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NUMC adopts ‘best practices’ for GERDHeartburn has become so common in the United States today that sufferers have a tendency to dismiss it quickly, feeling that it’s just something they have to live with, or they continue to pop antacids like candy in hopes that it will just go away. However, continuous occurrences of heartburn left untreated can lead to more serious conditions. People who have heartburn more than once a month are more likely to have Gastroesophageal Reflux Disease (GERD) which, when left untreated, can lead to problems up to and including esophageal cancer. Kathleen Kobbermann, MD, a Family Practice physician at New Ulm Medical Center, is part of a group of physicians putting in place the “Best of Practice” treatment for GERD patients. “’Best of Practice’ is a set of guidelines based on nationally recognized clinical evidence and expert opinion that will guide our physicians when they are treating GERD patients,” Kobbermann said. “Using ‘best of practice’ guidelines ensures our patients that the most up-to-date and successful treatments available across the country are also available to them right here at home.” GERD can be just heartburn, Kobbermann explained, or it can be a warning sign of gastric cancer, esophageal cancer, an ulcer, or bleeding in the stomach or small intestine. With some of these conditions, patients have “alarm features” such as vomiting blood, becoming anemic, experiencing unexplained weight loss, trouble swallowing, persistent vomiting or black stools. Karl Papierniak, MD, a General Surgeon at New Ulm Medical Center, performs endoscopies on a regular basis. A fiber optic scope is inserted down a patient’s throat and can travel through the esophagus, stomach and the duodenum (the first part of the small intestine). A camera mounted at the end of the scope can transmit full-color photographs to determine if there is any damage to the lining of the esophagus and is also capable of performing biopsies, if necessary. “Esophageal cancer is the fastest growing cancer in the United States,” Papierniak said. “And it is related to reflux. That is why treatment of heartburn or reflux can be so important.” For 80 to 90 percent of patients, Papierniak said, medications can be very effective. Some of these medications can be expensive, though. “Proton pump inhibitors are commonly used and they are $110 to $200 per month, costing individuals and health plans a lot of money,” Kobbermann said. “It’s a major expense for healthcare.” The Best of Practice guidelines are aimed at using these treatments more effectively and appropriately, in addition to not overusing them or potentially masking more serious underlying symptoms or diseases. “Our immediate goal is to be following the Best of Practice guidelines at least 80 percent of the time,” Kobbermann said. “We are conducting chart audits to look at how GERD patients are being treated now, how consistently we are applying the best practice guidelines and what areas may need to be improved upon.” Some anticipated areas of improvement, Kobbermann said, are in the length of initial treatment with medication for someone with a new diagnosis of GERD and a timely referral of patients to have an endoscopy. “Patients may find that physicians will be asking them more questions when they find that they have heartburn,” Kobbermann said. “They may be encouraged to have an endoscopy or may be treated with medicine for a longer period of time. There may be more frequent follow-up with the patient, too.” For the 10 to 20 percent of patients who do not find relief with medications, Papierniak said, the next step may be a non-surgical repair to the valve at the base of the esophagus using a tube-like Stretta catheter. Electrodes mounted at the end of the catheter cauterize tissue near the valve, creating scar tissue that helps increase the valve’s pressure and destroying some of the nerves that cause the valve to relax. When the valve relaxes, acid can escape from the stomach back up into the esophagus, causing heartburn. After receiving specialized training, Papierniak began performing the Stretta procedure on an outpatient basis about three years ago. Recovery from the procedure includes one to three weeks of eating pureed foods. “The procedure is much less expensive and much less invasive than traditional surgery,” Papierniak said. “It is a very viable option for patients when medication management has failed and they want an alternative to more traditional surgical procedures.” The first line of defense against heartburn, Kobbermann and Papierniak agree, is a change in eating and personal habits. To help reduce the chances that you will experience heartburn, lose weight and avoid large meals. Avoid lying down for two to three hours after eating, elevate the head of your bed six to eight inches to let gravity help keep that acid in your stomach where it belongs, and avoid tobacco. Some foods that can increase the likelihood of experiencing heartburn are: caffeine, chocolate, fats, alcohol, tea, coffee, soft drinks, citrus juices, peppermint and spearmint. |
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New Ulm Medical Center
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