Everyone experiences heartburn once in a while, usually after a large or
spicy meal. Most people just pop a few antacids, but for some, over-the-counter
medications aren’t enough. If you continue to have heartburn symptoms
even after taking nonprescription drugs, you might have gastroesophageal
reflux disease (GERD). To learn more about it, Advantage spoke with gastroenterologist
James A. Sattler, MD, at Digestive Care Consultants, who specializes in
the care of GERD patients.
What is GERD?
Gastroesophageal reflux occurs when the muscle at the bottom of the esophagus
weakens or relaxes when it should not, allowing stomach contents to flow
back into the esophagus rather than passing through the stomach into the
intestine. All people reflux to some degree. It’s considered gastroesophageal
reflux disease if symptoms are bothersome and present more than twice
a week for a few weeks. Some patients with large hiatal hernias are prone
to increased amounts of reflux and GERD.
What are the symptoms?
Since stomach contents are acidic, the most common symptom of GERD is a
burning sensation in the upper abdomen, which often radiates to the area
under the breast bone. This is commonly known as heartburn. A sour or
bitter taste in the mouth may be present. Some of the less common symptoms
occur when stomach contents reflux above the esophagus causing throat
pain, hoarseness, chronic cough, the sensation of a lump in the throat,
asthma, dental erosions, burning in the mouth or recurrent sinusitis.
How can you prevent GERD?
Limit foods and habits that relax the lower esophageal sphincter such as
caffeine, alcohol and tobacco. Don’t excessively fill the stomach.
Eat smaller portions, more frequent meals, limit carbonated beverages
and fatty foods. Maintain a normal weight to decrease pressure from the
abdominal wall on the stomach. Stop eating a few hours before bedtime
so there is less food to reflux.
How is GERD diagnosed?
There is no specific test. A diagnosis of GERD is generally made by the
presence of symptoms that respond to lifestyle modifications or a short
course of treatment with acid-reducing medications such as histamine 2
(H2) blockers or proton pump inhibitors. Patients should first see their
primary care physician. Referral to a gastroenterologist may be needed
for further evaluation and possible endoscopy to evaluate the lining of
the esophagus, stomach and duodenum.
What are the risks of untreated GERD?
Ulceration and possible narrowing of the esophagus leading to difficulty
swallowing. Additonally there can be exacerbation of asthma, bronchitis,
sinusitis and rarely pneumonia. Long-standing GERD can, in some people,
result in a change in the lining of the esophagus (known as Barrett’s
esophagus), which has a small risk of developing into esophageal cancer.
If GERD has been present for more than five years you should discuss with
your primary care physician about a referral to a gastroenterologist for
When is surgery recommended?
Generally, pursuing an anti-reflux procedure is an individual personal
decision for patients with symptoms that do not respond to or only partially
respond to lifestyle modifications and medication. Also, some patients
prefer an anti-reflux procedure rather than continuing long-term medication
to control their symptoms. Often patients with significant regurgitation
of stomach contents don’t adequately respond to medical treatment
alone. Surgery is recommended to prevent irreversible damage to the lungs
for patients whose GERD is unresponsive to treatment and continue to experience
symptoms of asthma, bronchitis or pneumonia.
What’s new in GERD treatment?
Torrance Memorial offers state-of-the-art diagnostic technology and therapeutic
options to help treat GERD patients. One anti-reflux alternative enables
us to treat some patients endoscopically through the mouth with a procedure
known as a Transoral Incisionless Fundoplication (TIF). This procedure
repairs the gastroesophageal valve (without incisions) via the mouth,
reducing the need for traditional surgery.
We at Torrance Memorial have performed more than 95 TIF procedures since
2012, the fourth highest number among hospitals in Southern California.
Some of these patients have also required a simultaneous minimally-invasive
(laparoscopic) surgical procedure to repair a large hiatal hernia if one
is present. We have continued to follow all of these patients. Our results
have been published and shared at major nationwide medical conferences.
Surgeons at Torrance Memorial continue to perform the latest minimally-invasive
surgical treatment options including the Linx procedure, where a string
of magnets is laparoscopically placed around the lower esophagus to tighten
the junction between the esophagus and stomach in order to reduce acid reflux.
Tell us about the coordination of care.
For the majority of patients, coordination of care involves their primary
care physician, a gastroenterologist and surgeon. The team approach for
patients with GERD symptoms affecting their throat, sinuses or lungs also
involves further collaboration and coordinated care with the ENT (ear
nose and throat), pulmonary (lung) and allergy specialists, as needed. •
James A. Sattler, MD, is a gastroenterologist at Digestive Care Consultants
with offices in Torrance at 23451 Madison Street, Ste. 190, and Manhattan
Beach at 855 S. Manhattan Beach Blvd., Ste. 101. He can be reached at