GERD Treatment
Gastroesophageal reflux (GERD) happens when acids from the stomach come back up into your esophagus, causing an unpleasant burning sensation in the chest, voice box, throat, and mouth. Acid reflux is such a common problem that you would think it is easy to spot and treat – but sometimes it is not. Having a team of experts who understand the pain and difficulty you are in and who can support you without judgment is vital to finding relief and effectively treating GERD. The Penn Medicine Becker ENT & Allergy Center offers a state-of-the-art fiberoptic evaluation of your nose and sinuses to get to the bottom of the issue and develop a personalized treatment plan.
What is GERD?
The backflow of stomach juices, including acids and occasionally ingested foods, constitutes gastroesophageal reflux disease or GERD.
GERD symptoms
Common esophageal symptoms of GERD include repeated bouts of heartburn, difficulty swallowing, hoarseness, lump-in-the-throat sensation, chronic cough and throat clearing, and mucus build-up in the throat. People can suffer from one or more of these symptoms.
What is the the relationship between GERD and sinusitis?
Sometimes, the symptoms of GERD can mimic some of the symptoms of sinusitis. The sensation of post nasal draining and the need to clear your throat constantly may be due to post nasal drip — but may also be due to GERD. The sinus specialist may therefore examine you in the office to see if there is physical evidence of GERD. Learn more about our ENT and sinus Specialist here.
When Acid reflux symptoms occur, they can sometimes actually contribute to sinusitis! That is to say, the acid can travel all the way up to your nose and sinuses (for instance, while you are lying down asleep), and this acid can inflame the nose and irritate the lining. This problem is more common in children — but it may also be seen in adults.
What causes GERD?
How do you diagnose GERD?
Are there any diagnostic tests?
How is GERD managed?
There is a one-way valve near the top of the stomach, this is because, ideally, things should go from the esophagus into the stomach and not the other way around. Stomach acid can escape through a weakened valve and travel up the esophagus — even up to the voice box and throat — and produce the symptoms listed above.
Heartburn is easily recognized by the family doctor. However, some of the symptoms relating to the throat and voice box should be evaluated by a specialist. The specialist will then perform a complete examination, including taking a look at the voice box with a small endoscope placed through the nose. If you have GERD, your sinus specialist may ask you to also see a gastroenterologist.
To evaluate GERD, additional tests may be ordered by a gastroenterologist, such as a Barium swallow to monitor dye as it moves through the stomach, a PH monitoring test to record 24-hour acid reflux, and Endoscopy to check for esophageal damage and stomach irritation or ulceration.
Laryngopharyngeal reflux (LPR) is a type of GERD that causes stomach acid to travel up into the throat, larynx, and pharynx. This acid can cause sore throat, hoarseness, coughing, and difficulty swallowing. Treatment includes dietary changes, medication, and surgery. Consult with a doctor to find the best plan. Relief from GERD can be achieved through lifestyle changes, medical treatment, or surgery.
Lifestyle and dietary changes
Don’t drink alcohol, and don’t smoke. Both nicotine and alcohol irritate the stomach and increase acid production. Also,
- Avoid clothing that is tight around the waist — corsets, belts.
- Avoid bending over.
- Lose weight.
Raise your head when lying down. This is best achieved NOT with pillows but by raising the head of the bed by 6 to 8 inches. This can be done by sliding blocks under the legs at the head of the bed or a wedge under the head of the mattress.
Dietary modifications
You may wish to avoid coffee and tea, carbonated beverages, alcohol, fatty fried foods, spicy food, citrus fruits and juices, tomato juice, orange juice, grapefruit juice, tomatoes, onions, peppermint, spearmint, chocolate, cheeses, and eggs.
Avoid large meals, especially in the evenings. Do not lie down right after eating. Allow three to four hours after supper and lying down. Make the mid-day meal the heavier meal of the day and eat small, well-balanced meals.
