Hi, my name is Rena Yadlapati.
I'm a gastroenterologist and I direct the Center
for Esophageal Diseases at UC San Diego Health.
So gastroesophageal
reflux disease, or GERD, is extremely common.
In fact, one in three adults in the United States
will experience troublesome GERD symptoms at some point
in their life.
So there are many different causes of GERD.
I think it's really important to remember that having
reflux of contents from the stomach up to the esophagus
is actually a normal thing that happens in healthy
humans about 40 times a day.
But GERD can become problematic when that reflux is happening
too often or if it's causing symptoms.
Our GI system is very much a plumbing system,
and if you have more pressure on your belly or abdomen...
so let's say you carry extra weight around your belly
or you're pregnant or you're wearing tight fitting clothes around the belly.
That pressure can cause more contents to come up into the esophagus.
Another thing that's very important is that we have 1000 nerve endings
in our esophagus, and in some people, those nerve endings can be more sensitive.
They can be a little bit more aware,
especially if you're under stress or if there's a hormonal imbalance.
And so in those settings, even normal amounts of reflux or
just drinking something can really elicit significant symptoms of GERD.
The current best test to
diagnose GERD is really starting with an upper endoscopy.
The camera goes through the mouth and then down through the esophagus.
The first goal is to see if there's any signs of injury or inflammation
from reflux, and also to make sure that there is nothing worrisome
in the esophagus, you know, such as Barrett's esophagus or esophageal cancer.
70% of patients usually have normal healthy
findings in their esophagus, which is very reassuring.
So if they do, what we're able to place is a small wireless capsule.
It's about the size of an eraser tip, so really small,
and we place it during the upper endoscopy.
It sticks to the lower esophagus, has a PH sensor, so it's able to measure
how much acid is coming up from the stomach for four days.
That's really the best test of measuring if there is abnormal amounts
of acid in the esophagus.
Lifestyle
modifications are probably the most important thing
that any person can do to manage their GERD.
I often tell my patients that 70% of patients I care for
have controlled GERD when they follow lifestyle recommendations, so it's amazing
and probably the most important lifestyle recommendation is weight management.
So whether you're overweight or you have a normal weight, maintaining
that and reducing excess weight around the belly is incredibly important.
Patients' symptoms can completely resolve and their ability to come off of
medications can improve just with about 10 pounds weight loss in some patients.
Other lifestyle modifications are avoiding late night meals that are heavy
because you want to empty the food from your stomach before you lay back.
Another thing we often recommend is just stress reduction, so mindfulness
breathing exercises like belly breathing or diaphragmatic breathing,
relaxation strategies can really help to dampen
the nerves in the esophagus and reduce the symptom burden.
laryngopharyngeal reflux,
also commonly known as LPR, is a condition where there is GERD,
but that the reflux reaches up high to the throat area,
and so in LPR, patients will experience throat clearing or sore throat.
They might have voice changes like voice hoarseness or a cough that just lingers.
Now, LPR is a very complex entity because about half of patients
that have these symptoms, when we ultimately do their testing,
they don't actually have reflux and their care needs to be directed elsewhere.
But for patients that do have reflux, we have a really great partnership
with the Center for Voice and Swallowing,
with our team of voice doctors and speech language pathologists.
And what's really integral is providing a team-based approach to patients with LPR.
Patients often ask, will their GERD ever get better?
I have every ounce of confidence
that every patient that has GERD symptoms will get better.
It comes down to us finding out why you're having that symptom,
personalizing your therapy to the actual mechanism
as to why you're having the symptom and remembering that here at UC
San Diego Health, we will never give up and we will always find an answer.