Amy Tyberg, MD: Defining the Patient Populations, Best Therapies for GERD


How increasing obesity rates have affected the prevalence of GERD and re-prioritized first-line care.

Gastroesophageal reflux disease (GERD) is among the most common gastroenterological diseases. Despite its major prevalence, it has a propensity to affect certain patient subpopulations more critically, and respond variably to treatment. That's why lifestyle changes may be the primary treatment.

In an interview with MD Magazine®, Amy Tyberg, MD, assistant professor, associate director of Endoscopy, and director of Therapeutic EUS at the Rutgers Robert Wood Johnson Medical School, explained the average GERD patient population, how modern diets are affecting the rates, and why physicians need to prioritize lifestyle change before therapy in new patients.

MD Mag: Why is GERD so common in the general population? What are some of the most at-risk patient subpopulations?

Tyberg: So, GERD is becoming an increasingly prevalent medical issue, and actually now is the number one reason why patients will seek out care from a gastroenterologist in the outpatient setting.

And we think that part of the reason that it's becoming so prevalent and increasingly common is because our diet is changing over time. You know, people are eating a lot less healthy, which can induce a lot more acid reflux ,and the obesity is becoming a larger problem, which is probably the most common risk factor for development of GERD.

And so, we're seeing more and more patients suffering from this condition in terms of populations at risk—as I said ,the obesity certainly correlates very highly with development of GERD symptoms.

Other patient populations include pregnant women people, people who are smokers or exposed to secondhand smoke. So certainly, huge components of the population.

MD Mag: What is the current standard of care for GERD for both surgeons and GI physicians?

Tyberg: There’s a mainstay for treatment of GERD. The first things that any gastroenterologist is going to recommend are lifestyle changes—avoiding those types of foods that are notoriously acid-producing foods, I call them. Also, lifestyle changes: trying to eat earlier, not lie flat right after eating, things like that. But after making those kinds of adjustments, the next treatment is really medication-dependent. And that is really the PPI class of medications. They really revolutionized the treatment of reflux, and that's because they're very effective at decreasing the amount of acid production.

But there are certainly patients that, for whatever reason, don't have a full response to the medications, or that their reflux is so strong that they just have reflux despite the acid production. In addition, over time you can lose your response to the PPI therapy and start to regain some symptoms, and there are certain anatomical abnormalities that make PPIs less effective.

For instance, if the stomach slides up into the chest, which is called a hiatal hernia, that can make the PPI less efficacious. So certainly there's a subset of patients that will need something more than just medication therapy.

And in the past, the only option for those patients was a surgical procedure which takes the stomach and actually wraps it around the bottom of the esophagus to narrow that connection between the stomach and the esophagus, making it harder for acid reflux from the stomach to go up into the esophagus. Now we have the option to offer this endoscopically as well, using a procedure called the trans-oral incisionless fundoplication (TIF 2.0 procedure / EsophyX Z). And that does essentially the same thing, but it's all done from the inside, without the need for any incision. So, we certainly have exciting options for patients with reflux these days.

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