good evening welcome to ask the dr our fifteen stay tuned we've got some great guests tonight about fifteen percent of those people need to take some sort of medication at least once a week and about five hundred thousand of those people have severe reflux that would be reflux where acid comes up from the specialized muscle between the esophagus which is the swallowing too in the stomach which is the reservoir breaks down and allows backward movement of fluid up into the esophagus and that causes patients symptoms of heartburn heartburn is tom's but that's that's really the spectrum of disease very very common and we don't know why it's so common in america now ok are there any breakdown between men and women that you see while i don't yes i'd say it's about fifty fifty and you mention some medicines that we tag and would you elaborate on that for the listening audience sure so you know usually it's a great nation in the types of medications that people are taking  number two the next one would be something called zantac or h two blocker and all of these are available over the counter and then the big gun in medication is what we call a proton pump and hitter and the or shuts off passes at its source in the stomach and so these have been great drugs but they've been in my opinion overused ok give us some of the symptoms that people have that they might not know you talk about some heartburn or in the gesture what are some of the other things that are less obvious that's a great question jean so basically we define reflux symptoms in two buckets the first bucket is what we call typical symptoms and typical symptoms are defined as heartburn with that burning turn if your breast bone and then regurgitation you know you're out picking up the newspaper in the morning and you get fluid that back washes up in your mouth and it tastes better and that's those are the spectrum of typical symptoms ok one other symptom in that typical symptom group is called dysphasia or difficulty swallowing and that's one that we really need to pay attention to if it doesn't go away with treatment and then the other bucket is  what we call a typical symptoms and that can be cough hoarseness adult onset asthma those sorts of things difficulty breathing so let's say somebody has that there wh the institute for the treatment of a soft feeling for acid diseases is opening this monday night or this monday at the outpatient center at peter so we're really excited about that and we hope that people will come and visit us there the new should also be a phone number heartburn they won't know exactly what it is and sometimes even end up in the emergency room concerned that they're having a heart attack that's a very frequent scenario but most often they're seen by their primary care physician and they're started on  things that people eat that cause or help exacerbated make these symptoms worse you know that's talked about a lot but modifying those things don't help very much in my experience but a lot of a lot of what people say is you know peppermint chocolate spicy foods those sorts of things alcohol alcohol can lead to relaxation of that specialized muscle that i was talking about that's supposed to protect you from reflux and it and it does but once you have the disease the true disease of gastro softer reflux disease then that muscle is broken most commonly and you can fix it ok so but some things that you can do to to help kind of minimize the symptoms are small meal size and not eating before you go to bed so those are the two and within a certain timeframe two to three hours later the practicality of that is very difficult i know it is for me how much do we have any modifications from if they go to bed and in the old days used to tom put some blocks under the head of the bed is that we still say still very common but interestingly there is one group of patients who have reflux that only reflux in the upright position and those are the people that tend to have hoarseness and chronic cough some of them may not even have typical yes it's the acid gives one the sensation of heartburn and when you control that acid it's very good for controlling heartburn but once the barrier is broken down you can't control the fluid movement so  medication controls the chemistry of the stomach but not if you bend over right you lean over to pick up something then the fellow would come up if you're just tuning in and i know you've probably turned off c b s evening news and you're watching us tonight is great but we have two now in america the majority of people that are having surgery for reflux disease it is very small compared to the number of people it is taking that are taking medication but there are very very good studies that have shown that up to thirty percent of people who are taking medication still experience heartburn and regurgitation so there really has been a gap in our ability to take care of that thirty percent because surgery is associated with side effects and some of the side effects are increased bloating the inability to vomit because you've created this valve that works so well and the goals of surgery really are to control regurgitation and to get patients off of medication enable them to sleep flat and that is that's a very beneficial thing there there have been a lot of things in the late a lot of reports in the lay press about the complications related to long term medication use such as osteoporosis which is bone tending in particularly in premenopausal women number two would be increase in certain types of infectious diarrhea illnesses and then number three an increase in the mon yes you know acid was put in our stomach for a reason and acid protect against bacteria bacteria being colonized or living in our stomach and if someone has gastroesophageal reflux disease that fluid can come up into the airway and cause pneumonia at least that's the thinking so there's a lot of people who are coming in to ask about surgery who have been experiencing those sorts of things  question usually what what we do when we're treating her furnace start low and go high so go for at least powerful to the most powerful so an h d blocker is the least powerful it's more upstream if you will and we usually can you give us just like a basic break on how does somebody pass or fail that test and also has it tied into the manami tree that you talked about at the ph testing is used to document the disease there are things that can masquerade as refl excess of thirty percent and once those were introduced and we understood who was the right patient then the success rates went up in the high ninety's park so what you're telling the folks that are watching now turned off used to be katie care and i have no idea  very very few of them develop cancer so again if you're just tuning in we're talking specifically about gerd and i'm sure they're running a by line underneath my video monitors been misplaced to see in but  you can get a hold of these two fine gentleman that are