and good evening.

Thank you so much for watching HealthLine tonight.

>> I'm Mark Evans here on PBS Fort Wayne.

We'll be talking about Gerd Gerd is the word.

We'll find out what that is and all the other aspects surrounding that.

We have a very special guest his first time on HealthLine.

His name is Dr. Jeremy Wilson and he is a general surgeon.

Great to have you here.

Well, thanks, Mark.

Thank you.

And I know that they probably had to twist your arm a little bit to get you here tiny, tiny bit.

>> I see that you're wearing some colors tonight.

I'm a Purdue grad and the they have an important road game tonight.

>> Oh yes.

And who are they playing?

Michigan.

Michigan.

OK, and of course we record the show we'll be playing it back on PBS for Wayne several times.

So when you hear that we're talking about the big event this evening.

>> So anyway we were talking about GERD and before we get into that and what that is, you are a general surgeo.

>> I always like to talk about some of the the I don't know the qualifications, you know, and also some of the education that you've had.

>> But can you tell us what a general surgeon does and then probably one does he's a general surgeon but what does that encompass?

>> Well, general surgery, you know, for the most part deals with a lot of I always tell folks soft and squishy things.

Oh, so intestines, some cancers, soft tissue tumor skin cancers, those sorts of things.

It's brain or hard like a bone that's probably not going to be us but OK. >> And you've discussed in the greenroom before the show started that you do a lot of and I do a lot of endoscopy as well.

>> You I wanted to come back to a smaller area, you know, in India and I grew up in Indiana and just outside of Marion and just kind of drawn to that area that patient population.

>> And one of the things that's needed in those areas is somebody to do the endoscopy is the screening.

>> Colonoscopy is the you know, the upper endoscopy for the folks with, you know, potential complications GERD So I was looking for residency program that was very strong in endoscopy.

So I get, you know, a fair amount of experience and be able to hit the ground running when I get to get into practice and I'm sure because of your particular area of specialty that you're quite busy so.

>> All right.

Well, we're going to give you a little break tonight but we're going to talk about what you do, OK, instead of having to do it.

>> You're not in scrubs right now so let's go ahead.

What is g e r d that's an acronym stands for Gastroesophageal Reflux Disease and with it being such a long thing it's nice to break it down into the little Yeah.

Acronym like that.

No wonder they call it Yeah OK yeah.

>> You know typically the classic definition is you know reflux of gastric contents up into the esophagus two or more times a week you classify them as having GERD are we finding people are getting that more often these days or has it always been around?

>> We just didn't know what it was.

>> You know, it's been around.

I think that some things that we're seeing more of now, you know, from our lifestyles and those sort of things maybe increase the prevalence of GERD ways to test for it and things like that.

>> You know, folks are a little more focused on those sorts of things.

Now to one of the complications and it's a rare complications.

>> I don't want folks to think that oh my gosh, I got girds something I'm going to get this right.

It's a very rare complication but it's adenocarcinoma of the esophagus and most cancers through the screening programs and those sorts of things we're seeing the incidence go down.

One that we're actually seeing kind of on the rise is the adenocarcinoma of the esophagus which is, you know, a potential complication of GERD.

>> OK, and by the way, we are taking phone calls tonight as we always do.

>> The number is on your screen at 866- (969) to seven to zero.

>> If you're a local you could drop that area code if you'd like.

We give us a call if you have any questions regarding GERD gastro esophageal reflex disease and that's probably the only time I'm going to say that during the entire show.

>> OK, I'm lucky I got through that without messing up your grade so we understand what GERD is but how common is it and what are the risk factors super common as you mentioned.

>> You know, I mean almost everybody experiences at some point some heartburn.

>> That's kind of the classic symptom.

Two main things you're talking about are going to be the heartburn or cirrhosis if you want a fancy name for it and then that regurgitation you know you don't have to have both but those are the two kind of classic symptoms for GERD.

>> OK, And it's not just restricted to adults, is it?

>> You know, kids and surprisingly even infants can suffer with GERD.

There are a lot less likely to complain of it because they-donn exactly.

