When it comes to acid reflux disease, time is the enemy. Over time GERD can progress, leading to a poor quality of life and several life threatening complications. However, as we note in our response below, there are several things to consider and many treatment options that can reduce the risk of disease progression over a lifetime.
I am 38-year-old male. Since the age of 18 I have experienced indigestion at least once a month. At the age of 30, I started having other GERD symptoms like heartburn and chest pain, and these were managed by antacids and home remedies. I had my first endoscopy in 2011 and found a mild hiatal hernia. In 2013, a doctor did the endoscopy again and I was then placed on triple therapy for H Pylori. After that I was told by a GP to take PPIs on a daily basis, which I continued for 8 months. With the articles posted by RefluxMD I decided to meet with a GERD expert and he asked me to stop my use of PPIs. He recommended that I only use them when I have symptoms, and not for more than 14 days.
I completely stopped drinking and smoking two years ago. For the past few years I have managed my GERD symptoms with the help of occasional use of PPIs (just few tablets will give me relief for few weeks) along with other home remedies. But I am worried about the progression of my GERD. With your articles and the scientific content I have read, I am worried about possible damage to my esophagus and throat. May I request you to answer my below questions?
- Do you suggest any medications or exercises for my hiatal hernia?
- I am aware PPIs have their own side-effects, but is it okay to use it on and off to reduce the intake of tablets, just to address the GERD symptoms? I find it difficult to manage the GERD symptoms without PPIs.
- At least two or three times I’ve had throat infections due to acid reflux. I am aware that my esophagus may have been damaged to a certain extent. Do you suggest any medicine, diet or therapy to re-tone the cells in my esophagus?
- What is your suggestion to stop the progress of my GERD?
I want to thank you for the excellent service you are providing through your website. I often suggest to my friends that they visit your website for useful information about GERD.
- Symptoms: regurgitation, chest pain
- Endoscopy diagnosis: YES
- GERD stage: Stage 3
- BMI: healthy (19 – 24)
Thank you for sharing your experience and for sending us your questions. You seem to be doing many things right: maintaining your BMI at a healthy level, endoscopy by a specialist, avoiding PPI use daily, ceasing smoking and the use of alcohol, and continuing to learn more about your disease. Your first symptoms started at 30, which is certainly earlier than most adults. Imagine the potential issues associated with taking PPIs for 50 years, the most common treatment plan today. What is the end game of this strategy for those with a long life ahead of them?
I understand your concern about disease progression, and the good news is that GERD is a slowly progressing disease. With appropriate monitoring, a specialist will be able to discover any progression and treat it in a timely manner to reduce your risks. Frequent regurgitation is an “alarm” symptom and you should consider a more frequent monitoring schedule, especially in light of the fact that you have several risk attributes: male, former smoker, and almost 10 years of acid reflux symptoms. If you are a “white male”, that is an additional risk factor. Also, since you have a hiatal hernia, research published in the Journal of Gastroenterology found that “the presence of hiatal hernia was associated with an increased risk of Barrett’s esophagus”, a pre-cancerous condition. All of these factors suggest more monitoring over your lifetime.
Hiatal hernia treatment options
Although there are several websites that encourage exercises to treat a hiatal hernia, RefluxMD is unaware of any research that supports this as a proven treatment alternative. Typically daily PPIs are recommended as the first line of defense for symptoms due to a hiatal hernia. However, adults with symptoms of frequent regurgitation typically have little or no success with PPI medications (John Pandolfino, MD, Hiatal Hernia and Treatment of Acid-Related Disorders). Research does support antireflux surgery as an effective treatment for GERD symptoms resulting from a hiatal hernia. The most common surgical treatment is a Nissen fundoplication; it is also the “gold standard” for antireflux surgery, but there are several other surgical options to consider as well.
Occasional use of PPI medications for symptom control
As stated earlier, the “status quo” treatment for acid reflux symptoms by most physicians is daily proton pump inhibitors (PPIs), and typically most adults stay on them for life. However, the potential dangers associated with these drugs are being publicized more frequently, and many adults like you are seeking alternatives. Our medical advisors agree with the FDA, a 14-day treatment program or shorter is safe and can be used intermittently to treat developing symptoms of acid reflux. RefluxMD is not aware of any research indicating intermittent use has any long-term side affects. In general, our medical advisors recommend the least powerful medications, used as infrequently as possible, that provide satisfactory symptom relief.
Esophageal damage from regurgitation
This is the primary concern for anyone with recurring regurgitation. Bathing the esophagus with the contents of the stomach, which is acidic and can include bile and pepsin, can lead to erosive esophagitis, esophageal strictures, Barrett’s esophagus, and potentially esophageal cancer. As mentioned earlier, a monitoring program with endoscopy and biopsies is the best means to determine erosive reflux disease vs. non-erosive reflux disease (NERD). There is significant concern about damage occurring during sleep, when the contents of the stomach can easily flow into the esophagus. We encourage you to raise the headboard of your bed by 7-inches, sleep on your left side whenever possible, and eat your last meal at least 3-hours before you go to bed.
Avoiding disease progression
The best treatment option to stop any potential progression is antireflux surgery: “Laparoscopic fundoplication is the gold standard for surgical treatment of severe GERD and results in approximately 95% patients’ satisfaction.” However, if monitoring is preferred, we highly suggest that it be combined with maintaining a healthy BMI, diet modification, as discussed in Recipe for Relief, adoption of several lifestyle changes, and experimenting with several home remedies.
Finally, we hope you will build a team to assist you on your path to relief and good health, and please be certain to include RefluxMD! We highly recommend that you work closely with a GERD expert to design, implement, and monitor your treatment plan.
I hope this helps.