Laura asks:
I am a 35 year-old woman with an extreme amount of pain in the upper gastric region. I had my gall bladder removed in 1998. I was recently diagnosed with a sliding hiatal hernia. Can a hernia cause stabbing pain all the time in the upper gastric area?

Anil Rustgi, MD responds:
Hiatal hernias are very common. This condition may cause reflux (backflow) of gastric acid from the stomach into the esophagus. A hiatal hernia by itself rarely causes symptoms — pain and discomfort are usually due to the reflux of gastric acid, air or bile. Reflux occurs more easily when there is a hiatal hernia, though a hiatal hernia is not the only cause of reflux.

The goals of any medical treatment are to relieve symptoms and prevent complications. Reducing the backflow of stomach contents into the esophagus (gastroesophageal reflux) relieves pain in most cases. Medications that neutralize stomach acidity, decrease acid production or strengthen the lower esophageal sphincter (the muscle that prevents acid from backing up into the esophagus) may be prescribed. If these measures failure to control the symptoms, or if complications appear, surgical repair of the hernia may be necessary.

To schedule an appointment with a Penn gastroenterologist who can evaluate your condition and recommend the best course of treatment, please call 800.789.PENN (7366) or request an appointment online.

Krystin asks:
I have a 6 year-old daughter who was having horrible coughing episodes in which she would gag and gasp for air. Reflux has been diagnosed as the cause and the episodes are decreasing in frequency while taking Prevacid®. What is causing such a young child to have reflux, and could it be indicative of a bigger problem?

Anil Rustgi, MD responds:
Gastroesophageal reflux disease (GERD) is very common in infants, though it can occur in children of any age. Children with GERD who vomit frequently may not gain weight and grow normally. Some children with GERD may not vomit, but may still have stomach contents move up the esophagus and spill over into the windpipe. In addition to painful ulcers, this can cause asthma and pneumonia.

Treatment varies from child to child. In many cases, GERD can be relieved through diet and lifestyle changes, sometimes accompanied by medication. These measures minimize reflux, vomiting and heartburn.

A pediatric gastroenterologist can examine your daughter and recommend further diagnostic tests based on her symptoms.

Robert asks:
I have had frequent heartburn and gas for years. A couple times a year, I have extreme discomfort in my chest. I feel it from the top of my throat to the bottom of my sternum. It feels like a balloon is inflated in my chest and sometimes I get a bit of foam in my mouth.

It doesn't hurt when I eat, drink or cough. It seems to subside when I finally get to sleep - but not long after waking up, it comes back. I took Prilosec OTC® with no relief, but Prevacid® does help. I'm not so sure it's GERD, as I don't have any burning. Do you think this could be GERD or something else?

Anil Rustgi, MD responds:
If you have heartburn more than twice a week, you may have GERD (gastroesophageal reflux disease). Prevacid® (lansoprazole) is a medication used to treat ulcers and GERD. It is best to be examined by a gastroenterologist. The long-term effects of GERD can cause Barrett's esophagus, esophageal ulcers or strictures. Whether or not it is GERD, a Penn GI physician can diagnose the problem.

To schedule an appointment with a Penn gastroenterologist who can evaluate your condition and recommend the best course of treatment, please call 800.789.PENN (7366) or you can also request an appointment online.

Kathleen asks:
I have been diagnosed with GERD and a hiatal hernia. I have been taking Zegerid® for more than six months and have modified my lifestyle. I occasionally have coffee or chocolate and feel completely nauseated.

Sometimes, I feel sick all day – regardless of what I eat. I usually feel OK in the morning and then deteriorate during the day. I don't think I should feel so sick while taking medication. I have an appointment with Dr. David Katzka but I would like to see him sooner. Any thoughts?

Anil Rustgi, MD responds:
Zegerid is a prescription omeprazole and sodium bicarbonate medication. It is used to treat ulcers, gastroesophageal reflux disease (GERD) and erosive esophagitis. Omeprazole is in a class of medications called proton-pump inhibitors. It works by decreasing the amount of acid made in the stomach. Omeprazole and sodium bicarbonate have a handful of possible side effects, including nausea.

Based on your symptoms, Dr. Katzka may decide to adjust your dosage. If your symptoms change or worsen, you should contact your primary care physician.