>> But I do remember in residency, you know, a lot of times especially premature infants for some reason are predisposed to having gerd issues.

>> So that's interesting.

So what are the symptoms?

How do you know that you've got to get something done?

>> The main things like we said are going to be that that burning sensation, some of the regurgitation, some of the more atypical type of symptoms can be even chest pain.

Sometimes the pain can mimic heart attack because you get that spasm in the esophagus.

>> People can if the reflux is bad enough and comes up high enough can actually cause issues with throat.->> Can I gee throat?

Well, that that sensation of a lump in the throat certainly but more so chronic cough voice changes always was hoarse voice always having to clear the throat.

Those can be signs of gerd gerd gerd can exacerbate some other underlying things like asthma things.

>> You know I think it's up that high.

Yeah.

And I did some research as I always do before the show and said more than 60 million American adults have heartburn at least once a month.

>> Probably have it a couple times because I love spicy foods but more than 15 million adults have heartburn every day.

Yeah, including many pregnant women.

>> Now why would pregnant women have so much heartburn that just has to do with physics.

You know, as the fetus grows in the uterus, the uterus starts pushing up.

There's only so much room in there and it can push the stomach up if there's a lot of contents in the stomach it's pgot to go somewhere in fluids going to be pushed up.

>> I see.

Well, that makes sense and you're right.

It seems like it is a physical thing.

>> We have a call coming in on line five now sometimes doctor voices on the air, OK?

>> They're shy.

You know there's people who don't mind going on the air and there are some people who do but we actually take calls and we read those off of our teleprompter and I'm going to let you know that Baze called and is acid reflux reflux reflux rather as what it says a cousin to GERD and it's reflux.

>> Yeah, reflux.

It's basically just a synonym you know, to me it means the same thing.

>> OK, that's you know people want to get technical I guess the acid part of it more is going to be that pyrolysis, that burning sensation GERD encompasses not only that but then the regurgitation as well.

>> But they're almost interchangeable then the same thing.

>> OK, and then and we were talking about the the symptoms.

>> How serious can this be?

I mean are there some situations where it can get to really bad?

>> Oh absolutely.

Absolutely.

Like I mentioned, you know, people forever are going into the emergency rooms with chest pain.

>> Mm.

It's not their heart.

It's really bad.

GRD causes esophageal spasm you know chronic long standing gerd can cause narrowings in the esophagus .

>> Food gets stuck quite often we get called in then to go do an endoscopy and we'll get that food bolus out mentioned you know briefly the adenocarcinoma of the esophagus that would be an extreme case.

>> There is a precursor state to that something called Barrett's esophagus where the lining at the bottom of the esophagus starts to change to one that's a bit more acid resistant and you think, well, that sounds like a great idea.

>> Problem is the potential for it to progress to a cancer.

OK, so it can get out of hand.

>> Yes.

And it can cause a lot of damage if it's not treated correct.

>> Now we're going to talk about the surgical procedures here in just a minute because you are the general surgeon but there are some non-surgical options, aren't there?

>> Right.

At least you try those first.

Yeah.

And you know, by the time they get to us as surgeons most of the time they've gone through the list of medical treatments be that with the over the counter medications and acids, things like that.

Now a lot of the H2 blockers, histamine blockers and proton pump inhibitors you can even get over the counter.

>> You've seen their primary care doctor.

They may, you know, see the gastroenterologist or something done the you know, traditional is when you first come in you don't have any of those dangerous symptoms where, you know, painful swallowing or you know, things getting stuck especially if that's coupled with weight loss.

>> Those folks need to go straight for endoscopy.

But if you're not having any of those sort of dangerous symptoms, then the traditional treatment algorithm is to go with the lower dose of the proton pump inhibitors for a couple of weeks.

If that works fantastic.

If not, then you go to standard dose if that doesn't work and that's when we start talking about endoscopy to see if there's damage, you know, esophagitis or the Barrett's esophagus, you know, ulcers or things of that nature.

>> Not to be morbid but can Gerd kill you if it's not controlled adenocarcinoma of the esophagus?

