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Diagnosing non-acid reflux

August 1, 2008 12:00:00 AM PDT
Sometimes the symptoms of acid reflux disease feel like heartburn, sometimes it just feels like pressure above the stomach. It's a disease that doctors can diagnose and usually treat effectively, but now there's a new kind of reflux disease popping up and there's been no way to diagnose it until now.Two years ago, Sylvia Gustafson's life changed forever. While working as a nurse at a hospital, a patient strangled her.

"I lost my voice within the hour," said Gustafson.

The massive throat injury damaged her esophagus, lungs and vocal cords. Her voice is now a whisper, amplified by a voice box.

"But I still feel grateful that I still got a little voice," said Gustafson.

Sylvia also started having asthma symptoms. Gastroenterologist Dr. Donald Castell is seeing these unusual symptoms in people on medication for acid reflux disease.

"It's a phenomenon that's occurred because of all the drugs that are out there now that control acid so well. They'll stop the acid, but they don't stop the reflux," said Dr. Castell.

It's called non-acid reflux. It can cause chronic cough, asthma, indigestion and nausea -- symptoms not typically linked with acid reflux disease.

"If we can detect it, then we're going to have a much better chance of treating it," said Dr. Castell.

Typical monitors depend on acid as a signal to detect acid reflux disease. Now, this new monitor can detect reflux when there's no acid present by measuring electrical resistance in the esophagus.

"It's a huge step forward," said Dr. Castell.

When patients learn reflux is the problem, they can have surgery to fix it. Dr. Castell thought non-acid reflux might be causing Sylvia's asthma symptoms. She wore the new monitor for 24 hours.

"It showed 144 reflux episodes and the normal is below 40," said Gustafson.

She had surgery and her reflux is gone. She's still fighting her way back to a normal life, but she's optimistic.

"I think you need to be just thankful for what you have," said Gustafson.

In one study, non-acid reflux disease was found to be the culprit in 26-percent of patients who had chronic cough. Once it's found, doctors say treatment works.

In another study, every one of the patients with chronic cough caused by reflux was cured of that cough after surgery.

Web Extra Information:

NEW REFLUX DISEASE BACKGROUND: Heartburn is a common problem, afflicting more than 60 million people in the United States. It's the most common symptom of gastroesophageal reflux disease (GERD). GERD is often treated successfully with over-the-counter or prescription medications. People can often remain symptom-free on these medications; however, the success of those drugs at controlling acid reflux has uncovered a new phenomenon: non-acid reflux disease. "It's a phenomenon that's occurred because of all the drugs that are out there now that control acid so well," Donald Castell, M.D., from the Medical University of South Carolina, explained to Ivanhoe. "They'll stop the acid, but they don't stop the reflux. Now, the acid in your stomach -- what you had for lunch and dinner -- is no longer acidic, but it still can reflux." Many times, some of the symptoms caused by the non-acid reflux are not linked with reflux by patients or doctors. Non-acid reflux disease can cause symptoms that include chronic cough, throat clearing, hoarseness, indigestion, nausea and even asthma.

NEW TOOL DETECTS NON-ACID REFLUX: Doctors have used PH monitoring devices for about 30 years to measure acid reflux disease in patients. The device detects the level of acid that flows into the lower esophagus to determine if a person has acid reflux disease and how frequently there is acid in the esophagus, but there has been no way to measure non-acid reflux disease until now.

Dr. Castell is leading studies that have shown a new measuring device (similar to the standard PH monitoring device) can detect reflux even when there is no acid present. "It's a huge step forward," Dr. Castell said. The new technique is called multichannel intraluminal impedance (MII). It works by measuring electrical resistance in the lower esophagus. Dr. Castell explained, "Whenever you have a reflux coming up from the stomach that puts liquid or even gas in the lower end of the esophagus, the impedance will change and we'll be able to detect it." If a patient is suspected of having non-acid reflux disease, doctors can simply have them wear the MII monitor for 24 hours. There is a tube that runs through the nose, into the esophagus, that stays in place for the full 24 hours. Patients can then push a button on a device that records when they've eaten, when they're laying down or sitting up, and when they have any symptoms like coughing or nausea.

THE BENEFIT: It's true when they say "knowing is half the battle." According to Dr. Castell, once non-acid reflux is finally diagnosed, it can often be corrected. Medications can be used effectively in many patients, but for some, surgery is the answer. In one recent study, surgery fixed non-acid reflux in 93 percent of patients who had it. In a second study in patients who had chronic cough, 100 percent of the patients were treated successfully with surgery after learning their chronic cough was caused by non-acid reflux disease.

 

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