Courtney asks:
I am a 25 year-old active female. I have had stomach issues my whole life. I have GERD and possibly Barrett's esophagus. I have been treated by a GI specialist in South Jersey for three years. However, for the past eight months, I have not had a normal bowel movement.

Changing my diet has not affected my symptoms. Normally, it is water and diarrhea. This affects my lifestyle significantly - I am scared to go out in public as I need a bathroom constantly. It then switched to constipation for a month. My GI doctor didn't think too much of this, yet I am in pain. The diarrhea has since returned two-fold. These symptoms are accompanied by tiredness, nausea, joint pain, dizziness, and so on.

Should I get another opinion? All my tests seem to be normal. I am starting to feel distressed that this is how my life will be. Is there a specific doctor I should request to see?

Anil Rustgi, MD responds:
GERD (gastroesophageal reflux disease) occurs when a muscle at the end of the esophagus does not close properly. This allows stomach contents to leak back – or reflux – into the esophagus and irritate it. The long-term effects of GERD can lead to Barrett's esophagus – a disorder in which the lining of the esophagus becomes damaged.

Normally, a combination of medications is used to treat GERD. Anti-reflux operations may help patients who have persistent symptoms despite medical treatment. There are also new therapies that can be performed through an endoscope. For advanced cases of Barrett's esophagus, surgical removal of a portion of the esophagus may be recommended – if a biopsy shows dysplasia. Dysplasia is cellular change that tends to lead to cancer.

We would be happy to consult with you and recommend the best course of treatment for controlling your symptoms.

Geoffrey Spencer, MD, is a Penn gastroenterologist who specializes in acid-peptic disorders. To schedule an appointment with Dr. Spencer, please call 800.789.PENN (7366) or you can also request an appointment online.

Dominique asks:
Could having H. pylori result in a false positive gastric analysis test? If so, what tests are not affected by H. pylori to rule out a gastrinoma, ZES, or MEN1?

Anil Rustgi, MD responds:
Most ulcers and many cases of chronic gastritis (inflammation of the stomach) are caused by helicobacter pylori (H. pylori) – a bacteria that grows in the intestines. In very rare cases, severe ulcers can be caused by multiple endocrine neoplasia type 1 (MEN1). MEN1 is an inherited genetic condition occurring in about 0.02 percent of the population. MEN1 can cause the pancreas gland? As opposed to just pancreas? to produce too much gastrin hormone causing the stomach to secrete excess acid, forming ulcers.

A gastrinoma is a tumor of the stomach's acid producing cells that increases acid output. About one in three MEN1 patients has these gastrin-releasing tumors. The illness associated with gastrinomas is sometimes called Zollinger-Ellison syndrome (ZES).

A combination of MRI and CT scans, and lab tests are used to diagnose MEN1. To discuss your genetic predisposition to MEN1 with a Penn gastroenterologist, please schedule an appointment by calling 800.789.PENN (7366) or you can also request an appointment online.

Debbie asks:
I have bad heartburn and recently, while on a long flight, I found myself unable to relieve the pressure built up in my chest. I had cardiac tests done and don't think it's a heart problem. Can air travel exacerbate the effects of GERD?

Anil Rustgi, MD responds:
Yes, gastroesophageal reflux disease (GERD) symptoms can be brought on by air travel. A change in the type of food consumed, the length of time between meals and sleeping habits can cause heartburn. If possible, when traveling try to eat small, frequent meals, avoid foods high in fat, get enough sleep and wear loose, comfortable clothing.

Tracy asks:
My mother has had a serve imbalance of H. Pylori in her digestive system for almost two years now. Her ulcers have been treated and she is no longer bleeding internally. A recent biopsy and scope showed no problems, but her last breath test returned a 3,000 count of bacteria. She has been on the PREVPAC® twice and HELIDAC® to no avail.

I am concerned about her prolonged exposure to such an excess of bacteria and constant stomach pain. What are other treatment options? Can you recommend a doctor who might deal specifically with this?

Anil Rustgi, MD responds:
Helicobacter pylori (H. pylori) is a bacteria that grows in the intestines and is responsible for most ulcers and many cases of chronic gastritis (inflammation of the stomach). It can weaken the protective coating of the stomach and upper part of the small intestine, allowing digestive juices to irritate these sensitive linings.

