GERD Frequently Asked Questions (FAQ)
What causes Heartburn?
Most people will experience heartburn when the lining of the esophagus comes
in contact with gastric acidity.
How common is heartburn?
You are not alone. More than 15 million Americans experience heartburn daily
and are considered severe refluxes.
Why doesn’t everybody suffer from
To experience heartburn you need to have two conditions:
- an incompetent lower esophageal sphincter (a one-way muscular valve located
between the stomach and the esophagus - this valve relaxes at the time
- excess gastric acidity.
What is the treatment for heartburn?
Lifestyle and dietary modifications are the first step. Over the counter antacid
and H2 blockers are the second step. If you continue to have symptoms or
need to take frequent antacid see your doctor for evaluation and prescription
What are Proton Pump Inhibitors?
See the section on prescription medications.
What is GERD?
All diseases related to Gastro-Esophageal Reflux (GER) are called GERD - GastroEsophageal
Reflux Disease. One of the manifestations of GER is heartburn. However, the
refluxed materials can damage the esophageal mucosa and cause ulcers or stricture,
it can travel up higher and produce sore throat, laryngitis, hoarseness,
chronic cough, or it can travel down the wind pipe specially when sleep at
night and cause asthma, chronic lung disease and pneumonia.
When should I be alarmed about my heartburn and GERD?
First of all, if you get heartburn frequently or you think you may be suffering
from other manifestations of GERD, you should see a Doctor and a Gastroenterologist
if possible. Second, if you have difficulty swallowing, weight loss, easy
fatigability due to low iron anemia, or if you wake up coughing and chocking
in the middle of the night, you should see a Doctor immediately.
Can GERD lead to Cancer?
Yes. Cancer of the esophagus secondary to GERD is very rare but its incidence
is on the rise. Amongst the risk factors for adenocarcinoma
of the esophagus are long-standing severe heartburn, Barrett’s esophagus and obesity.
Can this cancer be prevented?
Yes. If you are suffering from heartburn you should take it seriously, particularly
if you are a white male in you 40s or older. If you have any of the alarmed
symptoms you should see a Gastroenterologist immediately. If you are known
to have Barrett’s esophagus you should have regular surveillance for
possible early cancer detection.
Is surgery an option in GERD?
Yes. If you have failed medical treatment or opt not to continue with medical
treatment and watching your diet then you should consider surgery. The best
surgery is what is called a laparoscopic Nissen’s fundoplication. It
is successful in the hand of surgeons experienced with this surgery.
Does every patient suffering from GERD and heartburn require PPIs?
No. Majority of heartburn sufferers will benefit from life style modifications,
Antacid use when necessary, and if longer relief is required use of over
the counter H2 blockers like Zantac 75, Pepcid complete or Tagamet
Are all the PPIs the same in term of their effectiveness in heartburn relief?
No. In my experience of treating hundreds of patients with moderate to severe
heartburn, most patients will do equally as well on 20 mg of Prilosec, vs
30 mg Prevacid, vs 40 mg of Nexium. Protonix 40 mg appears to be the least
effective of all PPIs. Nexium is slightly more effective than Prilosec, however,
not many patients will require stronger medications.
Does esophageal injury due to reflux heals on its own without treatment?
I have never seen grade 3 and grade 4 chronic erosive esophagitis heal without
the use of PPIs or surgery to prevent acid reflux.
Which over-the-counter H2 blocker
do you recommend?
Cimetidine or Tagamet HB is the least expensive and Axid AR is the least effective
of this group of medications.
Which PPI is the best?
In term of expense and effectiveness, in my experience Protonix (pantoprazole)
is the least effective and least expensive of PPIs. The other PPIs are almost
equally effective in their most recommended clinical dose (Lanzoprazole 30
mg, Omeprazole 20 mg, Esomeprazole 40 mg) with Esomeprazole having edge over
the competitors partly due to higher dose and partly due to its metabolic
pathway. For more information please see the following study (A
Clinical Survey Comparing ---).