GERD/LERD Archive Questions

Below are Dr. Fantry’s answers to GERD/LERD questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.



Now displaying records 1 to 15 of 39.

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Q : 1 01/10/2010	Can a patient who had GERD problems recover? Yes. GERD is a medical problem for which there is very effective medical therapy. Dr. Fantry
Q : 2 12/07/2009	I had a scan which revealed several gallstones (4-6mm). Recently I have been suffering from heartburn, nausea after most foods and pain under right rib and in my back. I had barium x-ray which was clear and a pH test which showed no reflux. Would gallstones contribute to these symptoms? Everyone I speak to says that gallstones don't cause heartburn. Pain under the right ribs and in the back after eating can be caused by the presence of gallstones in the gallbladder. Heartburn and nausea after most foods is not likely to be caused by gallstones, however, some people with symptomatic gallstones can have associated chest discomfort. One would not expect gallstones to cause symptoms after eating most foods as symptoms related to gallstones tend to be much more episodic in nature.
Q : 3 11/05/2009	I am a 25-year-old female experiencing symptoms of acid reflux that come and go. I was put on RAN-Rabeprazole (20mg tab once a day), with great relief from my symptoms. I am still on this medication, but my reflux has come back even worse with some acid regurgitation at night. My throat is sore and scratchy, I have post-nasal drip, it feels like there is a lump at the back of my throat and it is hard to swallow some foods. I even have occasional heaviness in my chest during normal breathing. Do you have any suggestions as to what may be going on with me? Your symptoms may represent a flare of your acid reflux (GERD) on rabeprazole. If so, increasing the dose of rabeprazole to twice daily prior to meals may be beneficial. On the other hand, sore throat, post-nasal drip, a lump in the throat, and chest heaviness are an atypical constellation of symptoms that may not be related to GERD at all. At this point, you should discuss your symptoms with your physician regarding what additional assessment may be warranted to determine whether your symptoms are related to GERD or other issues.
Q : 4 10/12/2009	I suffer from heartburn. I was at the hospital last week to have a look at this. They told me that they could treat this with medication, but it mean that I would have to take it for the rest of my life. Is this true? The majority of adults with heartburn due to acid reflux or GERD do require long term medical management.
Q : 5 10/08/2009	had the Nissen Fundoplication done. It has been amazing for most of my issues but now I struggle with swallowing and choking. It's horrible. It consumes my life. Is there anything that can be done? If you have difficulty swallowing that is thought to be related to the Nissen fundoplication itself, endoscopic dilation of the fundoplication may be beneficial.
Q : 6 09/23/2009	Last spring I took Prilosec OTC for heartburn and it helped a great deal. The directions said to only take it for 14 days then wait a few months before using it again. For a few weeks after I stopped taking it, I was still free of heartburn, but then heartburn returned. Why do they tell you to wait for months? It seems like I would benefit from taking Prilosec OTC more frequently. Many people with frequent heartburn require chronic, daily therapy with medication like Prilosec. Often symptoms do recur within a few days to a few weeks of stopping medication. If it appears that you require chronic therapy, I would recommend discussing this with your physician.
Q : 7 07/11/2009	I am currently taking Aciphex (20mg b.i.d.) and Arthrotec (75mg. b.i.d.). I have developed iron deficiency anemia. Could this be a result of both medicines reducing stomach acid and therefore interfering with iron absorption? Or is iron absorbed in the small intestine and stomach acidity has no effect on iron absorption? Although iron is absorbed in the proximal small intestine (duodenum), stomach acid does have an effect on absorption by converting iron into a more absorbent form. However, even on these medications, iron absorption is usually normal and iron deficiency is not usually a side effect of these medications. Occult gastrointestinal bleeding is an important consideration.
Q : 8 06/22/2009	I have heartburn and think that I might have a hiatal hernia. In the last six months, when I wake up I experience severe dry mouth. Could this be related to heartburn or a hiatal hernia? Severe dry mouth is not typically associated with GERD or hiatal hernia.
Q : 9 05/06/2009	My GERD is controlled fairly well with Omeprazole and by not overeating or eating too late in the evening. However, I have had a chronic cough for years and have been to many specialists to eliminate possible causes. I am scheduled to have surgery for GERD at the urging of my pulmonologist who thinks it could be the answer to my problem cough. After seeing the surgeon I was under the impression that this surgery is not a big deal, no overnight, soft foods for awhile, no heavy lifting and that I could resume most normal activities within 6 weeks. But my daughter has a friend who had to be out of work for 4 weeks after his surgery. He couldn't get out of bed by himself when he came home and was in a great deal of pain. He is 42-years-old, slim and in good health. I am 68-years-old and in good health except for asthma. It is common to feel this way after having surgery for GERD? If GERD has been proven to be the cause of your chronic cough, antireflux surgery is a reasonable option. This is a major surgery. However, in my experience, I cannot explain why someone would not be able to get out of bed and be in a great deal of pain after antireflux surgery if it was performed by an experienced surgeon.