As much as half of the world's population is infected with H. pylori. It is passed from person to person and is usually contracted during childhood. Interestingly, many people have this organism in their gastrointestinal tract but don't get an ulcer or gastritis.

Treatment of H. pylori consists of a combination of medications including proton-pump inhibitors, histamine H2 blockers and antibiotics. These decrease and neutralize stomach acid, and most importantly, eradicate the bacteria. PREVPAC® and HELIDAC® are two pharmaceutical products that package these medications together. About 15 to 20 percent of patients still have H. pylori after the first treatment. This is due to a resistance of some H. pylori strains to certain antibiotics. In these cases, a different combination of antibiotics is necessary.

David Metz, MD, is a Penn gastroenterologist who specializes in motility and bowel disorders. To schedule an appointment with Dr. Metz, please call 800.789.PENN (7366) or you can also request an appointment online.

Kia asks:
I have acid reflux and woke up this morning with nausea and the feeling of moving my bowels, but I could not go. Should I be concerned?

Anil Rustgi, MD responds:
Acid reflux or gastroesophageal reflux disease (GERD) happens when the stomach's contents leak back – or reflux – into the esophagus causing irritation it. It can includea burning in the chest or throat, called heartburn.

Constipation, having three or fewer bowel movements a week, and nausea are common symptoms and in most cases, last a short time. If the nausea persists or if your bowel habits change significantly, check with your doctor.

To set up a consultation with a Penn gastroenterologist, please call 800.789.PENN (7366) or request an appointment online.

Rose asks:
I have had GERD (gastroesophageal reflux disease) for a number of years. I have developed Addison's disease and am on fludrocortisone and hydrocortisone, as well as medication for the GERD. I was sent an article about a non-surgical procedure called the Plicator. I am a RN and have researched the procedure and would like to know if this procedure is performed by a Penn physician.

Anil Rustgi, MD responds:
The NDO Plicator® is an FDA-approved device, but there is limited peer-reviewed published literature on the device and its application for anti-reflux therapy. Small, short-term, industry-sponsored follow-up trials suggest there is some benefit.

However, the technology has not been widely embraced and I am not aware of any centers currently offering this procedure. After considering the risk-benefit analysis of its use, we have opted not to pursue this technology here at Penn.

I recommend you see one of our esophageal specialists – David Metz, MD, David Katzka, MD or Geoffrey Spencer, MD – for consideration of anti-reflux surgery. To make an appointment, please call 800.789.PENN (7366) or you can also request an appointment online.

Paul asks:
I have GERD (gastroesophageal reflux disease), a hiatal hernia and dsphagia. Are there surgical procedures available to treat these conditions?

Anil Rustgi, MD responds:
GERD (gastroesophageal reflux disease) occurs when a muscle at the end of the esophagus does not close properly. This allows stomach contents to leak back – or reflux – into the esophagus and irritate it. A burning in the chest or throat, called heartburn, sometimes includes acid indigestion – stomach fluid in the back of the mouth.

Anyone, including infants and children, having these symptoms more than twice a week may have GERD. If not treated, it can lead to more serious health problems. GERD is treated by lifestyle modifications, medication and in some cases, surgery. Endoscopic techniques are used to improve the natural barrier between the stomach and the esophagus that prevents acid reflux from occurring.

A hiatal hernia is a condition in which the upper part of the stomach bulges through an opening in the diaphragm. The diaphragm is the muscle wall that separates the stomach from the chest. The diaphragm helps keep acid from coming up into the esophagus. A hiatal hernia makes it easier for the acid to come up, causing gastroesophageal reflux (GERD). Hiatal hernias are common, especially in people over 50. Most cases are treated with lifestyle modification and medication. Sometimes, laparoscopic surgery is needed to reduce the hernia.

Dysphagia, a swallowing disorder, causes pain and difficulty swallowing. Medicines and therapy can help some people, while others may need surgery. In very serious cases, feeding tubes are used.

To schedule an appointment with a Penn gastroenterologist who can evaluate your condition and recommend the best course of treatment, please call 800.789.PENN (7366) or you can also request an appointment online.