Gastroesophageal Reflux Disease (GERD)

By Robert D. Fanelli, MD, FACS, FASGE

GERD has a significant impact on the quality of life of people who suffer from this extremely common malady, and can be associated with an increased risk of esophageal cancer.  GERD, seemingly ubiquitous, is one of those problems for which patients might wind up seeing a variety of medical providers.  In addition to the primary care team that most often sees GERD patients for heartburn, ENT specialists see patients with GERD for hoarseness and chronic cough, pulmonary specialists for cough, chest pain, worsened asthma, and idiopathic pulmonary fibrosis, and cardiac specialists for chest pain, to determine if the etiology is cardiac or not.  Nearly all primary care and specialty providers will see GERD patients to evaluate and treat various symptoms.

So, how do I approach the patient with GERD?  I listen to their symptoms and try to organize them into four broad categories or buckets of symptoms that help guide evaluation and treatment.  The first is acid-mediated symptoms, those classic symptoms we all think of when referencing GERD, like heartburn and dyspepsia, that hint at physiologic failure of the LES mechanism.  The second is mechanical symptoms, like regurgitation or the feeling of a rising fluid column when bending or lying supine, that suggest mechanical failure of the LES.  The third bucket is for atypical manifestations of GERD, like adult onset asthma, non-cardiac chest pain, or hoarseness; symptoms that require exclusion of other important considerations before the diagnosis of GERD can be entertained or intervention considered.  The fourth bucket, the most important, is for alarm symptoms like dysphagia, odynophagia, weight loss, or hematemesis.

Once GERD symptoms have been sorted into these buckets, I find it easier to guide the patient through the workup, and to review with them a list of possible treatment options.  Most patients with acid-mediated symptoms are going to respond well to antisecretory medications, and while these may not relieve all of their symptoms, the majority of patients will do well with the combination of these meds, weight loss, smoking cessation, and dietary diligence.  People with mechanical symptoms typically will require a mechanical remedy; laparoscopic surgery, or one of the new promising endoluminal therapies in development.  Those with atypical symptoms will require a well-documented evaluation to rule out more concerning processes; for example, non-cardiac chest pain must be proven to be just that, not cardiac in origin. Patients experiencing weight loss, dysphagia, odynophagia, hematemesis and/or other alarm symptoms that raise concern should undergo upper endoscopy reasonably soon to explore a possible diagnosis of esophageal cancer.

Dr. Fanelli comes to Guthrie from western Massachusetts, where he served as Director of Surgical Endoscopy for Berkshire Medical Center, Associate Professor of Surgery for the University of Massachusetts Medical School, and as a minimally invasive surgeon with both Surgical Specialists of Western New England, PC, and Northern Berkshire General Surgery. He attended The Medical College of Pennsylvania in Philadelphia, served an internship at The Stamford Hospital in Connecticut, and completed his residency in general surgery at Michigan State University.

Dr. Fanelli was fellowship-trained in advanced surgical endoscopy/laparoscopic surgery at The Mount Sinai Medical Center/Case Western Reserve University and in endoscopic ultrasound at Strong Memorial Hospital/University of Rochester Medical Center.

Appointments with Dr. Fanelli can be made by calling 570-887-2355 in Sayre or 607-936-9971 in Corning.