Q : 10 04/16/2009	What are the long term effects or risks of the Nissen fundoplication surgery? Are they treatable? Also, what tests are used to confirm a diagnosis of GERD, hiatal hernia, etc.? The typical test used to assess patients with possible reflux is a therapeutic trial (response to medical therapy, endoscopy and pH monitoring). In general, if Nissen funoplication is performed in patients with proven GERD by an experienced and expert surgeon, this is an effective long term treatment for GERD with a low long term side-effect profile. One potential side effect is difficulty swallowing. This typically occurs early after surgery and improves with time and dietary modifications. If not, endoscopy with dilation may be performed. Gas-bloat syndrome can occur after antireflux surgery and can be treated with dietary modifications and medications, however, symptoms may persist to a degree. Delayed stomach emptying and diarrhea are other problems that have less frequently been described related to antireflux surgery. There are treatments that can be prescribed for this, but they are often of little clinical benefit.
Q : 11 03/25/2009	I have terrible indigestion with burning on the right side between my sternum and navel. I experience reflux that causes me to wake in the middle of the night with a burning sensation from my stomach to the back of my throat (I feel like I am going to vomit but usually do not). Eating does not help and it lasts for several hours per day (usually starts after lunch and continues until I fall asleep). I am certain I have GERD. Do I start with a GI specialist or any PCP ? You may well have GERD (waking in the middle of the night with burning from the stomach to the throat), however, you describe some atypical features (burning in the right side of your abdomen). In general, you would start with a PCP. Most GERD can be treated with reflux precautions or lifestyle modifications and acid-reducing medicine. Persistent or unexpained symptoms often require referral to a GI specialist.
Q : 12 02/19/2009	I read recently that proton pump inhibitors may contribute to bone thinning. As a 63-yr-old female, I'm reluctant to take the Prilosec prescribed by my doctor for presumed GERD. Are there any other medications suitable for this condition? Proton pump inhibitors are the most commonly prescribed and the most effective medications to treat GERD. In mild GERD, medications called H2-blockers (for example Zantac or Pepcid) may be effective for some individuals.
Q : 13 01/11/2009	My daughter has a diagnosis of LERD. She has been hoarse and had laryngitis since before Thanksgiving and has not responded to ENT treatment. She is going on a ski trip. I'm concerned her swollen throat meeting cold air, high altitude and her historyof asthma and rhabdo puts her throat at risk. How can she hydrate/protect her throat? Treatment for GERD with extraesophageal symptoms (or LERD/LPR) consists of reflux precautions and acid suppressive medications. If symptoms are not responding to therapy for GERD/LERD further evaluation ENT and GI evaluation (pH monitoring) may be warranted.
Q : 14 01/04/2009	I suspect I have LERD even though i have been diagnosed with GERD. I have a lot of throat symptoms including burning of the throat, swallowing difficulty, pain when swallowing, soar throat and having to clear my throat a lot. What do you think about that? Also I showed my GI doctor a print out explaining LERD and he said he never heard of it! He basically said there was no such disease. Is this is a common misconception among doctors? There is a small subset of patients with GERD who have a predominance of extraesophageal symptoms (throat symptoms) as you describe. This is often referred to as extraesophageal GERD, LERD, or LPR (laryngopharyngeal reflux). The diagnosis is usually made with a combination of ENT evaluation (laryngoscopy) to rule out other causes of symptoms and response to treatment for GERD. If the diagnosis is uncertain, a diagnostic test, namely pH monitoring may be beneficial.
Q : 15 12/30/2008	I recently started taking one dose of over the counter 75 Zantac per day for heartburn and some morning nausea due to GERD and a possible hiatal hernia. It has helped me some, but I am wondering if it is okay to keep taking one a day indefinitely. I am also thinking about trying Prilosec but it says you can only take Prilosec for 14 days and then you can't take it again for four months. Can Prilosec control your heartburn for four months and,if not, can you take other antacids like Zantac if the Prilosec wears out and you get heartburn again before the four months is over? If you have heartburn that requires daily medication, you should see your physician to discuss appropriate diagnostic testing and treatment.

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