A question from one of our members highlights an issue on the mind of many RefluxMD members – what type of specialist can help me? We have both gastroenterologists and general / thoracic surgeons listed on our website, but there is a certain amount of confusion about these two specialties. This response to our member’s question will provide more information for those considering a new specialist.
I had an endoscopy about a year ago (after 10 years of nagging cough) with a gastroenterologist in LA. He noticed significant esophageal erosion and a 5cm hiatal hernia. He said that because of my hernia that I would need to stay on PPIs for rest of my life, which I have been taking for the last year. Initially I didn’t try to change my lifestyle (i.e. beer, coffee, foods, etc.) but recently I have made a concerted effort to stop everything potentially negative – cold turkey – in addition to losing weight (about 15 lbs.). I don’t know if I should attempt to wean off of PPIs or just stay on them. I really need a strong voice for my career, so GERD is really a problem for me. I’m really confused at this point. I feel like I’m Stage 2 on your GERD stage chart, but could tip into Stage 3 if I don’t get my act together. I have tried a few other things (limonene, DGL, rafts, etc.) and I am taking one Prilosec in the morning daily with either Tagamet or cimetidine most nights. About five months ago my ENT found that my vocal cords looked fine but that there was some irritation on my voice box. Should I consult with a surgeon or get a second opinion from another gastroenterologist? What are your thoughts at this point?
Thank you for your questions and I’m sure that many people struggle with this same question – who should I see to help me find relief? First, I want to compliment you on your efforts to manage your symptoms. You are doing research on the Internet (we are happy RefluxMD is part of your team) while focusing on diet, weight loss, and your use of antireflux medications. However, there is no substitute for working with an expert on GERD. These specialists are essential to accurately diagnose the underlying cause of the symptoms and to outline all the treatment options to reduce or eliminate those symptoms. I would like to discuss the medical professionals that you can consider to find relief and long-term improved health.
Your history and GERD stage
Before we focus on medical professionals, let’s focus a little bit on your symptoms and treatment history. Since you are member of RefluxMD we reviewed your GERD Stage results that you completed in January 2014 and February 2015. With this data and your comments, we learned a bit more about your condition and treatment program:
- You have been struggling with symptoms for approximately 10 years;
- During the last year you saw a specialist and had an endoscopy showing damage to your esophagus;
- You are now using PPI medications daily (with H2 blockers) rather than when necessary, and;
- You are less satisfied today with the effectiveness of your PPI therapy.
So let’s now get to your question: what medical specialist should you visit next?
Seeing a medical specialist
We want to highlight that RefluxMD does not encourage the diagnosis or treatment of GERD by a primary care physician (PCP). First, PCPs are unable to perform the necessary tests to determine the underlying cause of your symptoms or confirm GERD. Second, if GERD is the diagnosis by a PCP, then you should always get a referral to a GERD expert. Assuming that the PCP correctly diagnosed, PCPs are unable to evaluate damage to the esophagus, which may require special treatment and monitoring. Additionally, PCPs are unable to detect or diagnose actual disease progression, or the potential for such progression. This can include Barrett’s esophagus and esophageal cancer. Hence, we always highly recommend that you consider a GERD specialist if you believe you have acid reflux disease. There are two medical specialists, and we have some thoughts for your consideration:
Today GIs are the primary referral from a PCP for anyone with GERD symptoms. They can accurately diagnose and treat acid reflux disease. RefluxMD has many GIs in its physician panel that agree with our patient care philosophy. However, GI specialists as a group generally tend to support the “status quo” treatment model today – PPI therapy, with some support for both diet and lifestyle changes. In a recent poll conducted by RefluxMD, patients treated by GIs reported the following:
- 39% were only offered PPI therapy;
- 8% were only offered lifestyle modification or diet changes;
- 52% were offered PPI therapy and at least one other treatment option;
- Antireflux surgery was only discussed with 13%.
In total, 91% of the patients were presented with PPI therapy, with approximately half of those receiving some discussion of other treatment options. Using analytics to assess the GERD stage results of RefluxMD’s members and visitors, we have determined that they are more advanced in terms of both symptoms and disease progression, particularly regurgitation. We are surprised that antireflux surgery was only discussed with 13% of these patients, and we think that 90% to 100% of all GERD patients should have been advised on diet and lifestyle changes along with weight management. You mentioned that your GI told you that you would be required “to stay on PPIs for rest of (your) life”. Unfortunately, this is consistent with our findings, but it is not accurate. In addition to diet, weight management and lifestyle changes, antireflux surgery is another viable option. In most cases, PPIs are not required after a successful surgery by an experienced surgeon. More importantly, the medical risks associated with PPIs are mounting, and in addition to the FDA mandated warning on the package insert, medical researchers have found increased risks of heart attack, chronic kidney disease, and dementia.
General Thoracic Surgeons
We recognize that many people who suffer from acid reflux disease are concerned when they hear the term “surgeon” since most of them are not considering antireflux surgery. However, most surgeons that perform several antireflux procedures weekly also perform all the diagnostic tests to confirm and evaluate GERD. In our experience, they will discuss all the treatment options, including weight management, diet, lifestyle changes, medications, and surgical procedures. RefluxMD has a group of surgeons on our panel that we consider GERD experts and most will evaluate, advise, and monitor GERD patients in addition to performing surgical procedures. If there is no GERD expert on our list in your area, use our online DocMatch tool to request one. We have several lists of GERD experts that are not on our panel.
Next steps to relief and good health
The most important thing you can do now is to create a partnership with the “right doctor for you.” If you are not satisfied with your current GI, you can consider a full diagnostic workup with a GI or surgeon, but preferably a known GERD expert. You can also seek a second opinion of a GERD expert and stay with your current GI. Again, this can be either a GI or an antireflux surgeon – but confirm in advance that they will discuss all treatment options noted above with you. If your doctor does not discuss the following treatment alternatives with you, be certain to ask:
- Achieve and maintain a BMI of 24 or less;
- Adopt a GERD-friendly diet program;
- Make all the necessary lifestyle changes;
- Experiment with natural home remedies;
- Utilize less powerful antireflux medications like antacids and H2 blockers;
- Consider antireflux surgery if the above don’t provide adequate relief.
I hope this helps
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