Reflux1 Discussion with Dr. Foley
September 3, 2003
Note to our users:This interactive feature is in no way a substitute for the examination and advice of a physician. You are responsible for all actions you take after reading material on this site. Always seek the advice of a doctor for concerns about your health or a specific condition.
Reflux1: Dr. T. Raymond Foley is a partner in an established private practice in Lancaster, Pennsylvania.
Reflux1: Welcome to today's discussion with Dr. T. Raymond Foley of Lancaster, PA.
Reflux1: In addition to having his own practice, Dr. Foley has served on innumerable committees and advisory boards throughout the medical industry, from hospital advisory boards to insurance company committees to the Lancaster Board of the American Cancer Society.
Reflux1:He has also participated in and published research on clinical trials of new medical treatments for several years.
Reflux1: Dr. Foley, thank you for joining us today.
Reflux1:Users, thank you also for joining us. We welcome your questions for Dr. Foley!
Reflux1: Dr. Foley, why don't we start by having you tell us briefly how you got started in gastroenterology?
Dr. Foley: After my medical residency, I did three years in the public health service and then did my GI fellowship at Penn State Hershey Medical Center. I am been in private practice since then.
Reflux1: Great! We'll begin with some questions...
lilrowo: I have gerd and have been taking Prilosec off and on when needed for a flare up for the past few years. Now, it doesn't seem to be working. I've been taking it regularly for 3-4 weeks, and still have severe heartburn and belching. I also have "spasms" or fluttering that start in the upper part of my stomach and can be felt to my throat. It's hard to tell if it's heart palpitations or a digestion problem. I have had an EKG taken which was okay. Would changing medications help?
Dr. Foley: Increasing the dose of Prilosec, increasing the frequency of Prilosec or changing to a new medication could all help.
Bob: What less invasive treatment for reflux disease would you recommend for someone in their 30's?
Dr. Foley: Treatment for GERD, typically begins with life style modification and the use of antacids. If patients are still symptomatic, they are then usually treated with H2 blockers or proton pump inhibitors. Patients who respond well to medications could be candidates for endoscopic treatment of GERD or anti-reflux surgery.
JJones: I have recently been diagnosed with Barrett's esophagus and prescribed 40 milligrams per day of Nexium for one year or more. Is it safe to take this drug for that long?
Dr. Foley: Long term treatment with Nexium and other proton pump inhibitors appears to be quite safe.
schweetheart: I have reflux and asthma which I have had for several years. Lately when I take a sip of water at night and layback down it comes back up and chokes me. What could cause this?
Dr. Foley: You have regurgitatent symptoms which occurs when stomach contents reflux into the esophagus. This implies that your lower esophageal sphincter is too loose or relaxes too frequently.
SuperFudge: Is it true that caffeine aggravates acid reflux?
Dr. Foley: Yes. Foods that are associated with lessening the tone of the lower esophageal sphincter include caffeine, alcohol, tobacco products, chocolate and mints.
Bob: What's the best dietary advice you can give, to ensure that a paitent has a healthy digestive system?
Dr. Foley: From a reflux point of view, people should avoid the products mentioned above, should avoid eating late in the evening before lying down. From an overall digestive system point of view, a high fiber/low fat diet seems to be the healthiest.
Gina35: Is there a connection between fibromyalgia and GI diseases? It seems that a lot of people with fibromyalgia are prone to heartburn, etc. What is the connection if so?
Dr. Foley: I am not aware of a direct association between fibrolyalgia and heartburn, however, both diseases are quite common so it would not be unusual to find that people suffer from both illnesses.
Wanda: are there any medications that can aggravate GERD or cause it to worsen?
Dr. Foley: Medications that can aggravate GERD by diminishing lower esophageal sphincter pressure include calcium channel blockers and nitrates.
bosarge4: what is right bundle branch block
Dr. Foley: Right bundle branch block is a cardiac conduction system defect which is outside of my field of expertise.
schweetheart: Can Zelnorm for IBS also help your esophagus from constricting?
Dr. Foley: Zelnorm may potentially be useful in the treatment of GERD by increasing gastric emptying. Studies are underway.
RobbieD: Can Prilosec cause heart palpitations? I have heard of this happening and am curious.
Dr. Foley: I am not aware of Prilosec being associated with heart palpitations.
GERD guy: Will you be treating patients with Enteryx outside of clinical studies?
Dr. Foley: Yes, lower esophageal sphincter augmentation with Enteryx appears to be a safe, effective endoscopic treatment for GERD in patients whose symptoms are well controlled with medications.
DeAmor: I am a young woman diagnosed with acid reflux disease. At the time of my diagnosis I was also being treated for a small peptic ulcer. My doctor at the time instructed me to keep my weight down and to go off the birth control pill. The target weight that he suggested is very low for my high and I am concerned that is unhealthy. Also, did mean for me to stay off the pill forever or just until i completed treatment.