Certainly.

>> You know, that's one of those things.

Like I said, it's not most people just have routine benign run of the mill gerd.

>> It's a nuisance.

It's a hassle.

It can interfere with your everyday life very, very, very few people are actually going to get cancer from it.

But yeah, it can it can happen.

It can happen.

>> OK, well you got to have to get this taken care of telephone numbers on your screen 866- (969) 27 two zero.

>> We're talking to Dr. Jeremy Wilson, a general surgeon about gastro esophageal reflux disease also known as GERD.

>> So you know, I found out too that there are some medications that can aggravate the symptoms of GERD.

>> Would you talk about that?

>> There's medications there's just some some lifestyle things we always tell folks if you if you're a GERD sufferer one avoid smoking, want to keep your weight healthy.

>> The classic triggers like you mentioned spicy foods, other things caffeie, carbonated beverages.

A lot of folks have trouble with tomato based stuff.

Then we start talking about some of the medicines that can make things things worse over the counter things like the ibuprofen Advil leave Naprosyn aspirin they can make good words that can give you ulcers.

Some of the blood pressure medications can actually lower the tone at the bottom of the esophagus and can exacerbate your problems.

>> Oh wow.

I didn't think about that because I am on a VP medication myself.

Not all of them do it but some of them can OK, well keep an eye on that then.

>> You mentioned the pain relief pain relievers.

It could be what we call it a double edged sword if you if you got GERD and you say I think I'm going to take some Tylenol or some ibuprofen or something a pain reliever I mean that could actually aggravate it.

>> Can't Tylenol not so much but ibuprofen certainly can.

>> All right.

And that's something to and that's another subject that even my physicians have said take the medication that starts the tea and yeah.

Yeah.

And don't take the other one.

Yeah.

All right.

We have another call coming in and it's Paul and he's asking to stay offline but Paul will be more than happy to read your question Paul is asking is is coffee OK for someone with GERD and is there a special diet I should stick to good questions .

>> Right.

Coffee is one of those things where you know, goes back to caffeinated and caffeine can worsen reflux symptoms.

What I tell patients is if you can drink coffee and it doesn't bother you, OK, OK, but not everybody can tell folks to to stay away from those classic triggers caffeine, carbonation, chocolate mint spicy foods and any personal triggers.

>> You know somebody might say if I have onions I have terrible reflux tonight and stay away from the that Bob that's more or less say this whole thing is an individualized things not very much the same symptoms aren't going to show up in everyone.

>> What you describe is heartburn somebody else may describe as something else.

So yeah, the symptoms are going to be individualized a lot of times treatment plans are going to be individualized.

>> There's some base work that you do but then you kind of gauge based off a patient response and either add something or delete something or change to a different medicine or take it in a different time.

>> OK, so change the schedule on that a little.

>> All right.

So we've talked about the medications when as as a surgeon and first of all before they come to a surgeon, who are they going to see besides their family doctor or will there be anybody else in between?

You know, like I said, I do a lot of endoscopy and so that's typically the point where I'll pick up a patient, you know, because they've tried over the counter medications.

>> They've tried, you know, the usual treatments through their primary care and they're just not working.

>> And then we start to look for the complications of the Barrett's esophagus, the ulcers strictures get a gauge on hiatal hernia which can make reflux symptoms certainly worse.

>> Now what is that hiatal hernia?

Basically what happens is that there's what's called the diaphragm which separates the chest cavity from the abdominal cavity.

>> Well, there are things that start up here that need to get down there, one of them being the esophagus.

>> So there has to be an opening in that diaphragm for the esophagus to get through to attach to the stomach.

That's called the diaphragmatic hiatus.

Then I eedle hernia happens when part of the stomach or something else herniate threw that up into the chest and say again like we were talking about physics fluids going to follow physics.

It's going to go from high pressure inside the abdomen to low pressure inside the chest and so it's just going exacerbate and make things easier for things to come up, exacerbate any symptoms depending on what else if anything else is in there could even, you know, become painful stomach can rotate on itself and you know, there's something else I want to ask you about if I can find real quick here let's see there was about how people can keep food in their stomach longer than others delayed empty stomach.

