We love getting questions from our members and visitors to our website. Many of these questions permit us to offer ideas to avoid acid reflux disease progression, complications, or treatment, including the use of PPI drugs for GERD. Unfortunately, we also hear from those who are suffering from those complications: Barrett’s esophagus and esophageal cancer. This question pains us since disease progression can be avoided by monitoring and proper treatment. If you have been diagnosed with GERD by a family doctor, please read our response to this question.
Your question – PPI drugs for GERD and complications:
My doctor has been giving me repeat prescriptions of Ranitidine and Prevacid for 12 years. He has never sent me for endoscopes and never examined me. I was diagnosed with stage 3 esophageal cancer in January 2014 and had surgery and chemo soon after. Should I have had regular tests to check for Barrett’s esophagus?
Thank you for your questions, and I am so sorry for the progression of your disease. Like so many others that rely on a family doctor, a diagnosis of GERD is almost always treated with medications, usually PPI drugs for GERD daily — and for life. Unfortunately, medications may not be the best treatment strategy for everyone as we have discussed in many articles on our website. More importantly, very few patients are provided with adequate information concerning their medical treatment, especially the use of PPI drugs for GERD. One of our polls highlighted the fact that only 11% of patients were informed of the potential side effects associated with their antireflux medications, and only 15% were informed that reflux would continue and that it could lead to disease progression. A full 80% were never told either fact! To make matters worse, those that find symptom relief from these medications believe that they have found a “cure” for their disease.
Many family doctors believe that if their patients report reduced or total elimination of symptoms while on medications, their job is done. For those patients that have non-erosive reflux disease (NERD), they may be right. However, for those with erosive reflux disease (ERD), their job is certainly not done. As stated in a research report titled Diagnosis and Management of Non-Erosive Reflux Disease, the researchers offered this comment on diagnosis by primary care physicians (PCPs) and family doctors: “For the practicing non-gastroenterologist clinician, the diagnosis of NERD (which, by definition, requires endoscopy) is not intuitive. Moreover, the findings of ultra-structural changes associated with acid-related damage suggest that NERD might be part of a continuum with erosive reflux disease (ERD), adding further to semantic confusion.” This is a big problem today since most GERD diagnosis are made by primary care physicians who simply do not have the diagnostic equipment to confirm GERD, or to differentiate between NERD and ERD.
What Should Be Done if Your PCP Tells You that You Have GERD?
There are really two questions that every patient should ask their family doctors or PCPs if they are diagnosed with GERD:
- “Are you 100% confident that my symptoms are due to GERD?”
- “Are you 100% confident that my GERD condition has not progressed to esophagitis or worse complications?”
No PCP can be 100% confident that a “discussion of symptoms” can provide any assurance that the symptoms are due to GERD – there are just too many other medical conditions that could result in similar symptoms. However, if the answer is “YES” and if the doctor is honest, I can assure you that they cannot answer “YES” to question #2, since no family doctor or PCP can diagnose or “predict” disease progression. That would require an examination of the esophagus, and they simply do not have the diagnostic tools to perform such an examination.
GERD and monitoring of disease progression
In your case you took an antireflux medication for twelve years without any additional examination or monitoring. The US and European health systems, as part of their cost-reduction efforts, would prefer that less money be spent on monitoring than more. We understand this problem, and when it comes to esophageal cancer, we recognize that the incidence of the disease is still low. However, as in your case, if you are the person diagnosed with cancer, those probabilities don’t mean much. We think it is important to find a GERD expert that both understands these probabilities and the cost guidelines, and yet still insists on adequate monitoring to safeguard their patients. That is why we developed our Find-A-Physician tool to assist our members to find such GERD experts.
What should anyone do when diagnosed with GERD by a PCP?
We highly encourage anyone diagnosed with GERD by his or her family doctor or a PCP request a referral to a GERD expert. Why? Because GERD experts have the expertise to confirm a GERD diagnosis (or help you explore the underlying cause of your symptoms); determine if your disease has progressed to esophagitis, Barrett’s esophagus, or esophageal cancer; and provide you with all the available treatment options for YOUR consideration. Isn’t that what you want? We think so.
We hope this helps others taking PPI drugs for GERD!
By the way, you can help us reach others like you with similar questions by simply going to our Facebook page and clicking the LIKE BUTTON! If a friend or family member is having frequent heartburn, chest pain, regurgitation, a chronic cough, hoarseness in the morning, or clears their throat frequently, they may have acid reflux disease. Please, encourage them to see a GERD specialist – you may be saving their life.