Gerd
Patient Education

Doctors Who Treat Gerd - Patient Education

The initial examination and evaluation for symptoms of GERD is often done by the doctor who has been maintaining ongoing care and knows the patient best. They are listed in this patient education guide, and include:

• Internists - Focus on prevention, discovery and treatment of adult illnesses.
• Gerontologists - Focus on seniors and elder medicine.
• Pediatricians - Focus on infants, children, adolescents.
• Obstetrician/Gynecologists - Focus on women's health.
• General Practitioners (Family Physicians) - Deal with prevention, discovery and treatment of illnesses in all age groups.

After an initial trial of antacids, it may be deemed necessary to investigate symptoms further, in which case a team of specialists will be called. These include:

Gastroenterologist - An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer, and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to see internal organs.

Radiologist - Specializes in the use of imaging to detect, diagnose and treat visualized abnormalities and disease.

Anesthesiologist - An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an operation, an obstetric or diagnostic procedure. The anesthesiologist assesses the risk of the patient undergoing surgery and optimizes the patient's condition prior to, during and after surgery.

Nutritionist - Looks at the diet of a patient to help make him or her make adjustments that will help mitigate symptoms.

How to Prepare for Your Gerd Doctor Visit

It is of utmost importance that you discuss the tests for GERD with your doctor prior to the day of the exam so that you can plan ahead and be ready for the particular event. Below are the preparation steps listed in this patient education guide.

Preparation for Upper Gastrointestinal Endoscopy

• No food or beverage for 6-8 hours prior
• Bring a list of any medications and their dosage being taken
• Notify the physician of any allergies
• Let the doctor know if pregnancy possibility
• Discuss ahead of time the amount of insulin needed if a diabetic (since abstaining from food)
• Discuss anticoagulants being taken and if they should be altered prior to the exam
• Stop aspirin (with doctor approval) for 1-2 weeks prior to the exam
• Inform physician of any prior esophageal surgery or radiation
• Make sure that you understand the test being given with a description of what will be experienced in addition to the risks and the indications of the exam prior to signing the consent
• Have a designated driver for transport home after the exam

Preparation for Barium X-ray

• Diet change may be advised for 48-72 hours prior to the exam
• No food or beverage for 6-8 hours prior
• Notify the physician of any allergies and bring drug list
• Notify physician if pregnancy is a possibility
• Do not wear any jewelry above your waist level on day of exam
• 16-20 ounces of a barium drink (milk shake consistency) must be ingested prior to the exam
• Have a designated driver for transport home after the exam.

Questions to Ask Your Doctor About Gerd

From your initial GERD diagnosis throughout your treatment and care, you will have questions about your condition. In this patient education guide is a list of helpful questions for you and your doctor to discuss so you can make informed decisions about your condition.

Question About My Diagnosis

• How did you distinguish GERD from heartburn in my case?
• Is my condition mild or severe?
• Will this condition get progressively worse?
• Am I at a higher risk for esophageal cancer?
• How often should I be tested for GERD and to rule out cancer?
• Does this recur?
• How do I tell the difference between GERD and heartburn?

Questions About My Treatment

• Do I need surgery or will medicine suffice?
• Will I need medicine forever or only a finite period of time?
• Could I use antacids without further prescription medications?
• Are there over-the-counter medications besides antacids? Are they effective?
• Which medications are appropriate for me? What are the side effects? Are these medications c compatible with the drugs that I am currently on?
• Are the generic drugs equally effective?

Questions About My Lifestyle & Family

• Does this condition run in families? Can my family do something to prevent GERD from occurring?
• Is there a special diet that would improve my condition?
• Which foods (if any) must I avoid?
• Can I consume alcoholic beverages or must I avoid them?
• Does weight influence GERD?
• May I drink beverages with caffeine?
• Does smoking have any effect and if so, what cessation program is recommended for me?

Common Tests or Labs to Diagnose Gerd - Patient Education

When an individual has prolonged or repeated episodes of heartburn, it should be further evaluated to make a diagnosis of GERD. Diagnostic procedures may be performed after a trial of acid-suppressive therapy has been tried. Read more in this patient education guide.

Test	Why Test?	What Happens?	What is Normal/Abnormal?
Upper Endoscopy	Used to see the walls of the upper digestive tract Ulcers, tumors, narrowed areas (strictures) and hiatal hernias can be seen and diagnosed	During this procedure, a thin flexible tube with a light attached is inserted through the mouth and advanced to the esophagus.	In normal results, the esophagus looks white. A red appearance will indicate inflammation or irritation.
pH Test	Measures the amount of acid that flows into the esophagus from the stomach. Rules out other conditions, such as heartburn.	A thin plastic tube with a sensor is inserted into the lower esophagus from the nose and left in place for 24 hours to measure the amount of acid flowing upward into the esophagus along with how efficiently it clears the esophagus.	Normal esophageal pH is considered to be close to pH 7.0. GERD is typically diagnosed with pH is below 4.
Barium X-Rays	Used to see abnormalities of the gastrointestinal tract, such as ulcers, hiatal hernias, strictures, erosions or tumors. The test often indicates patients with dysphagia (difficulty swallowing), as opposed to a GERD diagnosis.	Involves the ingestion of barium into the digestive tract after which diagnostic x-rays are taken to visualize and diagnose any abnormalities.	Doctor considers shape, size and movement of esophagus, stomach and small intestine.

Medications and Treatments for Gerd - Patient Education

There are three main types of treatment that physicians consider for GERD based on the severity of symptoms.

• Lifestyle Changes
• Drugs
• Surgery

Lifestyle Changes

By making some simple lifestyle changes, some symptoms of GERD can be avoided. These include:

• Quitting smoking
• Taking antacids (of aluminum hydroxide content)
• Avoiding food consumption within 2 hours of going to bed
• Elevating the head of the bed

Drugs

Several medications have been FDA approved for GERD treatment.

Drug Category	How it Works
Alginic acid	Increases pH Decreases Reflux Coats the mucosa
Antacid	Increases pH Reduces gastric acidity
GABAB Receptor Agonist	Reduces esophageal sphincter relaxation Decreases reflux episodes
Gastric H2 receptor Blocker	Decreases secretion of gastric acid Type of antihistamine
Proton Pump Inhibitor	Decreases secretion of gastric acid at the source of production (the proton pump)
Prokinetics	Fortifies the lower esophageal sphincter Hastens gastric emptying
Sucralfate	Heals the esophageal damage caused by GERD
5HT4 Receptor agonist	Therapy for dyspepsia and GERD. (Used outside of the U.S.A.)

Surgery

Surgery may be necessary for more serious GERD cases. Surgery is used to address the relaxation of the esophageal sphincter in order to reduce acid reflux.

Transoral Incisionless Fundoplication (TIF) - The esophageal valve is repaired without an external incision by going through the esophagus.

Nissen Fundoplication - The lower esophageal sphincter is strengthened by wrapping the upper portion of the stomach around it and can be done laparoscopically (using a minimal incision and use of video camera equipment). Not only does it diminish acid reflex, it also repairs any hiatal hernia present.

Vagotomy - No longer performed, this surgery removed the vagus nerve innervation to the stomach lining. This surgery has been replaced by drugs.