run the number for the west plan and health system for doctors referral number two so you do these tests how do you do surgery who's a candidate i think  you know that the inclusion for surgery is is fairly simple it would be a young person who doesn't want to be on a lifetime of medication it would be a person who is been on an escalating dose of an acid medication and that acidosis no longer working for them it would be a person who has complications related to reflex disease such as adult onset asthma chronic cough they can't go to church anymore because they're coughing all the time or they can't go out to have dinner those types of people would be ideal for surgery but primarily it's for regurgitation which is the movement of fluid up towards the mouth that causes the patient distress and discomfort ok placed in the office through the nose into the us off again it's about the size of a piece of linguini and when the patient swallows it causes a stroke it evaluates how the esophagus strips so normally the esophagus when you swallow should be like a squeegee you know when you squeeze the a window in the water pushes in front of it that's what your esophagus should be doing and so we're evaluating the esophagus is ability to coordinate and to use force to push food through into the stomach if  we find that the esophagus isn't doing that it may be accounting for regurgitation from within this off i guess because it's not squeezing right and that would help us to understand better how what the impact of surgery would be on somebody so that we could properly inform them as to what to expect ok but it may change what we do as well it just popped into my mind a question that i had people that aren't hypertensive and hypertensive medication such as calcium channel blockers how does that affect what  them how does that affect what and if you may want to name some accounts and cardio zein would be one of the cardio of them is actually we use it occasionally and also use a biography for certain motility problems of the esophagus and the calcium channel blockers which which is that these are healthy it's often feel muscle to relax if people have this court nation the success rates have been variable them ok but it won't interfere will taking one of these medicines an affair with any of your other treatments such as the p p i blockers it shouldn't shouldn't but one one potential red herring in the work is that if someone is on an ace inhibitor and has a chronic cough that we should be in tune with the fact that ace inhibitors can cause a chronic cough and shouldn't be faked out that that that's related to reflux disease perfect ok so in the last third of this discussion tonight who do you how do you select for sure julie who who really needs surgery who fails what you needed mention it just so we can regenerate who fails medical management that has to go into surgery you know i think when people are on high dose or maximal those therapy and medication with medication that would be an ideal person who could do well with anti reflux surgery i think in talking about anti reflux surgery it's important to talk about what the outcomes of that surgery are and we now have eleven twelve year results of cohorts of patients and performed where the surgeries been performed in  a specialized center where the success rates are well into the ninety's down to twelve years that is success rates defined by patient satisfaction so you know it only takes five five minutes on the internet to hear all the terrible things that the surgery does and i think that reiterate the point that this is something that requires a specialty and an interest physicians interest and technical experience ok long does the surgery take it takes about an hour and a half and is there anybody that should have the surgery because as we supersize our society is there anybody that's too big to have surgery or too small that is like an outstanding question i think yes so as it is you know we are getting bigger as a society and you just have to look at the maps of of the increase in obesity across our country and obesity is a known independent risk factor for the development of gastroesophageal reflux disease so there's a chicken in the egg phenomenon that occur but if you were to do this procedure in somebody who was morbid just to be sure that we're on the same page is that done the reflux that would be that would be done as a secondary pursued as a primary procedure depending on the body mass index greater than forty those patients are referred for a gastric bypass because the results of nessun or anti reflux surgery the rap that we're talking about have not been as good ok and do you do any tests after you do this you do your lap alterations so patient to usually go home on the next day without any testing yeah and whatever restrictions after surgery i know you said the soft for two weeks are there anything else like no failure rate at ten years is about six percent that's pretty good yes and but there are there are quite a few re operations that are done and the success rate with each re operation is less than the primary or the very first operation that you have the first guy you want the expert to do it the first time as in most as in most or yes i mean the first time is their best shot right if you just tuned in you can catch this on the internet i'm sure will run this  field they can also get ahold of them on the web either that or on the internet on the phone through west power gainey are interested in talking to patients even if it's a patients they don't necessarily have to offer and if they can if you have a question or i think some of the points you brought up which are very important which i didn't know is that now we select that with a ph monitoring and ometer that's right because when i went through a thousand years ago i was arres and you know they just seem to do you know people didn't so this is something new that just come upon the last few years are i not been reading a little you know i think you know there's been an evolution in erbil a t to test for the disease and to fin tune who should have it it shouldn't and that has really opened up a whole new door for us to evaluate these patients particularly patients who have that atypical type of symptom which is that chronic cough in the hoarseness and so we have  here today gene and thank you so much for having us and for giving us the opportunity to talk about what we can offer here and in peter's we feel honored to be able to work with the clinicians and been just been really a great deal of fun i think the main thing that i'd like to get out is that you shouldn't just be taking over the counter medication for gastroesophageal reflux disease that should be under the supervision of a of your physician and if you've been on that medication for more than five years and have never had an in dhaka p and are dependent on that medication you probably should have an endoscopy it's others no question and you know