Medical treatment for GERD
Medical treatment for GERD aims to neutralize or reduce stomach acid and improve gastric emptying. Neutralization can be done using over-the-counter antacids like Sucralfate suspension, Maalox, and Ryopan. Acid reduction can be done with H-2 blockers, such as Cimetidine, Ranitidine, or Famotidine. Lower doses are also now available over-the-counter.
Antacids and H-2 blockers should be taken one hour apart as antacids may reduce the other drugs’ effectiveness. New drugs like Omeprazole (Prilosec) and Nexium completely stop stomach acid production. These drugs are generally prescribed for short-term use.
Improving gastric emptying can be undertaken by Cisapride, Metoclopramide, Bethanachol, Proton pump inhibitors (PPIs), and other drugs. These drugs increase the squeezing action of the esophagus and tighten the esophageal sphincter, in addition to making the stomach empty faster.
Why Choose Our Specialists?
- Dr. Daniel G. Becker, Founder and Medical Director of The Penn Medicine Becker ENT & Allergy Center, is a highly trained, board-certified specialist who graduated magna cum laude from Harvard College in 1986.
- Dr. Samuel S. Becker, Director of Rhinology at The Penn Medicine Becker ENT & Allergy Center, is a highly trained, board-certified specialist who graduated from Amherst College in 1991 and attended medical school at the University of California San Francisco.
- Dr. Kenneth Rosenstein is a highly trained, board certified otolaryngologist who attended medical school at Mcgill University, and completed his residency training at the prestigious New York Eye and Ear Infirmary.
- Dr. Naomi Gregory is a highly trained, board certified otolaryngologist who specializes in the diagnosis and treatment of diseases of the ear, nose, and throat. Dr. Gregory completed medical school at the Philadelphia College of Osteopathic Medicine in Philadelphia PA.
- Dr. Michael Lupa, MD is a highly trained, board certified otolaryngologist with additional training in sinus surgery and allergy treatment as well as advanced skull base surgery. He studied Biology at Tufts University and went on to complete medical school at Case Western University School of Medicine in Cleveland, Ohio.
- Dr. Robert Mignone is a highly trained, board-certified otolaryngologist-head and neck surgeon who attended medical school at New York College of Osteopathic Medicine.
- Dr. Aubrey McCullough is a highly trained otolaryngologist, facial plastic and head and neck surgeon who completed medical school at Midwestern University Arizona College of Osteopathic Medicine.
- Dr. Luke Kim is an otolaryngologist who specializes in the diagnosis, medical management, and surgical treatment of diseases of the ear, nose, and throat. Dr. Kim graduated with honors and with distinction from Cornell University and completed his medical studies at the Perelman School of Medicine at the University of Pennsylvania.
Surgical treatment of GERD
Surgery is a last option if diet and medication don’t ease GERD or the patient has difficulty following them. “Fundoplication” is a surgical procedure that wraps the stomach around the esophagus to reduce reflux. It’s better to opt for medical treatment if possible to control GERD.
Sinusitis is caused by viral or bacterial infections that lead to inflammation of the sinuses and blockage of the drainage pathways to the nasal passages. Symptoms include facial pain, headaches, nasal drainage, cough, postnasal drip, bad breath, and more. Even after treatment of a sinus infection, inflammation can persist even after treatment, leading to chronic sinusitis for weeks, months, or even years.
Chronic sinusitis affects approximately 35 million Americans each year, or 15% of the population. Sinusitis is more prevalent than arthritis or hypertension. Americans make 645,000 emergency department visits annually due to sinusitis. Chronic sinusitis resulted in approximately 13 to 18 million physician visits in 1994. The health impact of sinusitis on bodily pain, chest pain, and social functioning has been noted to be worse than that of congestive heart failure, angina, or back pain.
At The Penn Medicine Becker ENT & Allergy Center, physicians can do a fiberoptic evaluation of your nose and sinuses to pinpoint the problem and can show you the specific problem on a video screen. Treatment options vary and are personalized to your particular anatomy, history, and the nature of your problem. Recent technology has made these treatments more effective, safer, and more comfortable than ever before. GERD Telemedicine available now.
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