Is it Acid Reflux...Diagnostics is the First Step
Heartburn, a nonproductive cough, chest pain, asthma that’s difficult to control, hoarseness, difficulty swallowing – these are just a few of the common symptoms associated with GERD (acid reflux). Typically acid reflux is the backward flow of stomach acid into the esophagus. If left untreated, it can lead to a whole host of complications, including erosions or narrowing of the esophagus as well as other changes that could put you at risk for developing cancer.
Approximately 40% of individuals have at least one reflux episode per month. However, symptoms that appear more frequently may be more concerning, particularly when over-the-counter (OTC) medication and diet modification don’t provide any alleviation, explains gastroenterologist Brian Moquin, MD, of Milford Gastroenterology Associates. “The big question becomes, ‘Is there anything else going on?’ he says. “We get concerned that perhaps there may be some underlying ulcer disease or something cardiac in origin.” Other serious conditions that can mimic GERD include hernias (see story on page 3), blockages within the stomach, achalasia (when the esophagus doesn’t squeeze properly), or gastroparesis (when the stomach doesn’t empty properly).
If a patient experiences symptoms of GERD, Dr. Moquin first recommends trying a brief course of an over-the-counter (OTC) acid reducing medication and discussing results with his/her primary care physician (PCP). If the medications work, patients will usually continue to take them long-term under the supervision of their PCP and/or Dr. Moquin.
If a patient doesn’t respond to medications, Dr. Moquin begins a series of tests to identify potential complications of GERD that could be causing the symptoms. To do so, he first performs an upper endoscopy to detect any scarring or abrasions in the esophagus. This involves the insertion of a thin, flexible tube (catheter) with a light on the end of it. During the endoscopy, Dr. Moquin may also insert a Bravo® capsule to monitor whether acid entering into the esophagus is causing a patient’s symptoms. The tiny capsule, which is no bigger than the tip of a pen, affixes itself to the esophagus. When the patient experiences a symptom of GERD, he/she pushes a button on a pocket-size device (carried throughout the test) which then transmits data wirelessly to the device. This allows Dr. Moquin to correlate the acid or pH environment within the esophagus to the patient’s symptoms. The capsule typically collects data for two days before it falls from the esophagus and is passed naturally through the body.
If the upper endoscopy and Bravo pH test come back normal, Dr. Moquin must explore several other avenues to rule out or confirm other diagnoses. For example, if a patient has difficulty swallowing solids and liquids, Dr. Moquin might perform esophageal manometry to help diagnose or rule out achalasia. This procedure involves threading a small, flexible catheter through the nose and into the esophagus to determine how well the esophagus squeezes. “It’s a rare disorder,” he explains, “but people who have it won’t get better, and the treatment is really different from how you would treat GERD.”
If a patient feels full and bloated frequently, Dr. Moquin might perform a gastric emptying study to help diagnose or rule out gastroparesis. This test measures the speed with which food empties from the stomach and enters the small intestine.
If a patient is ultimately diagnosed with acid reflux, OTC medications and dietary modifications are the primary treatments. However, medications may not work for everyone, and in some cases, surgery, such as the Nissen fundoplication (see the following story), may be appropriate. If it is determined that a patient doesn’t ultimately have GERD, Dr. Moquin refers him or her to the appropriate specialist for further evaluation.
Dr. Moquin says the bottom line is that it’s important for patients not to delay seeing a gastroenterologist once symptoms appear. “The vast majority of people will have garden variety reflux that respond well to medications and don’t present diagnostic dilemmas,” he says. However, for those cases that turn out to be something else, diagnostics are the first key step towards the right treatment and a return to good health.
