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Acid Reflux – Kenneth Buch, MD Video

[Serious music]

Announcer (V.O.): More than 60 million American adults experience acid reflux and heartburn at least once a month. And about 25 million adults suffer daily from severe reflux. Gastroenterologist, Doctor Kenneth Buch, at Valley Presbyterian Hospital tells us that the improvements in medications for gird have almost ended the need for surgeries for this condition.

V.O. visuals: Photo of middle-aged man holding upper stomach area; Photo of man with fist to area below his chest; clip of male doctor talking with male patient who is rubbing upper stomach and esophagus area; Dr. Buch in studio being interviewed against colorful abstract background; camera pan of exterior of hospital; surgeons operating on patient.

Kenneth Buch, MD: Gird is the disease that we call when people have substantial reflux over an extended period of time and heartburn is a symptom.

Visual: Dr. Buch being interviewed in studio; introduced with title “Kenneth Buch, MD – Valley Presbyterian Hospital – American Health Journal” in lower-third.

Buch (V.O.): Heartburn is caused by stomach juices going back into the esophagus and as we know the stomach makes a great deal of acid. When acid comes into contact with the esophagus, it can cause irritation and that irritation is what we know as heartburn.

V.O. visuals: Motion graphic titled “Healthy Antireflux Valve” shows valve closing to prevent stomach juices from coming up and includes the caption “Valve closes to prevent reflux”;

(visual continued below) avatar of male anatomy including chest and stomach area;

(visual continued below) close-up motion graphic of the stomach and esophogus;

(visual continued below) close-up motion graphic of stomach churning acid upward into the esophagus;

(visual continued below) motion graphic titled “Dysfunctional Antireflux Valve” shows valve staying open, which allows stomach juices to come up. It includes the caption “Valve does not close to prevent reflux.”

Buch: There are certain warning signs people can have with heartburn and gird. And if you have these warning signs you absolutely need to see your doctor. For example if you have evidence of internal bleeding, if you have trouble swallowing, something we call dysphasia, if you have trouble with nausea and vomiting that’s persistent, if you’re taking a medicine for reflux and the symptoms don’t get better is another reason, or if you have weight loss. A lot of time if you have those symptoms…

Visuals: Split screen with the slides “Internal bleeding,” “Trouble swallowing,” “Nausea & vomiting,” “Medicines not effective,” and “Weight loss”

Buch (V.O.): …and see your general doctor, he’ll often times refer you to a Gastroenterologist, someone like me. The reason they do that is that gird, untreated, can sometimes give rise to damage of the esophagus.

V.O. visual: doctor pressing lightly on stomach area of male patient lying on his back; Dr. Buch showing a male patient an endoscope device that he uses to see inside the stomach; nurses prepare equipment for the procedure.

Announcer (V.O.): Dr. Buch discusses the risk factors for gird.

V.O. visual: Female nurse takes the blood pressure of an overweight female patient.

Buch (V.O.): Obesity is a predisposing factor to reflux and the reason is that obesity causes increased pressure in the abdomen and that pushes stomach juices up into the swallowing tube where it can cause irritation.

V.O. visuals: Nurse continues to take blood pressure; close-up of scaled in medical office; close-up clips of the stomachs of obese and overweight people as they walk along city streets.

Buch: So there is a correlation between increasing risk of esophageal adenocarcinoma and obesity.

Announcer (V.O.): Treatment for reflux starts with lifestyle changes and then medications.

V.O. visuals: Close-up of hands picking up a slice of pepperoni pizza; middle-aged man in restaurant picks up slice and eats it; close-up of palm of hand holding purple pills.

Buch: If the non-drug measures don’t help such as losing weight, elevation of the head of the bed, avoiding meals before bedtime, avoiding certain foods that are triggers such as chocolate, coffee, alcohol, spicy foods, tomatoes, citrus. If those things don’t work, then you have to think about going on medications. Now, the medications that have been around the longest are antacids.

Visuals: Text over background including “Lose weight,” “Elevation of the head of the bed,” “Avoid meals before bedtime,” “Avoid certain foods”

Buch (V.O.): The downside of those is that they’re very short-acting. They only temporarily give relief of heartburn. The next step up, in terms of strength of medication are something called histamine 2-receptor antagonists.

V.O. visuals: Camera pan of various bottles of antacid medication on a counter including Pepto-Bismol, Zantac, Maalox, Rolaids, Mylanta, Gaviscom and others.

Buch: The downside of those medications is that people get tolerance to them. After being on them a number of weeks or months, their efficacy decreases. The strongest medications for reflux symptoms are…

Buch (V.O.): …what we call proton pump inhibitors. The stomach makes acid. It makes acid through proton pumps that are in stomach cells. And there are medicines now available that block those proton pumps. And those things turn off the pump and dramatically decrease acid. The vast majority of patients get relief of their symptoms from taking those medications.

V.O. visuals: Dr. Buch with a nurse in the exam room preparing for an endoscope procedure; patient lying under blankets on her side with a device in her mouth to receive an endoscope, a flexible tube with a lighted camera attached; Dr. Buch inserts the tube; close-up of the inside of the woman’s stomach; photo of a package of Prilosec medication with its tagline “The Round-The-Clock Heartburn Blocker”; photo of Nexium packages on a store shelf; photo of an elderly couple with pills on a table; photo of fingers holding a pill next to a water glass.

Buch: Before we had proton pump inhibitors, it was very common that people would have serious complications of…

Buch (V.O.): …gird, such as if they had ulcers, which would bleed. They could develop strictures, or narrowing, and sometimes people needed repeated dilation, repeated stretches of the esophagus to even allow them to eat. And sometimes people even wound up with major surgeries to treat these problems and complications of reflux. Well, now in this day and age…

V.O. visuals: Dr. Buch holding endoscope; close-up of endoscope; close-up of inside of a stomach; Dr. Buch turning dials on the endoscope; nurse prepares for endoscope procedure.

Buch: …it’s pretty rare that we see someone who needs surgery. Pretty much the medications have done away with the need for surgery except in fairly unusual situations.