Episode Transcript
Interviewer: Gastroesophageal reflux disease or GERD is a condition that impacts up to 20% of people. But many people aren't even aware they have it or recognize its symptoms which can lead to really serious health issues if it's left untreated. To help us better understand GERD and how to recognize it we're joined by gastroenterologist Dr. Jessica Stout with University of Utah Health. Dr. Stout first of all is it a fair statement to say most people don't even know they have GERD or are experiencing GERD symptoms?
Symptoms of GERD
Dr. Stout: Yeah. That's a really fair statement actually. I mean it's a very very common disease. And a lot of people either don't know they have it because they have the silent symptoms which means no symptoms or they have atypical symptoms which means that they don't present with the typical symptoms of GERD. And a lot of people if they do have symptoms that are pretty classic which is that heartburn sensation or just the sensation that things are refluxing up into their esophagus or even their mouth they just don't really do much about it because either maybe it's not too bothersome or you know they're just busy with their day-to-day lives and don't have time to go see somebody about it or educate themselves on how or what they should do about it.
Typical GERD Symptoms
Interviewer: Let's talk about those typical symptoms and then the atypical and maybe even the silent symptoms. So what are we looking for?
Dr. Stout: Yeah. I think the typical symptoms most people are quite aware of and that's that heartburn sensation or "I have this like just burning sensation in the center of my chest." And oftentimes people use their hand to motion this upward kind of movement of the burning sensation and that is really oftentimes the acid in the esophagus just refluxing up causing a burning sensation.
The reflux is also pretty self-explanatory. You know you just feel like you have food or fluid that's moving upwards in the chest and then some people even get it that fluid will get into their mouth. It'll have like a gross bitter sour taste or they'll even feel like food and things like that. And oftentimes people feel this the most when they're sleeping. Maybe that's because they're (a) not as busy and they're more aware of what's going on when they're lying down and it's quiet. Also literally gravity isn't helping keep those fluids and foods and things like that down.
So those are the really typical symptoms which is just heartburn and reflux that people will get.
Atypical GERD Symptoms
Interviewer: All right. And then those atypical symptoms what do those look like?
Dr. Stout: So atypical symptoms are . . . Really what it probably is is the acid and like fluid contents from the stomach moving so high up into the esophagus that it's actually spilling over into the windpipe. We call them extraesophageal symptoms in the world of GI or like if you're really fancy you'll call them laryngopharyngeal reflux symptoms. But again literally it's that acid or fluid moving into the windpipe oftentimes and it can be really difficult to determine whether or not this is really due to reflux. A lot of these patients will end up seeing ear nose and throat doctors first because they have like hoarseness or they'll see a lung doctor or a pulmonologist first because they've got symptoms of cough or maybe they're having shortness of breath because over time the acid and fluid that's spilling over into the lungs is actually causing inflammation and damage. Some people will have a lot of post-nasal drip or maybe they'll have like some what we call globus sensation or just the feeling that something is stuck way up high.
There are patients who you know again they get referred first to other specialists because they're thinking "Oh this is a lung problem" or "This is a throat problem." And then oftentimes rightfully so after the pulmonologist or ENT doctor has done their whole workup they're like "You know what? I think this actually might be reflux" and then they come to our gastrointestinal or GI clinics.
The symptoms that we will see too are something called dysphagia or people who are having trouble swallowing or even odynophagia which is a fancy word for painful swallowing.
Silent GERD Symptoms
Interviewer: Then there are these silent symptoms. You know this could be happening and you're not even really experiencing symptoms. What are some of those?
Dr. Stout: Silent GERD is silent. Oftentimes people just don't have any symptoms or they're just not aware of the symptoms that they're having. And I would say if you really tease things out you know like in hindsight when you look backwards people probably did have some of the either typical or atypical GERD symptoms that we've already talked about. They just ignored them or didn't realize what they were or they weren't so bothersome that they decided to go in and seek care. But really a lot of times silent GERD is just that. Like people really have no symptoms at all whatsoever but there are abnormal number of reflux episodes that are happening.
Interviewer: Another indication you might have it that could surprise some people is when you go to your dentist and they say "Do you think you have acid reflux?" And I'm like "Why?" "Because we can see these pits in your teeth that indicate that perhaps acid is coming into your mouth." How often do patients come into you after they've been to their dentist?
Dr. Stout: Honestly not super often but I have definitely had that more than a handful of times you know happen. "My dentist thinks that I have acid reflux" you know and then you start to ask them more questions and you agree either by what they're saying or maybe they are having silent reflux you know and have no symptoms. And then that's when I kind of start to recommend more testing like endoscopy or these little reflux monitoring probe placements to definitively say yes or no you do or don't have acid.
Consequences of Untreated GERD
Interviewer: You know of all of the kind of . . . I don't know if GERD's typically referred to as a disease or condition or what but I've done these podcasts for a long time and a lot of times one of the questions I ask is you know ultimately if somebody doesn't do something about this condition you know what's going to be the outcome? And I feel like not doing something about GERD is one of the more serious things you should actually do something about because the down-the-road ramifications don't sound fun.
Dr. Stout: Yeah. And I mean a lot of people will live and die with GERD that's not been adequately treated and they'll do okay you know. But I mean having strictures and not being able to eat or getting esophageal cancer I mean those are very very serious dreaded complications of the disease and can vary . . .
Interviewer: Or losing your voice. Like that's the thing . . .
Dr. Stout: Or losing your voice. . .
Interviewer: . . . that I don't want to ever have happen to me.
Dr. Stout: You would be in trouble right? I think my husband would be super excited if that happened to me. But yeah I mean all those things are really serious and can be prevented I think. So it is definitely worth treating and not ignoring.
Managing GERD
Interviewer: When it comes to managing acid reflux I understand lifestyle has a lot to do with it. Can you talk a little bit about lifestyle modifications to help manage symptoms?
Dr. Stout: So this is always huge for me in clinic. You know I always try to talk to patients first about lifestyle modifications and hey just like really take a deep dive. Look at what you're doing on a day-to-day basis that you have control over. Unfortunately we as humans we like to do what we like to do and we don't like to change things that we enjoy. And so it ends up being a conversation that's actually quite a bit more difficult for people to implement once they go back out of my office you know. But I like to think that I have these like wonderful motivating conversations with people.
So one of the things like dear god I hope that nobody is still smoking but unfortunately people are smoking and we know that this increases your risk of having reflux episodes. Booze it seems like also increases the like number of lower esophageal sphincter that little valve at the bottom of the esophagus increases the amount of times that that opens up. Also it seems like citrus foods tomato-based foods really like fatty foods carbonated beverages chocolates and unfortunately things like coffee which you know I really really