Dr. Foley: I am not aware of oral contraceptives being associated with ulcers or reflux. Obesity can make GERD worse and we recommend a body mass index of 25 or less.
dts: My father and my brother have peptic ulcer disease. Is this condition hereditary?
Dr. Foley: Rarely, peptic ulcer disease can be associated with hereditary syndromes. More commonly, ulcers are caused by medications (aspirin and other non-steroidal drugs) or a bacterial infection (Helicobacter Pylori).
HeathersMom: Are there any foods to eat that counterbalance the effects of H Pylori? I read a while ago that broccoli could potentially fight this - are there other foods that do the same?
Dr. Foley: Not that I am aware of.
Agent Bean: What should one do for a nervous stomach?
Dr. Foley: I am not sure what you mean by a "nervous stomach" but to see if your symptoms are related to acid it may be worth while to try an over the counter antacid (Mylanta, Maalox or Gaviscon) or an H2 blocker (Pepcid, Tagamet or Zantac).
schweetheart: If my lower esophageal sphincter is too, loose what can be done to correct it? On occasion I have to have a balloon procedure on my esophagus to widen it, are there any connections with the two?
Dr. Foley: Your GERD has been complicated by a peptic stricture requiring balloon dilatation. A stricture is a scar formed from acid-induced injury to the lower esophagus and this results in a fixed narrow area. A loose lower esophageal sphincter could be contributing to acid in the esophagus. These patients are usually treated with high dose proton pump inhibitors.
Bob: Would you ever expect endoscopic treatments to become more popular than drug therapy?
Dr. Foley: Endoscopic treatment of GERD with Enteryx injection is the procedure with which I am most familiar. In our study at twelve months approximately 70% of patients were off medications and another 10% had reduced their medications by 50% or more. I think that many people may find this an attractive alternative to daily medication.
Ted: Can Gaviscon (for gastro esophageal reflux disease) cause sores to develop in the mouth?
Dr. Foley: Not to my knowledge.
Marcia: What is chronic cholecystitis? I have heard of this and because I experience severe abdominal pain (with inability to burp or release the pressure), I wonder if I have this. Thank you.
Dr. Foley: Chronic cholecystitis is a pathologic diagnosis made after a gall bladder is removed surgically. It would seem unlikely that an inability to burp would be associated with a gall bladder problem.
SamBone: How do I tell the difference between a heart attack and heartburn?
Dr. Foley: Good question. Some people with GERD can experience severe chest pain which can mimic a heart attack and requires that an individual proceed to the emergency room to make sure it is not a heart attack. Once a cardiac cause has been excluded (non-cardiac chest pain) a large number of these patients will be found to have GERD and usually respond well to medical treatment.
Kay: Is the feeling that something is stuck in the throat a common symptom of reflux disease, or a sign of some other problem?
Dr. Foley: This symptom is called globus. Some patients have this secondary to reflux and it is reasonable to see if anti-reflux medications improve this,; however, most of the time, despite extensive investigation, an exact cause cannot be found.
curious: Are there any contraindications associated with taking 39mg Prevacid b.i.d. to protect the vocal chords in a GERD patient
Dr. Foley: No.
harriett10: Almost every time after eating, I seem to suffer from excess gas in my stomach and never feel completely comfortable. I feel heavy in the lower stomach almost all the time, which increases after eating something. Do you have any suggestions?
Dr. Foley: People who suffer from excess gas associated with eating almost always have a condition called aerophagia. These people swallow air either consciously or subconsciously. I would recommend eating slower, eating smaller volumes, avoiding carbonated beverages and a trial of over the counter anti-gas medications, which are variably effective.
Terry: what are the symptoms of an esophageal spasm?
Dr. Foley: Esophageal spasm is usually characterized by either chest pain or difficulty swallowing solids and liquids.
Bob: what is your view on alternative therapies for GI disorders?
Dr. Foley: I am not sure what you mean by "alternative therapies for GI disorders" but if you are referring to the newer endoscopic treatments of GERD I would limit my comments to treatment with Enteryx, the procedure with which I am most familiar. It seems to be safe and effective but I think its exact role is yet to be determined.
Reflux1:We're just about out of time. Dr. Foley, do you have any closing thoughts on GI health for our users? Or any tips on attaining reflux relief?
Dr. Foley: From a GERD point of view, we recommend normalizing weight, avoiding alcohol, caffeine, chocolate, mints and tobacco, not eating before reclining and the use of over-the-counter medications. If your symptoms do not respond to these measures, you should see your physician. If your symptoms are well controlled on proton pump inhibitors and you would like to consider discontinuing the medications, then you could be a candidate for endoscopic treatment or anti-reflux surgery. For those of you over 50, don't forget to talk to your doctor about colon cancer screening. Thank you.
Reflux1: Thank you, Dr. Foley, for joining us today and sharing your knowledge with us. Users, thank you for joining us as well. Stay tuned for upcoming Body1 discussions!