Gastroesophageal Reflux Disease
Guest: Dr. Donald Castel – Gastroenterology-Hepatology
Host: Dr. Linda Austin – Psychiatry
Dr. Linda Austin: I am Dr. Linda Austin. I am interviewing Dr. Donald Castel who is director of the Esophageal Disorders programs at the Digestive Disease Center here at MUSC. Dr. Castel, you have done a lot of research on a subject that people call GERD. What do those letters stand for?
Dr. Donald Castel: The acronym, GERD, stands for gastroesophageal reflux disease, but it has become very popular for people to just talk about their GERD and their GERD symptoms, or their acid reflux.
Dr. Linda Austin: What are the symptoms of acid reflux?
Dr. Donald Castel: The classic one is heartburn, or a burning sensation behind the breast bone or the sternum often accompanied by a feeling of regurgitation of food or liquid, the burning may go up into the throat area, so, heartburn, regurgitation, acid reflux.
Dr. Linda Austin: Are there certain characteristics of people who are more likely to get GERD, age, for example, or other risk factors?
Dr. Donald Castel: Because GERD tends to be chronic once it starts, it becomes, therefore, more common in older patients, that is, they have more years to accumulate it. So, the elderly patient, patients with hiatal hernias are more likely to have this problem. There is a tremendous amount of interest right now in the relationship between obesity and GERD. There seems to be a direct relationship.
Dr. Linda Austin: Are there any health habits that predispose to GERD?
Dr. Donald Castel: There has been a lot written on that, including many of the things we have done over the years. But, yes, smoking, high fatty foods, large volume meals, lying down too soon after eating, these are some of the factors that we know contribute to the symptoms and the development of GERD.
Dr. Linda Austin: Now, let’s shift focus a little bit and talk about your research on this very common problem. What tact have you taken in exploring GERD?
Dr. Donald Castel: Over the last 10 years or so, what we have noticed is that many patients, despite good treatment, that is, treatment to control their stomach acid content, are still having symptoms, we call those treatment failures, so, persistent symptoms despite adequate acid control has generated a lot of interest in just the last few years. What we have discovered, much of this work done here at MUSC, is that this is due to ongoing reflux but without the acid component.
Dr. Linda Austin: So, it is not an acidic reflux then, but it is a reflux nonetheless?
Dr. Donald Castel: Indeed. We call that nonacid reflux. The simple story would be that reflux occurs when you fill your stomach, and the more you fill it, the worse the reflux, that is, the larger the meal, the greater the likelihood for reflux. It occurs when you have a full stomach because the valve at the top of your stomach is incompetent, and that is simply what reflux is. Whether or not the contents of the stomach has acid or not, you are still going to reflux if your valve is incompetent.
Dr. Linda Austin: If it is non-acidic, can that cause symptoms? Is it painful, and can it damage the esophagus?
Dr. Donald Castel: Well, those are actually a group of questions, all of which are important. If you take away the acid content, then the reflux is much less likely to cause injury. We call that esophagitis or inflammation of the esophagus. But, when the reflux occurs, whether or not it has acid, the patient can feel it often. So, symptoms may continue but healing of the esophagitis may occur.
Dr. Linda Austin: Are there any long term consequences to that, such as predisposing to cancer of the esophagus, for example?
Dr. Donald Castel: Yes, the major reason that there is so much interest in GERD is that it is generally recognized that it can lead to a premalignant condition that we call Beret’s esophagus. Many patients these days, because they go to the internet and learn a lot about these things, know what Beret’s esophagus implies, if not what it is. So, chronic reflux, particularly the acid exposure early on, can lead to this condition called Beret’s esophagus, and that is a premalignant change.
Dr. Linda Austin: So, if a patient, then, is taking an antacid and they are having non-acidic reflux, what is the treatment for that?
Dr. Donald Castel: That pretty much defines many of the patients that we get referred to us here at MUSC, so, symptoms despite good acid control with antacids or other medications. The treatment is aimed at doing something to actually reduce or stop the reflux. There are some medications that can be used. We are actually doing research at the present time with some endoscopic approaches to try to control that reflux. Some of these patients, we send to the surgeons to actually do a surgical procedure to stop the reflux.
Dr. Linda Austin: Do you have any active clinical trials going on now?
Dr. Donald Castel: We do, in fact. One of the major ones is with a new endoscopic procedure to stop the reflux. We also have some studies going with some new medications.
Dr. Linda Austin: So, that might be very helpful for people to participate in for their own benefit, to get new treatments and to help others, as you get data back from those trials?
Dr. Donald Castel: Oh, absolutely. Yes, we would be extremely interested in seeing patients that suffer from ongoing reflux symptoms.
Dr. Linda Austin: So, if somebody were interested in participating in a clinical trial, then whom would they call?
Dr. Donald Castel: The easiest thing to do would be just to call essentially anybody at the Digestive Disease Center. Certainly, they could call my secretary, Louise, and she would be happy to get them in the right direction.
Dr. Linda Austin: So, we will give the number for the main MUSC call in reference number.
Dr. Donald Castel: Louise would appreciate that.
Dr. Linda Austin: I am sure she would. And, they could then direct interested people to your study. Dr. Castel, thank you very much.
Dr. Donald Castel: You are welcome.
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