time? Can you recommend more natural treatment than Prevacid what do you think about Carbone?

Dr_Erim: Our acid production increases when we eat, some people may have an abnormally high acid output as a very rare condition. If your daughter has not been evaluated for this, please see that she is. Stress can certainly worsen reflux symptoms. I am not familiar with Carbone. There are no "natural" supplements that are as effective as Prevacid.

hkirkwood: I have pulmonary fibrosis due to Hermansky-Pudlak Syndrome, so I am especially concerned about my GERD. I've been on medication for GERD for three years now. Should I have any long-term concerns about being on these medications (such as Prilosec) for so long? Or, are there things I should be watching because I've been taking these medications for so long (and probably will for years to come)?

Dr_Erim: Prilosec has been safely used for many years long term in many patients. With that being said, we are finding that long term use may be associated with benign stomach polyps, diarrhea, and possibly increase risk of a hospital acquired colon infection, and possibly early bone loss (jury is still out on this last one).

Irish: Hello. I have been taking Nexium for a number of years and I am concerned about some of the research that has recently been released highlighting a number of side effects and calling into question the medicine's effectiveness. Moreover, I have tried many times to back off my dosage but my acid reflux is too severe to do so. What is your advice? I also have a hiatal hernia and am concerned about being on Nexium for life!

Dr_Erim: Please see my above posts regarding safety and adverse effects. If your hiatal hernia is amenable to fundoplication, it may help you get off of the medications. However, keep in mind that even after surgery many people have found it necessary to restart medications.

nutzy: 2 weeks treatment with amoxicillin+chloromycetin and losec ,there is enough to eradicate Helicobacter pyloris?

Dr_Erim: Yes, this is a very common therapy regimen, usually successful in 80%+

NK: Can GERD caused by H Pylori go away after the bacteria is treated with strong antibiotic doses? If not, how does one diagnose the cause of it?

Dr_Erim: H pylori infection of the stomach should not lead to worsening acid reflux. In fact, you may have worsening of acid reflux symptoms if you had atrophy of the gastric mucosa due to h. pylori and treatment caused you to produce more acid.

chuckarc: My mom who is 80 suffers from GERD. She loves coffee, can she have decaf or does decaf make her condition worse?

Dr_Erim: Sure, she can have decaf.

smbart_1: How about damage to the esophagus? How can it be prevented?

Dr_Erim: Lifestyle changes to reduce reflux, such as not eating 3 hours before sleep, weight loss, avoiding smoking, limiting coffee, etc. And medications help very much.

there4jsweetie: Have you seen success where dietary changes without medication or surgery will stop acid reflux and GERD?

Dr_Erim: Yes, definitely. Avoiding fried/fatty foods helps a lot, also some have symptoms with tomato sauce, wine, etc.

BEACHBABIES: I was diag. w/GERD at CC many years ago by a pulmonologist (after GI testing), as I aspirate the reflux into my lungs resulting in a horrible, debilitating productive cough and bad breath. Now local doc has also diagnosis, delayed gastric emptying. I am wondering if there is a "routine" procedure that can tighten the sphincter so reflux does not aspirate into my lungs. Local doc is more focused on DGE than the loose sphincter muscle.

Dr_Erim: Yes there is a procedure called fundoplication but you have to be careful because in your case having a slow gastric emptying makes you a less ideal candidate for this. You will be much more likely to have gas/bloat/nausea type symptoms if you have fundoplication.

smbart: What is a fodmap diet?

Dr_Erim: "Fermentable, Oligo-, Di-, Mono-saccharides and Polyols". http://areyoutheresoy.files.wordpress.com/2012/01/low-fodmap.jpg

Cleveland_Clinic_Florida_Host: We have approximately 15 minutes left in the chat. We received a large amount of questions and we will continue to answer as many as possible. We apologize if we did not get to your question. If you have additional questions after the chat, please use our contact link clevelandclinic.org/webcontact to submit your questions.

stovskb: I’ve had GERD for many years, being treated long term with a PPI. I was recently diagnosed with sarcoid, and was wondering what connection they may have.

Dr_Erim: GERD is such a common issue that it is very hard to say if there is a connection between the two, likely not.

Jsweetie: Could a sour taste in your mouth, along with a slightly coated tongue, be from reflux?

Dr_Erim: Yes.

Jsweetie: After treatment with medications or surgery for reflux, do you still have to elevate your bed?

Dr_Erim: All depends on how much improvement you've had from your treatments, it may still be necessary.

NK: I'm on acid suppressants 40mg of Ranitidine daily. Yet have hoarseness. Endoscopy does not show anything serious other than mild esophagitis. What could be the other causes of GERD like symptoms?

Dr_Erim: Often, it is post-nasal drip that causes those kinds of symptoms.

Grannyscott: I have a diagnosed large hiatal hernia; treated until a year ago with once daily Omeprazole 20 mg; after a 2 month siege of violent coughing spells at night, dosage was increased to twice a day; seems to have solved the coughing problem; is there a risk in taking this much of the antiacid on a permanent basis? I am 84 years old.

Dr_Erim: No significant risk most likely. I would make sure to stay up to date with bone density measurements though.

smbart_1___songcanary: What is a PPI? Can PPIs cause malabsorption of nutrients?

Dr_Erim: Proton Pump Inhibitor, medications like Prilosec, Prevacid, Nexum, etc. No malabsorption.

carduini: Are many burps at night caused by GERD?

Dr_Erim: GERD is the act of gastric juice refluxing into the food pipe and causing damage. It should not cause you to burp. But when you burp you do generally reflux.

there4jsweetie: I noted your comment about the bed wedge not being as effective as elevating the bed. Do you think that a hospital type adjustable bed is as good as an elevated bed?

Dr_Erim: The hospital type bed is pretty much the same concept as the wedge I believe.

ls0505_1: What do you think about charcoal for acid reflux symptoms?

Dr_Erim: It probably works the way that other antacids like calcium work, by trying to neutralize the acid. This is not something I would advise you to use to treat reflux symptoms.

ralphallen: hi couldn’t access site i take 30 m Prevacid daily for hiatal hernia am i correct nothing in ppi cures the hernia only slows acid is it safe to take forever PPI?

Dr_Erim: The only thing that the PPI does is to reduce the acid, you are still refluxing but there is no acid in it. PPIs have been safely used for many years in millions of patients.

Jsweetie: Onions, garlic, lemon, tomatoes -- do you have to avoid or can you have a little cooked in which other foods?

Dr_Erim: I would eliminate at first and then try to add them in and figure out which ones cause symptoms.

Irish: I have been experience severe gassiness for the past two weeks. No change in diet or exercise routine. What could be the culprit?

Dr_Erim: Likely diet related, try the low fodmap diet.

Cleveland_Clinic_Florida_Host: We are getting ready to close for today. A large number of questions were received and we apologize if we did not get to your question. We will try to answer as many questions as possible in these last few minutes. If you have additional questions, please go to clevelandclinic.org/health/livepersonchat to chat online with a health educator.

ralphallen: Do PPI help prevent cancer of the esophagus, I believe Barrett’s disease?

Dr_Erim: We are not certain if it does, but it may delay progression, the jury is still out.

Cleveland_Clinic_Florida_Host: I'm sorry to say that our time with Tolga Erim, MD is now over. Thank you again, Dr. Erim, for taking the time to answer our questions today about GERD / Acid Reflux. To make an appointment with Dr. Erim, or any other specialist at Cleveland Clinic Florida, please call 877.463.2010. You can also visit us online at vanity clevelandclinicflorida.org.