>> What's that called?

That's called gastroparesis k basically the stomach is paralyzed or you know, not functioning as you said normally should.

>> There are certain things that are predispose somebody to gastroparesis diabetes being one the main culprits.

Interesting.

And even some of these newer diabetic medications like unpicks and things in that nature will actually almost induce a gastroparesis and that's kind of how they help you lose weight because you feel full all the time your stomach doesn't empty.

>> Well yeah.

Yeah.

Is that common gastroparesis.

>> Yeah, I think it's more common than what we realize.

You know there are a lot of times we'll see somebody for GERD and we'll end up scoping them and there's you know, the traditional you don't have any solid foods for eight hours before the procedure no liquids for six hours before the procedure.

We get the go down in the stomach.

>> We still they are there.

Yeah.

Wow.

And that's not necessarily a materialistic thing now that's just the you know, sometimes the innovation to the stomach that causes it to squeeze and propel contents.

>> Sometimes it's a medication side effect.

OK, all right.

That makes sense.

All right.

We have another call coming in but before we get to that as we're loading that question up, I want to ask him we've talked about the medications and non-surgical types of procedures that we can at least try and how successful are those?

>> You know, we mentioned the groundwork that needs to be laid to treat GERD.

>> Yeah.

And it's just like building a house if you build a house on a poor foundation it's not going to stand long.

I say you're going to build that solid foundation and that's, you know, exercise avoiding those triggers, keeping your weight healthy.

>> Then you start adding to that the medications and I see yeah.

You got to get what you call a baseline and figure out and go from there.

>> Yeah.

So it's not going to be in some cases many cases it's not going to be an overnight cure overnight change in most cases in almost all cases it's not even with the medications it's going to if you have an erosion in the esophagus or something going to take that several weeks for it to heal so you're not going to notice a dramatic symptom relief with the first dose of medicine.

>> All right.

Before we get into the surgical procedures, Mr. General Surgeon, we're going to go ahead and talk to Rose here.

>> Rose is asking a question.

She said she's I had am our visit due to I guess a morning E.R.

and due to esophageal spasms and was this because of GERD and will any of the medication to treat this give me worse acid reflux know those esophageal spasms certainly can be related to reflux.

Interestingly, they respond to the nitroglycerin just like chest pain would because you know that the esophagus is just a tube of muscle and it's spasms down.

Nitroglycerin is going to allow that to relax.

>> OK, so you know medications for the spasm.

>> It's going to depend like I said, certain medications that are classically used for blood pressure treatment can also relax the esophagus spasms but in the process could potentially worsen good symptoms.

>> OK, well that kind of that makes sense actually essentially laid it out that way.

>> All right.

Well, let's get into the fact that you go through all the medication, you try these various things and of course the last thing anybody wants to do is have surgery but in some cases you have to do it.

So what are we talking about?

>> Their surgery usually is reserved for the worst of the worst.

Like you said, they failed lifestyle modifications.

This failed the the over the counter medications.

They failed prescription medications or they have some of these other complications, you know, be that a baratz or you know, early stage cancer, those sorts of things.

>> There are different procedures that can be done to help with GERD symptoms.

>> Some less than surgical will say OK, there's a procedure called a tiff which is a trans oral incision was fundoplication which is done endoscopically where they go in through the mouth into the stomach and all of these procedures are designed to increase the pressure at the bottom of the esophagus, you know where it meets the stomach .

The idea is to have a high pressure zone, make it harder for things to come up so fundoplication involves actually taking the top of the stomach and wrapping it around the bottom of the esophagus and suturing that in place.

>> So that could be done with this type procedure which is the endoscopic one where it can be done surgically.

>> There's a newer one that actually is a magnet that can be implant, is that right?

>> Yeah.

Now explain that that's fascinating.

Magnetic augmentation of the sphincter there and it's just a ring of magnets that they put around and it causes that area to almost narrow off.

