Dialogue on Heartburn -- John Bryant Wyman, MD and Chandra Prakash, MD, MRCP -- 05/22/01

WebMD Live Events Transcript

The opinions expressed herein are those of the guest's alone. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Welcome to WebMD Live. Our guests today are Dr. John B. Wyman and Dr. Chandra Prakash of the American Gastroenterological Association (AGA). You may ask a question at any time.

Moderator: Welcome to WebMD Live, Dr. Wyman and Dr. Prakash. How are you today?

Prakash: Doing well, thank you.

Wyman: Doing good, thank you.

Moderator: Before we begin taking questions, can you each please tell everyone a little bit about your background and area of expertise?

Prakash: I am a gastroenterologist. I am based in St. Louis. I am a faculty member at the Washington University School of Medicine. I am an assistant professor of medicine. I see a lot of patients with GERD in my practice.

Wyman: I am John Wyman. I am at the University of Wisconsin, a professor of medicine. My interest is in motility gastrointestinal disorders.

Moderator: Let's get started with our member questions.

johnsmom2_webmd: How do you feel about the use of Reglan in children, and do the effects of this medication outweigh the possible side effects?

Prakash: I am not a pediatrician, I only see adult patients, and I do not use Reglan very often at all.

mikecons_webmd: I'm 23 and have heartburn. Is it normal to have it at such a young age?

Prakash: It is not uncommon to see heartburn in young individuals. If your heartburn is constant or regular or several times a week you probably need to be evaluated and treated. On the other hand, if you only have it very occasionally you will probably be all right taking over-the-counter medication or antacids.

Wyman: I draw the line if a person has heartburn 3 or more times per week. Then I begin more formal treatment.

rollwitz35_msn: I have a question about acid reflux. I have been told by a doctor that I have "slight" reflux, but now and then I wake up in the middle of the night with acid coming up in my throat and even in my nose. Is there any treatment for this?

Prakash: It seems like you do have reflux disease, and what we in general do for patients with symptoms of reflux is to give you medicines to decrease the production of acid in your stomach. Now, if you only have the symptoms at night, sometimes it is useful to elevate the head end of your bed on blocks or bricks about four inches thick when you sleep at night. Some of the other measures that are recommended include trying to lose weight and avoiding fatty foods, alcohol, smoking, et cetera.

Wyman: I would stress to not eat or drink anything within three hours of lying down. That alone may prevent the symptoms from occurring. I urge you to see your doctor because nighttime reflux is thought to be the most dangerous in causing chronic complications in the esophagus.

Moderator: Why is nighttime reflux more serious than daytime reflux?

Prakash: When a person is recumbent, the affects of gravity are eliminated so the acid tends to hang around the swallowing tube for a longer time, hence exposing the patient to a higher likelihood of complications.

Wyman: The complication is chronic inflammation of the lining of the esophagus caused by the acid that is in contact with the lining for hours when one is recumbent. The complications are stricturing, which is scaring of the esophagus, which can cause obstruction, ulceration of the esophagus that can result in hemorrhage, and the formation of an abnormal lining of the esophagus that can become cancerous.

Moderator: Member question: I can't eat or keep down fried food or sometimes things like baked potato w/butter. I'm taking Pepcid AC all the time if I want to eat in a restaurant. It's expensive! Help me, please.

Dr. Prakash: It is well known that foods are that are rich in fat tend to cause relaxation of a little valve at the junction of the swallowing tube and stomach. That is why we recommend patients with reflux disease to decrease their intake of fat-rich foods.If over-the-counter medications alone do not control regular or constant symptoms, then your doctor can prescribe a stronger medicine to decrease acid in your stomach, which might help you.

Wyman: Another complication of fatty foods is that they are retained in the stomach for a much longer period of time than are carbohydrates and protein. Reflux occurs more often when the stomach has food in it than when it's empty.



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