Drs. Jonathan Aranow and Nadeem Hussain Take on GERD
Written by Lori Miller Kase Photography by Allegra Anderson
One in five people in the United States suffers from gastroesophageal reflux disease (GERD
Drs. Jonathan Aranow and Nadeem Hussain Take on GERD
Written by Lori Miller Kase Photography by Allegra Anderson
One in five people in the United States suffers from gastroesophageal reflux disease (GERD), a digestive disorder that causes heartburn and acid indigestion. GERD accounts for 4-5 million physician visits per year, and 7-8 million Americans remain symptomatic despite taking heartburn medications, according to Middlesex Health gastroesophageal surgeon Jonathan Aranow, MD.
Not only does GERD affect patients’ quality of life, he says, but if inadequately treated, it can lead to more serious medical problems. In fact, 15 percent of those with GERD may go on to develop Barrett’s esophagus, or precancerous changes in the lining of the esophagus. Barrett’s, in turn, dramatically increases the risk of esophageal cancer.
Middlesex Health recently launched a comprehensive GERD program with the goal of helping patients suffering from the disorder to get the treatment they need. By dialing in to a new toll-free number – 1-833-END-GERD – patients can consult with a GI nurse, who will refer them to either the health system’s gastroenterologists or gastroesphageal surgeons, depending on their history and symptoms. Using an array of diagnostic tools, these physicians then determine the best course of treatment for each patient.
Says Dr. Aranow, who collaborated with gastroenterologist Nadeem Hussain, MD, to develop the program at Middlesex Health: “We’re the only people in Connecticut to have all this under one roof, with a foregut surgeon closely collaborating with the GI team in the evaluation and management of patients.”
A breach in the anti-reflux barrier
During healthy digestion, food passes down through the esophagus and into the stomach, where enzymes and acid break down food particles so that nutrients can be absorbed by the body from the intestines. “There is a muscle in the lower esophagus – known as the esophageal sphincter – that normally works as a one-way valve, closing behind the food as it passes through the digestive tract so that it doesn’t come back up,” explains Dr. Hussain.
There are two components to the anti-reflux barrier: the esophageal sphincter, and the esophageal hiatus – the opening through which the esophagus traverses the diaphragm (the muscle between the chest and abdomen). “GERD is a failure of the anti-reflux barrier,” notes Dr. Aranow. In some patients, the opening in the diaphragm becomes progressively wider with age, creating a hiatal hernia. “The stomach can slide up into the chest if the opening is too wide,” he explains.
Whatever the cause – a malfunctioning valve or a hiatal hernia – if the barrier isn’t working as it should, food (along with digestive acids and sometimes bile from the intestine) is regurgitated back up into the esophagus, causing heartburn and indigestion. “It’s normal to produce acid in the stomach,” says Dr. Hussain. “You need it to digest food and kill bacteria. But it’s not normal to get acid climbing up into the esophagus.” Symptoms of GERD may include a burning sensation in the chest, chest pain, “wet burps” and regurgitation, trouble swallowing or the sensation of a lump in the throat. GERD can also cause coughing and hoarseness.
While over-the-counter antacids often relieve such symptoms by reducing the acid that rises in the chest, they don’t address the bile, says Dr. Aranow. Both acid and bile can play a role in damaging the esophagus, leading, in some patients, to Barrett’s and, ultimately, esophageal cancer. “We want to catch people who have evidence of Barrett’s and prevent the changes from getting worse,” adds Dr. Hussain.
The incidence of esophageal cancer has increased 600 percent in the last 30 years, according to Dr. Aranow. He points out that the rise in esophageal cancer coincides with the adoption of antacid therapy. “So we’ve masked a lot of the disease,” he says. “But the most carcinogenic component of reflux is bile, not acid.” At the same time, there has been a rise in obesity, which increases the risk of both reflux and esophageal cancer, notes Dr. Hussain, as do smoking and alcohol consumption.
Making a diagnosis
Dr. Hussain says those who get occasional heartburn and feel better after modifying their diet and taking antacids probably do not require further treatment. “But if they have a family history of esophageal cancer, risk factors like smoking or obesity, or are having problems like unexplained w