September 3, 2023 • 27 mins
The Healthy Matters Podcast
S02_E19 - Feeling the Burn. Talking Upper GI Health with Dr. Jake Matlock.
BBQ! Hot salsa! Gas station sushi! What do they have in common? Well, they're not exactly health foods. But that doesn't mean we don't (or won't) eat them when we crave them. And, as we all know, sometimes they punch back...
On Episode 19, we're joined once again by Hennepin Healthcare's Dr. Jake Matlock to break down the causes and effects of heartburn, acid reflux (or GERD), ulcers, and the like. These are conditions that we all fall victim to every once in a while, and for many of us, they can have a very large impact on our day-to-day. We'll go over the origins, diagnoses, and treatment options, as well as the best bets for maintaining a healthy gut. Join us!
Got a question for the doc? Or an idea for a show? Contact us!
Email - healthymatters@hcmed.org
Call - 612-873-TALK (8255)
Find out more at www.healthymatters.org
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Speaker 2 (00:04):
Welcome to the Healthy Matters podcast with
Dr. David Hilden , primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, healthcare
and what matters to you. Andnow here's our host, Dr. David
Hilden .
Speaker 3 (00:21):
Hi everybody. It's Dr. David Hilden, your host of
the Healthy Matters podcast.
Welcome to episode 19 where weare going to explore your upper
GI tract. You ask what that is?
Well , we're gonna find out. Soit's a holiday weekend and
hopefully you're gettingtogether with family and
friends, or you're enjoying theunofficial last few days of
summer. Many of those holidaygatherings revolve around the
(00:42):
grill and food that we allenjoy. However, for some of us,
these foods bring on heartburn,gastric reflux. Maybe some of
us can't even enjoy ourfavorite foods 'cause we're
suffering from ulcers. Ontoday's episode of the podcast,
I am joined once again bygastroenterologist, Dr. Jake
Matlock, who is gonna help usunderstand what all these
ailments are, what causes them,and the best ways to prevent
(01:04):
them. Thanks for being back onthe show, Dr. Matlock.
Speaker 4 (01:07):
Glad to be here, David.
Speaker 3 (01:08):
Okay, Jake, let's start talking about sort of the
basics. What causes upsetstomach or indigestion?
Speaker 4 (01:16):
Well, the short answer, David, is that there's
not one cause. As with many ,uh, symptoms that people have,
there are a number of thingsthat can cause you to have an
upset stomach. Some of them arepredictable and transient. Uh ,
I think all of us know thatthere's certain foods that
don't agree with us. And, and,you know, maybe we like those
foods and we choose to eat themsometimes and decide that, hey,
you know, it's worth it todayto have that hamburger or to
(01:39):
have that , uh, uh, chilipepper. Uh, others , uh, uh,
are more persistent and notnecessarily related to the
foods that we eat. And, andthat's, that's when things
start to get more concerningand potentially more serious.
Speaker 3 (01:52):
So some of it could be what we eat, but not all of
it. So with that gas stationsushi I had the other day, was
that, was that a good idea?
Speaker 4 (01:59):
Yeah. And then , and you may know that for you gas
station sushi is gonna upsetyour stomach and you may decide
today that's worth it for me.
'cause I really want that gasstation sushi. Mm-hmm.
. Uh, and that'sokay. Uh, you know, once you
know that about yourself , uh,it may not be a good idea to do
it all the time, but on anoccasion, you know, a dietary
indiscretion that you pay forfor , uh, an hour or so
(02:22):
afterwards is not the end ofthe world.
Speaker 3 (02:24):
I wanna delve into that. Um, and you use the term
that I use all the time. It'sthe doctor term dietary
indiscretion is, is the doctorterm for what we always say
that for . You probablyshouldn't eaten that, but
, you're gonna livewith the consequences. There is
a local , uh, Mexican Americanrestaurant in Delta ,
Minneapolis that I've beengoing to for 40 years, and I'm
(02:44):
not gonna name it , um, but ithas the best salsa in the
world. Every time I eat thissalsa I have this. And I I've
even said to myself, it wasworth it. Yeah. So what is
happening to your stomach whenyou eat, say, a really spicy
food? Uh, uh, what is happeningin , uh, physiologically in
your body?
Speaker 4 (03:02):
So your stomach's a pretty hostile environment in
general. And , uh, you know,it's, it's basically a big bag
of muscle that is full of anacidic soup. And, and its job
is to take the food that youeat, whatever you decide to put
into it, break it down withacid, and then using the muscle
, uh, of the stomach wall tomix and grind and break those
(03:26):
particles of food into smallerparticles that can then be
transmitted down further intoyour digestive tract. Once you
get down further, that acidgets neutralized and, and the
magic of absorption happens.