>> It's not one that you're going to see, you know, being performed a lot in a community hospital.

>> You know this is going to be one that's done more in university centers and this is one of the more serious cases.

>> Almost all of these procedures are reserved for the absolute worst of the worst because the procedures by themselves aren't benign.

There are complications that can come from procedures.

You know, any surgery is going to have complications but with the reflux procedures especially there's what was called bloat syndrome where you actually lose the ability to Belgya vomit so you can eat and then you just blow it up, feel miserable and also a fair amount of failure with some of the surgeries.

You know, up to a third of people can be back on medications within a year.

>> Oh, well, after an anti reflux surgery.

So it has to be done in the right person at the right time.

At the right time.

Yeah.

And there are there are other tests that need to be done before you go to a surgery, you know the probes and many trees and things like that to see if you're a good candidate for any of the anti reflux surgeries know that makes a lot of sense.

>> All right.

We have another question coming in.

>> Let's see.

I think it was just a tag on to a Nancys question before.

>> So this is actually a question that I was going to ask you, Doctor, is is when should you go to the doctor with these concerns?

>> Any time you have chest pain, you know, be it cardiac be good chest pain you don't play around with you get into the emergency room right away.

>> Yeah.

You know other things specific things would be, you know, mentioned trouble swallowing, painful swallowing, you know, especially if that's coupled with some unintended weight loss.

>> You need to be seen right away.

Get that looked at you know, be that through upper endoscopy or an upper GI X-ray because those are some of the warnings that you could have a stricture or in a worst case esophageal cancer.

>> Well, and you said you need to be seen right away so that you don't jump the gun.

>> I mean, for instance, if you were on a new diet and for some reason that particular food is causing or some of those foods in a new diet plan or causing these issues.

Right.

So I guess the first thing you need to do is actually go to your family physician, say I'm having these issues.

>> Yes.

And then I guess of course sort it out from there, figure out what your what your food intake is.

>> Does stress have anything to do with this?

>> There are some there are different triggers for acid production and one of them is what's called the autonomic nervous system and that can be shipped off I guess by stress so that everybody thinks, oh, you know, I'm stressed out so I'm going to get ulcers.

>> Yeah, probably not.

But I grew up with that.

>> You don't get too stressed out because it causes a going to get an ulcer.

True, right.

You know we found over the years one of the main culprits for ulcer development is actually a bacteria that can grow in the stomach.

>> Up until we learned about that, people were having surgery all the time for ulcers because they couldn't treated you give them medicine but had just come back.

>> We found this bacteria and so now we treat that bacteria eradicate it and where does that bacteria come from?

>> It's just it's in the environment.

People just pick it up so and then mentioned also, you know, the non-store Atlantean Sematary medications, ibuprofen, aspirin, Advil those things are also some of the main culprits for ulcerative I guess so.

>> So you go through all that and go to the doctor and of course they're saying well you know, there's not a whole lot I can do for you.

I'm going to have to send you to get a scope done.

Of course that would be the role you play and then if anything else in addition to that after the scope you would also in some cases most cases take care of that as well.

>> I personally don't do and to reflux surgery I did back in training but an acid reflux surgery is one of those things where if you don't do a lot of it you shouldn't do anything.

OK, all right.

You know, for those reasons that we mentioned, you wrap the stomach around the bottom of the esophagus be wrapped too tight then you get the gas blowed if you wrap to loose symptoms come back so you need somebody that does a lot.

>> All right.

Well, listen, this has been very, very educational and we appreciate all the phone calls from the viewers as well as why we do the show.

It's what we do so and I don't think we've ever talked about GERD on this program so I'm glad we had this chance and I would like to have you come back some other time.

>> We'll talk about some other issues.

I'd be glad to do a little encounter.

Hopefully not but if they do, we know how to take care.

>> All right.

All right.

Dr. Jeremy Wilson, general surgeon talking to us tonight.

>> Listen, we'll be back next week with another very educational very informative show.

So please join us seven thirty on Tuesday night.

Until then, you can always watch us with a special note this another episodes on YouTube until next time.

>> Good night and good