Gastroesophageal Reflux Disease and Heartburn- GERD

Although, heartburn is the most common symptom of gastroesophageal reflux (GERD) disease (stomach acid entering the esophagus, food tube, in the chest), some patients only experience a tightness in their lower throat or hoarseness. In these patients, there is no chest discomfort, only throat tightness. For years the medical profession called this symptom "Globus" and felt it was due to a psychological problem. Now it is known that the throat tightness is usually from spasm of the cricopharyngeous muscle in the lower throat and that this spasm is usually caused by stomach acid. Chronic spasm of this muscle along with forceful swallowing can cause dilatation of the lower throat (hypopharynx) and pocket formation (Zenker's Diverticulum). It has also been found that occult reflux disease is the most common cause of hoarseness in a non-smoker and has been implicated in sinusitis in children.

As with any symptom, other more serious causes are possible and a full medical evaluation is advisable. Patients with recurrent or persistent reflux disease should be evaluated by endoscopy. Chronic reflux disease can cause scaring and narrowing of the esophagus and is one for the predisposing factors to esophageal cancer. Newer endoscopes are smaller and can be passed via the nose down the esophagus. This procedure is less expensive and can be performed in the office. Much like a fiberoptic examination of the larynx (voice box). View Abstract Examination of the larynx (voice box) my give some indication that reflux is present. The finding of pachydermia (thick wrinkling mucosa) of the back part of the larynx used to be thought to be caused by reflux but a Hill et.al. reported that this finding is unreliable in predicting gastroesophageal reflux disease. View Abstract .

Patient Suggestion: If your doctor has recommended an examination of your esophagus and stomach using a fibroptic scope. Ask him if instead of being sedated in a surgery center and having a large tube placed down through your mouth, if you could be evaluated using trans-nasal esophagoscopy where a small tube is placed down your nose. This procedure is performed in an office setting is costs less than the traditional fibro-optic esophagoscopy.

View Report View Scope

View Videos of Gastroesophagoscopy Procedures

Patient Suggestion: Ask your doctor if a generic or over the counter medication may be able to treat your condition at a lower cost. For example:

A discount pharmacy was consulted on Nov 20, 2007 (prices used in this example may change and vary).
1) A 30 day supply of 40 mg of Esomeprazole (Nexium) taken once a day cost 139.99. Instead consider taking Omeprazole (Prilosec) 20 mg twice a day at a cost of $41.99.
2) A new drug Zegerid (40 mg) is a combination of Omeprazole (Prilosec) and an antacid. It costs $155 for a months treatment. However, the same dosage of Omeprazole (Prilosec) and antacid bought over the counter cost under $50 a month.

Patient Directions For: HEARTBURN-TROUBLE SWALLOWING

1. Elevate head of bed by 6 to 8 inches. (Place blocks under bed posts.)

2. Do not eat 4 hours before sleeping.

3. Take Prilosec (20 mg once a day) or Zantac (75 milligrams once a day)
--All are over the counter anti-reflux medications..

4. Avoid the following Foods:

Fried/Fatty
Caffeine (Coffee, Tea, Chocolate)
Spices (Peppermint, spearmint, garlic, onions, cinnamon, herbs)
Alcohol
Acidic Foods
Citric Foods
Tomato Juice

5. Avoid tight clothing.

6. Avoid smoking.

7. If overweight, lose weight.

8. If possible avoid the following medications:

Anticholinergics
Aspirin
NSAIDS
Benzo diazepams
Prostaglandins
Theophylline
Tricyclic Antidepressants
Calcium channel blockers

*Consult your general physician regarding your current medications, so he can advise you on which ones you can discontinue.

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