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.