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 29.

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Q : 1 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 : 2 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 : 3 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 : 4 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 : 5 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.
Q : 6 12/05/2008	What foods should one avoid with GERD? Please advise name/s of fat and caffeine substitutes that would not impact negatively. Dietary modifications for GERD as part of reflux precautions include smaller meals, low fat diet, avoiding chocolate, mints, and caffeinated or carbonated beverages and avoid eating within a couple of hours of lying down.
Q : 7 04/30/2008	Is it better to leave be the hiatus hernia I have bulging up in the esophagus,and watch what I eat and take the Nexium, which helps really well if I double up on them, or have the surgery? I'm 65 years old. The correct approach depends on multiple factors. If your symptoms are primarily related to GERD (in the setting of a small or medium size hiatal hernia) and well controlled with Nexium once or twice daily, continuing medical management is fine and appropriate. If you have a large or complex hiatal hernia that is symptomatic in and of itself, surgery may be appropriate.
Q : 8 02/22/2008	For the past six months, I have been having some stomach and acid reflux issues. I tried antacids for about two to three months before finally making an appointment to see my primary care doctor. I told her my symptoms which were burning of the stomach and it feeling like it was rising up through my esophagus, this was waking me up at night and in the morning, sometimes to the point where I felt nauseous. It felt better to eat, but no over-the-counter drugs were helping. So, she put me on Nexium for two months and then I am to take Zantac for one month. Well, I have taken the two months of Nexium and have about two more weeks on Zantac. I am starting to have the acid reflux, burning of the stomach, and nausea again. Any suggestions? Should I see a specialist? Do you think this is just acid reflux or maybe an ulcer? Your symptom of burning in the stomach rising through the esophagus is suggestive of heartburn related to acid reflux or GERD. Stomach or duodenal ulcers would not typically cause symptoms in the chest or esophagus. GERD symptoms usually respond very well to medications such as Nexium (a class of medicines called proton pump inhibitors - PPIs) and often recur when the medication is stopped. Zantac (a different class of medications called H2-blockers) is typically much less effective in treating GERD. You likely need to resume therapy with Nexium. Given your recurrent symptoms, it is certainly reasonable to see a specialist (gastroenterologist) to assess your symptoms, to decide whether any diagnostic tests are warranted, and to develop an optimal long term treatment strategy.
Q : 9 02/21/2008	What would I need to do to have my condition reviewed by one of your physicians? I am a 37-year-old female with a hiatal hernia since 1994. As the years go by the GERD condition worsens. I've had several tests performed last year to measure the acid reflux, how I digest and how my esophogus is working.I recently had an endoscopy that reflected chronic reflux and I had some polyps removed. I am still waiting for the results on the biopsy for the esophagus, stomach and deudenum. The main issue I have is that I have all these tests run and no real answer to what is causing the problem. My gastroenterologist just keeps changing pills on me (most I cannot take because of the side effects) but what I am really looking for is a answer to what the real problem is and a solution, not a cover up to the problem. If GERD is the cause of your symptoms, one would expect a positive pH test (test to measure the acid reflux) and an excellent response to medical therapy with acid suppressive drugs like Nexium, Prevacid, Prilosec, Protonix. These medicines would not cover up the problem. If GERD is the problem, these medicines are appropriate treatment for the problem. If the diagnostic tests are negative and your symptoms do not respond to medicines, GERD is an unlikely primary cause of your symptoms. If your evaluation is suggestive or diagnostic of GERD and you continue to have symptoms or are unable to tolerate appropriate therapy, evaluation at our GERD Center may be helpful. If this is the case, you can FAX all of your records pertaining to your evaluation to our office (410-328-1897) for review. After review, if appropriate, an appointment will be sheduled for you in our GERD Center.
Q : 10 05/22/2007	I have been having this burning on my chest for about one year and maybe getting worse. And yes, after a big meal around 3:00 pm a few days ago, I suffered extreme heart burning for about three hours late at night, and radiated down my right arm. I have visited my doctor about this, but I still have the symtoms. Is there a cure for the acid reflux, if that is what I have? What would you recommend I do at this time? With chest discomfort radiating down your arm, cardiac causes should be ruled out. Your symptoms certainly are suggestive of acid reflux or GERD. There is not a "cure" for GERD, however, there is highly effective therapy which typically includes lifestyle modifications and an acid-reducing medication. I would recommend that you discuss this with your doctor. If cardiac disease is ruled out and your symptoms do not respond to standard GERD treatment, diagnostic tests may be performed such as endoscopy and pH monitoring.