But in that hostile environmentof the stomach, if you're
adding in more things that makethe environment more acidic or
(03:46):
more caustic, then the normalprotective lining of the
stomach may not be enough to,to fully protect you from
symptoms. Now, whether thosesymptoms signal something
that's actually causing damageis a whole nother question
entirely. But that's whatyou're feeling. Uh , when ,
when you get that heartburn,indigestion, acid reflux, upset
stomach. So
Speaker 3 (04:06):
Your stomach, why doesn't it get damaged
permanently by all this acid inthere? Why doesn't like self
digest itself?
Speaker 4 (04:13):
So your stomach lining secretes a , a mucus ,
uh, that coats the lining andprotects it from its own acid.
And there are things , uh, thatcan break down that mucus
lining and break down thatprotective barrier. Certain
medications can do it , uh, aninfection with a , an organism
called h pylori can do it. Uh ,but in general, your stomach is
(04:36):
able to coat its own lining andprotect itself from itself.
Speaker 3 (04:39):
So let's talk about that. The word heartburn Yeah.
Um, that people sometimes get.
Is that what we're talkingabout here? Or is that a
distinct separate thing? Andwhy do we call it that
Speaker 4 (04:48):
? So, so
that is, at least from a
medical perspective, a separatething. It's often hard to
distinguish , uh, when you're,when you're talking to somebody
about symptoms. 'cause youknow, often , uh, what we are
experiencing as a person whenwe're having these symptoms is
pain. That's somewhere fromright underneath our breast
bone radiating up to somewherebetween our, our collarbones.
(05:10):
And, you know exactly where itis and exactly how long it
lasts and whether it movesaround. It helps us as
clinicians to, to give it alabel. I'm not certain that
those labels are thatmeaningful. Mm-hmm .
, you know, it ,it hurts. Uh, and , and that's
really what matters. And it's,and most of the symptoms are
felt to be, at least to somedegree, related to the acid in
(05:31):
the stomach. When we talk aboutheartburn, classically what
we're talking about is, is painrelated to the movement of
contents from your stomach upinto your esophagus or
swallowing tube. That, thattube that runs through your
chest from your mouth down toyour stomach. So
Speaker 3 (05:48):
Reflux.
Speaker 4 (05:49):
Yeah. Well , usually yes. Yeah . And, and , and
that, that structure, yourswallowing tube, your esophagus
doesn't have the same kind ofprotective mucus coating that
your stomach does. It's, it'snot well suited to be acid
resistant. So when it's exposedto the contents of your
stomach, it hurts.
Speaker 3 (06:07):
Right? So we're gonna delve into acid reflux as
a specific entity in just a fewminutes. But before we do,
there's all kinds of things youcan buy at the store. Plop,
plop, fizz . Fizz .
Speaker 4 (06:18):
Yeah . Soer . What a relief. Well ,
Speaker 3 (06:20):
What a relief it is.
Many of us remember thatcommercial not to like , uh,
tell one particular product,but there's that, there's Pepto
Bismol, there's all these otherthings, and we're gonna get
into some of them more as theshow wears on. But just lay the
, the groundwork for us onthose remedies. Are they
helpful?
Speaker 4 (06:36):
So they are helpful and, and choosing amongst them
and when it's appropriate touse one versus the other is the
tricky part. And, and, youknow, the marketing that , uh,
goes along with it doesn't,doesn't make that choice any
easier for people. I think ,uh, what all of the medicines
do, and, and here I'm talkingabout Tums , ALCA , seltzer,
(06:57):
Malo , uh, Pepcid , Prilosec ,omeprazole, all of these things
are medications that areintended to change the balance
of the acidity in whatever isin your stomach. None of them
change the fact that thingsreflux up into your esophagus.
They don't alter that at all.
They just change what's in thesoup. What's important to
(07:19):
understand about the drugs ishow much they can change what's
in the soup and how quicklythey can change it. So
something like Alca Seltzer orToms or Rolaids , those are
products that are bufferingagents. They can rapidly change
an acid into a less acidicmixture. So they work quickly.
So if you've
Speaker 3 (07:39):
Got within
Speaker 4 (07:39):
Minutes. Minutes, yeah. Yeah . So if you want, if
you want relief right now,that's where you should go. If
you've got some time, if you,you know, can wait 15 minutes,
30 minutes, an hour, you mightwant to go with a medication
like Pepcid or Ranitidine.
These are medications that havealso been around for a long
time. They also reduce theacidity , uh, of your stomach
(08:01):
secretions, but they takelonger to work. And then the ,
the most popular and andprobably most potent drugs that
we have are, are a class ofdrugs called proton pump
inhibitors. And omeprazole orPrilosec, the most common of
those, those are the mosteffective at reducing the acid
content of your stomach. Butthey take a long time to work.
(08:21):
Typically, they reach maximaleffect after a period of a few
days of exposure. And so if youwant relief right now, pop in a
PRIs X , probably not your mosteffective , uh, move.
Speaker 3 (08:33):
That's a good time for me to pivot then to gerd,
gastroesophageal RefluxDisease. Many people experience
this, you've touched on italready, but tell us a little
bit what is happening in acidreflux disease?
