Dear Dr. Yasmin Williams,
Your article was well written. Just three brief comments:
1. Endoscopy isn't a good test to
diagnose acid reflux. Oesophageal PH monitoring is the test of choice in
diagnosing acid reflux (although most patients do not need this test; the
symptoms plus a trial of proton pump inhibitor are usually enough to make the diagnosis). Most patients with GERD have normal endoscopy.
Endoscopy is neccessary in the
evaluation of patients with GERD,
especially patients older than 40 years old and any patient with chronic GERD symptoms more than two times weekly. The reason for the endoscopy is to
eliminate other underlying cause for GERD and to rule out Barretts
oesophagus in those with chronic GERD.
2. The cough in GERD is also due to a reflex bronchospasm. Acid in the lower oesophagus stimulate receptors in the distal oesophagus causing a reflex
bronchospasm via vagal stimulation. Patients will also get wheezing.
3. The reflux is most commonly
due to transient LES (lower oesophageal sphincter) relaxation (65 per cent of the time). The LES is usually normal
(manometric measurement frequently demonstarate normal LES pressure).
These are very technical points just for your information. Your article was
adequate in getting the salient points across to the general public.
I am, etc.,
ISAAC A. BARTLEY, M.D.
bartleymd@aol.com
(Chairman, Dept. of Gastroenterology,
Huntington Memorial Hospital;
Director, Gastrointestinal Endoscopy Unit,
Glendale Adventist Medical Center;
Medical Director, Pasadena
Gastroenterology Medical Group)
Dear Dr. Bartley,
Thank you for your
feedback. I appreciate your comment "Well-written
article," in reference to my piece on GERD and I am pleased that you thought it was adequate in getting the salient points across to the general public.
I am not aware of
oesophageal PH monitoring (the test of choice in diagnosing acid reflux) being done locally and, in practice, the diagnosis of GERD is made based on the symptoms and the response to medication.
I agree that though the
diagnosis can be substantiated by seeing an inflamed
oesophagus on endoscopy,
the endoscopy may be
normal and that endoscopic examination is necessary
in the older patient with
frequent reflux and the
chronic GERD patient.
We note your comments that: (1) The cough in GERD is also due to reflex bronchospasm (contraction of muscles in the walls and narrowing of the tubes of the respiratory tract) because acid in the lower oesophagus or gullet stimulates certain areas on the oesophagus called
'receptors' causing reflex bronchospasm due to the involvement of the vagus nerve. (2) Patients can also get wheezing. (3) Acid reflux is commonly due to transient relaxation of the lower oesophageal sphincter.
We welcome your input
as we aim to make the
health feature interactive
and try to pitch the articles
at a level that both the general public and our local medical practitioners find useful.
Many of the Jamaican
colleagues inform me that
they look forward to the
medical information offered weekly by the health feature
and I am sure they especially appreciate your input.
Regards,
Yasmin Williams