Q : 11 01/23/2007	I just had a Nissen procedure six days ago. I'm still experiencing some minor reflux. Is this normal? Will it get better with time? It is difficult to assess the final outcome of a Nissen fundoplication at 6 days post-operatively. I would recommend waiting at least a few weeks to assess the final outcome as you may see further improvement. You should discuss any new or residual symptoms with your physician at a follow-up visit. A Nissen fundoplication is not necessarily 100% effective and a subset of patients may have residual symptoms that require medical management.
Q : 12 09/14/2006	I am a 35-year-old female who has been experiencing heartburn in excess of 10 years. I went to see my GI because I was "drowning" in acid at night and would then vomit. I had a scope and they found Barrett's but I am just not sure where I should go from here. I am not good at asking the right questions for myself. Last night, after eating dinner, I felt sick like before I started taking my meds and vomited. In the vomit was red blood. I am taking Aciphlex, Zelnorm and (Zantac at night before bed.) I guess my question is what should I be doing and what questions should I be asking of my doctor? Heartburn is a classic symptom of gastroesophageal reflux disease (GERD). Barrett's esophagus is a complication of longstanding GERD. GERD is treated with lifestyle modification and acid reducing medications (most commonly a class of drugs called proton pump inhibitors-PPIs such as Aciphex). These medications are taken once or twice daily 15-30 minutes prior to breakfast and dinner. If symptoms persist, other tests may be performed to assess for breakthrough acid reflux or nonacid reflux. If present, evaluation for antireflux surgery may be considered. In patients with GERD and Barrett's esophagus, endoscopy is usually repeated every 3 years. Questions you may ask your doctor if you have persistent symptoms on your medication as described above may include: Are there any modifications to my medical regimen that may be helpful?, Do you think that my persistent symptoms are related to GERD?, Are there any other tests that can or should be performed to try to figure out why I am still having symptoms?, Are there any other treatment options for my symptoms?
Q : 13 07/26/2006	I had Nissen Fundplication surgery two years ago. I have had acid reflux return a couple of times. Now, I have had it for over a month and it won't go away. I have tried Tums, etc. Is this common or do I need to visit my surgeon? It is not common to have significant, recurrent and persistent reflux symptoms within two years of a fundoplication. Certainly, if your symptoms are due to recurrent reflux, medical management with a proton pump inhibitor, such as Prilosec or Nexium may be effective. However, I would recommend a follow-up visit to your gastroenterologist or surgeon.
Q : 14 07/25/2006	I have been diagnosed with LERD after many years of a cough. I actually have two questions. What is there a relationship between LERD and abnormal esophageal motility(diagnosed on cine esophogram) and can the lower esophageal sphincter ever improve function after found to be abnormal on a manometric study? "Abnormal esophageal motility" on an esophagram is a nonspecific finding. If a significant esophageal motility disorder is suspected, an esophageal motility study (manometry) is the test of choice. In a GERD/LERD patient, if lower esophageal sphincter function is abnormal (such as a low lower esophageal sphincter pressure), one would not expect this to change significantly over time.
Q : 15 05/16/2006	I've had GERD for at least 5 years. I was put on Nexium a little over 3 years ago. While it has greatly helped my heartburn, over the last few months I get a distinct heavy indigestion feeling in the chest about one to two hours after eating my evening meal. Is it possible that over the years the Nexium has by reducing stomach acid also altered or destroyed some vital digestive enzymes and in effect messed up the overall digestive process? Would it be beneficial to take supplimental digestive enzymes and acidophilus and also is it wise to continue with the Nexium indefinitely? My main problem is my weak sphincter. Are there medicines to aid in strengthening the sphincter to prevent reflux in the first place? Sorry for the long winded question but I seem to be in a catch 22 situation. I am a 58-year-old male. I exercise regularly, do not smoke and have stopped drinking as of four months ago. Nexium is unlikely to have significantly altered your digestion and adding digestive enzymes or acidophilus should not be necessary. There are no medications that are of long term benefit to strengthen the lower esophageal sphincter. In patients with severe, refractory GERD, metoclopramide (Reglan) is sometimes used as an adjunctive therapy to help esophageal motility, however, its use is frequently limited by side effects. If you have developed this new symptom of heaviness/indigestion in the chest after meals while on Nexium, it may be important to rule-out a cardiac cause of this symptom and to follow-up with your gastroenterologist as endoscopy or an UGI series may be warranted.

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