Dr. Eisner Answers Your GERD Questions
I have acid reflux and I am concerned about undergoing anesthesia for an upcoming procedure. Am I at increased risk of aspiration?
While acid reflux disease does increase the risk of aspiration in patients undergoing anesthesia, as long as your reflux is controlled you should be okay. While you should check with your surgeon, who in turn may want to check with the anesthesiologist, it will be best to take your reflux meds the morning of surgery with a small sip of water. Also, insure that you have nothing to eat or drink (other than perhaps your medications) well before bedtime the night before surgery. This will increase the chance of having an empty stomach at the time of surgery.
I have Barrett's esophagus and take a daily Prilosec to control my heartburn. My internist ordered a bone density test and it came back very low. She wants to start me on Actonel. Is this safe with my Barrett's?
Your question raises many issues and they all have to do with risk and benefit. As most of you who read this site are aware of, Barrett's esophagus is a precancerous condition of the esophagus causes by acid exposure. As to your question, first off, proton pump inhibitors such as Prilosec are beneficial in preventing esophagitis and possibly the development of longer segments of Barrett's esophagus. There is however some data that shows that long-term use of proton pump inhibitors can decrease bone density. It is therefore recommended that long-term proton pump inhibitors only be used in patients who need it to control symptoms.
Since you have Barrett's esophagus which is precancerous, you should be taking your Prilosec regularly. Medications used to prevent and treat osteoporosis such as Actonel can cause esophagitis. They therefore need to be used with caution, especially in patients with a history of esophagitis and or Barrett's esophagus. Your internist should speak with your gastroenterologist and your rheumatologist to best determine your risk-benefit of taking the medication. As long as your heartburn is controlled and your Barrett's is stable without dysplasia, it would likely be reasonable for you to continue therapy with Prilosec and begin the Actonel, watching for gastrointestinal symptoms. You should take the Actonel first thing in the morning with a full glass of water and do not lie down or recline within an hour of ingesting the pill, to minimize the chance for esophageal problems.
I have mitral valve prolapse and will be undergoing an endoscopy. Do I need to take antibiotics as I do when I go to the dentist?
For many years, antibiotics were administered to patients prior to endoscopy in patients with mitral valve prolapse due to the risk of developing infective endocarditis. The most recent recommendations of the American Society of Gastrointestinal Endoscopy now state that antibiotic prophylaxis is not indicated to prevent infective endocarditis. This is even true for such high risk patients such as those with a prosthetic valve or those with a prior history of endocarditis. Similarly, there is no indication to administer antibiotics prior to upper endoscopy in patients with vascular grafts and other nonvalvular cardiac devices such as defibrillators and pacemakers.
These recommendations are based on recent recommendations by the American Heart Association, and were developed because among other reasons, there have been no reported cases of infective endocarditis after GI endoscopy and the fact that there is more bacteria in the blood when one brushes their teeth, than as a result of a GI endoscopy. Of course, you should check with your physician as there may be other reasons why antibiotics might be required.