Symptoms of Nighttime GERD

Dr. Robert Bresalier: I think the first thing is what is GERD, and GERD stands for Gastroesophageal Reflux Disease. An important there is the D, the disease, we all have reflux if we eat late at night. You know we all spontaneously reflux, but for most of us where our protective mechanisms are in place, we don't necessarily have an 0:24 that. But in many people where there is prolonged contact of reflux of acid and stomach contents from the stomach into the esophagus a damage can take place and therefore the D or disease, and that's really the key. It's where this gastric contents or the contents of the stomach which include acid, what we call pepsins, sometimes bile will come up into the esophagus, be there for prolonged period of time and overcome the normal protective mechanisms to cause damage to the lining of the esophagus. Dr. Steven Morris: Sometimes people will get regurgitation where they actually feel or see the food coming back up from the stomach, really gastric contents, whatever that might be. Sometimes dysphasia, where they have difficulty swallowing and even painful swelling. Sometimes it just a chest pain, not describe this burning but more of a heavy pain. Sometimes it can be indistinguishable from that suffering -- patient suffering from heart disease or cardiac type of pain, so the two pains can be very close together. Other people will get symptoms that are non-esophageal in nature, such as chronic cough, recurring sinusitis, pneumonia. Sometimes such as get a tickly or sore throat over a long period of time, worsen this as well. Dr. Robert Bresalier: Less commonly appreciated are, but important are things like bronchospasm, a good portion of adult asthma can be related to reflux. Chronic cough, chest pain that can mimic a heart pain, cardiac pain, a variety of things. And if reflux is high enough, even erosion of the teeth, the dental enamel. So the whole variety and spectrum of disease that can be associated with reflux, but most typically associated are heartburn or chest discomfort with radiation upwards. Dr. Steven Morris: The danger that we're increasingly realizing are the complications that occur from chronic reflux. They can be complications such as difficulty swallowing secondary to stricture or narrowing of the esophagus that occurs from chronic inflammatory state. And there is a problem with what we call Barrett's Esophagus. This is a development of changes in the esophagus, that go from normal tissue to what we call dysplastic tissue, which is a step towards cancer. And if it's untreated for a long period of time, a large percentage of Barrett's patients can go on and develop cancer of the esophagus and this is a totally different form of cancer than is associated, for example, with smoking. Dr. Robert Bresalier: We have come to realize that GERD is a spectrum. And not only the people reflux during the day but reflux even while sleep. And point to that is while one is asleep, the normal protective mechanisms which prevent damage are overcome. So for instance, during the day we're walking around, we're sitting upright, gravity helps train acid and gastric contents that have come up into the esophagus. Where we were supine at night, so we lose that protective mechanism. Another major protective mechanism for the esophageal lining is what called Peristalsis. It's a normal movement which strips materials that have come up into the esophagus downwards, that is severely decreased during the nighttime period as well. Our salivary glands make bicarbonate and people were familiar with bicarbonate soda or things like that know that it's something that neutralizes acid, but we don't salivate as much at night will lose that protective mechanism. Dr. Steven Morris: It occurs in a larger percentage of patients. So it's very common and it's in many ways difficult to treat. Dr. Robert Bresalier: All you need to do is turn your TV to see how common this is and you know it is being appreciated more. I think as I said with any disease, as we learn more about it, we learn that one size doesn't fit all and we now are starting to break down things into its components. So reflux is not all the same. There are many people -- some people reflux just during the day, but probably three-quarters of the people who do have reflux, reflux at night as well. Dr. Steven Morris: The other thing is that a nocturnal GERD can result in some symptoms that you wouldn't think of ordinarily. In other words, these patients have a lack of sleep. A disturbance in their normal sleep pattern, which then makes it difficult for them to function the next day. So it has consequences behind the immediate symptoms. So relieving the patient of nocturnal GERD symptoms can have benefits also beyond relief of the initial symptoms. In addition, if a patient has nocturnal GERD, and it occurs every night, it really hastens you down the road towards the complication, such as esophageal stricture, worsening Barrett's disease. Dr. Robert Bresalier: It's a disease that has a lot of affects not just in terms of damage the esophagus, were over it symptoms but can affect lifestyle, and quality of life. So there have been quality-of-life surveys then to show that people with nighttime reflux especially are actually can feel tired during the day, have decreased energy. Actually, during nighttime hours they snore more, they have dream disturbances. So refluxes are really has multi-factorial affects people usually don't think of.