Getting Help for GERD: Why a Doctor Should Diagnose & Treat GERD

September 25, 2019
Many illnesses are suitable for self-care without needing a doctor’s involvement. Not GERD. Symptoms of gastroesophageal reflux disease, including two or more heartburn episodes per week, should be checked by a doctor, for the compelling reasons discussed below.

Almost everyone has an occasional episode of acid reflux, when stomach contents move backwards into the esophagus, producing a heartburn sensation in the chest and unpleasant taste in the throat. It can happen after eating too much or lying down on a full stomach, and over-the-counter antacids will help neutralize the acid temporarily.

It can take quite some time to progress from occasional acid reflux to the more serious GERD — defined as at least two heartburn episodes per week. GERD is a chronic condition involving the lower esophageal sphincter (LES) loosening or becoming weak, enabling gastric acid in the stomach to be refluxed back up into the lower part of the esophagus, the muscular tube connecting the throat with the stomach.

The stomach has a lining to protect it from acid, but the esophagus has no lining. Over time, frequent episodes of acid reflux can damage the tissue cells in the esophagus, eventually causing them to develop into cancerous cells.

Eventually Help is Sought

For a variety of reasons, a lot of people who suspect that they have GERD have not been diagnosed or treated under a doctor’s care. “Before coming to see me, some of my patients already made their own diagnosis, since GERD seems like a simple and easy condition to figure out just from the reflux symptoms,” said Dr. Vibhakorn Permpoon, a specialist in Gastroenterology and Hepatology at Bumrungrad International Hospital.

“Some ordered their own endoscopy for investigation purposes or had a barium swallow X-ray imaging test. It is common for them to have been taking antacid medications such as proton pump inhibitors (PPIs) for a few months or even longer, but the symptoms haven’t improved, so finally they decide it is time to see a doctor.”

Self-diagnosis Downsides

Dr. Vibhakorn pointed to the most serious consequence of trying to self-diagnose GERD: “The worst case is for a patient to mistake their symptoms for GERD when the symptoms are from something more serious, such as a heart attack. GERD and some other gastrointestinal disorders can cause chest pain that resembles a heart attack, so as a general rule, any episode of major chest pain requires urgent medical attention.”

In some cases, patients turn out to have reflux but not acid reflux, so the self-prescribed medications would have been wasted on something that is not GERD. “It is certainly possible to have a reflux condition without acid being present,” Dr. Vibhakorn said. “Sometimes patients think they are tasting acid being refluxed, but it may just be alkaline elements from food particles being refluxed instead.”

Still, in other cases, self-diagnosing patients might attribute their heartburn symptoms to GERD despite heartburn also being a symptom of gallstones, stomach ulcers and esophageal cancer.
But the most frequent downside when self-diagnosing GERD is that a second motility disorder is present at the same time which goes undiagnosed and, thus, untreated. “Some patients have GERD plus gastritis,“ Dr. Vibhakorn explained. “Some have GERD plus constipation. And some have GERD plus bloating, likely from a condition called SIBO, or small intestinal bacterial overgrowth, which produces a lot of gas. If only GERD is treated, the second condition is still going to be there and producing symptoms.”

Treatment Approaches & Considerations

While GERD can be treated with a combination of three categories of medications — anti-acid medications such as PPIs to reduce acid production; medications that act as protective coatings to guard against acid damage; and motility medications to promote faster movement through the esophagus and the stomach — Dr. Vibhakorn believes the most effective treatment approach begins with lifestyle modifications.

Weight loss can help alleviate GERD symptoms, and changes in eating times and habits can have a significant impact as well. Eating dinner earlier, avoiding evening snacking and not lying down for three hours after eating are often recommended, allowing the stomach enough time to fully digest its contents before bedtime. Smaller portion sizes may also reduce the likelihood of reflux episodes.

In most GERD cases, Dr. Vibhakorn tries to limit long-term medication treatments. “Taking any type of chemicals for an extended period can have consequences,” Dr. Vibhakorn noted. “That is certainly true for taking antacids to relieve GERD symptoms. Antacid medications, even the over-the-counter type, can lead to long-term problems, including declining bone strength and higher risk of bone fractures. Other side effects such as vitamin deficiencies, even small intestinal bacterial overgrowth (SIBO) — these types of problems are linked to long-term use of antacid medications.”

No-incision TIF

For some people, problems related to the lower esophageal sphincter (LES) enable acid reflux to persist even after significant lifestyle modifications and medications. Surgical repair of the LES, a procedure known as fundoplication, may be the next best option.

Fundoplication surgery has been the most effective surgery for treating GERD for more than 50 years. During fundoplication, the surgeon wraps the upper curve of the stomach (the fundus) around the esophagus and sews it into place. The goal of the surgery is to strengthen the LES so it can prevent acid from being refluxed out of the stomach.

Fundoplication has traditionally been performed through conventional open surgery or a laparoscopic keyhole procedure, which is less invasive than open surgery. A new and potentially transformative fundoplication method known as TIF, for transoral incisionless fundoplication, is a minimally-invasive endoscopy procedure for GERD that is done through the mouth. TIF does not require any surgical incisions, so recovery times are shorter, and there are fewer post-surgery complications.

“Until now, many people have been reluctant to undergo fundoplication surgery using the open surgical or keyhole techniques,” Dr. Vibhakorn noted. “But the new TIF procedure marks a significant change from the current surgery methods for GERD. With a minimally-invasive, no-incision option, those who thus far have preferred to wait may finally see the new TIF option as a GERD game-changer.“

One-month Limit

Some of the people who suspect they have GERD do indeed have it. But they may have GERD plus another condition, something entirely different, or nothing at all. That “not quite sure” aspect is the difficult part of self-care, especially self-diagnosis. Dr. Vibhakorn recommends following a one-month rule — if a medical issue does not clear up within one month, have a doctor check it, first to make sure it is not something more serious, then to provide a proper, professional diagnosis and recommendations for the course of treatment for each individual situation.
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