Speaker 4 (08:47):
All of us have a barrier between our esophagus
or swallowing tube and ourstomach. And that barrier is
very smart, but imperfect.
Speaker 3 (08:56):
Hey, I think mine's perfect. Yours
Speaker 4 (08:57):
Is perfect.
Everybody else's is smart, butimperfect , uh, what I
mean by that is it's, it'ssmart in that it has, this
barrier has to open when youswallow food to allow food to
get into your stomach. Mm-hmm .
. And then it hasto know when to open and, and
then rapidly close after thefood passes. What I mean by
imperfect is that nobody'sbarrier completely prevents
(09:19):
contents of the stomach frommoving up into the esophagus.
All of us have that happen tosome degree with some
frequency. Some of us,particularly if the contents of
our stomach are particularlyacidic or caustic, will feel
that when it happens. Now, whenthat happens, our esophagus
responds by, by squeezing and,and pushing things back down
(09:40):
into the stomach. And, and thatsqueezing and pushing function
can become impaired. So we maynot do that as well as we did
when we were 18. And some of ushave a more imperfect valve.
And so we get more frequentepisodes of stuff washing back
up into our esophagus. And ifit's enough to bother us enough
to bring us to the attention ofa healthcare professional, we,
(10:01):
we may get labeled as havingGERD or reflux disease. Um ,
but it's, it's really a problemof, of quality, not quantity
necessarily.
Speaker 3 (10:10):
So how do you know if it's serious, if, if, if
some of us every now and thenget a little upset tummy, a
little indigestion and a littleheartburn, but it happens
really rarely. Maybe it's notso serious, however, it can be.
Right? How do you know whenit's serious? There
Speaker 4 (10:24):
Are certain alarm features that we look for, that
signal the need to look into ita little more deeply. So as you
said, if you get a little bitof heartburn every once in a
while, you know, it passes withsome time. Or maybe by drinking
something that's non acidiclike some milk. Or you take a
tums and it goes away and thenyou don't think about it for
(10:45):
several weeks until you have,you know, more of that gas
station sushi perhaps. Thenit's probably nothing to worry
about. We do start to getworried if it's persistent,
it's happening more than once aweek. It's happening really
without an identifiabletrigger. If you've lived your
whole life and it's neverhappened to you before, and now
all of a sudden it's happeningall the time, if it's a
(11:06):
significant change for you ,that's concerning. And then
other things which are a littlebit more obvious, you know, if
you're throwing up blood or ifyou are, you know, losing 20
pounds without trying to, or iffood's getting stuck and is not
going down , uh, and you're notable to get food to your
stomach, those are things thatwould bring most people to the
doctor. But if, if not, that's,that would be recommended.
(11:27):
Okay.
Speaker 3 (11:27):
So what happens in chronic acid reflux disease if
you don't treat it?
Speaker 4 (11:32):
So it, it depends on how frequently it's occurring
and how much acid the esophagusis being exposed to. Uh, some
people can have occasionalheartburn or , or acid reflux
for their entire lives, decidethey're just gonna live with it
and do fine. That doesn't makeme happy. There are things we
can do to make people feelbetter that, that, that I wish
that they would let us help 'emwith. But it's not necessarily
(11:54):
something that shortens yourlife or ends your life or leads
to problems. The concern,though, is that for some
people, it, it does do thosethings. And so if you have
persistent acid exposure and itis a, a, a problem that is
causing you symptoms on afrequent basis, getting it
evaluated is probably a goodidea. And the things that we
would be worried about would beburns to the esophagus from
(12:16):
acid scarring from repeatedcycles of burns and healing and
burns and healing the creationof strictures or narrowings
from scar tissue build up inthe esophagus. And even
occasionally the developmentof, of cancers of the esophagus
from chronic inflammation. Now,and I don't wanna be alarmist,
those cancers are not terriblycommon, but they do occur And,
(12:37):
and talking to a healthcareprofessional about your
symptoms and trying to figureout do they merit further
evaluation is probablyimportant if you're, if they're
continuing to bother you. We'regonna
Speaker 3 (12:46):
Talk about how you do diagnose these things and
about what's an endoscopy andall that after the break.
Before we do that, one lastquestion about treatments.
People take medications ongoingfor a long period of time and
they can get relief of theirsymptoms. Is there any problem
with doing that, takingmedications for the long term ?
Speaker 4 (13:05):
So I think the important thing if you're gonna
be taking a medication for thelong term is understanding what
it is that you're doing, whyyou're taking it. And with
medications for upper digestiveproblems, there are two
separate reasons to be on them.
One is to make you feel better,to make the symptoms go away,
and that's fine. The other isto try to protect you from some
future bad thing, some badhealthcare consequence of not
(13:29):
being on the medicine. Thosegoals are not always aligned
with one another. So somepeople have conditions of their
upper digestive tract, and I'lltell 'em, you know, you need to
take this pill every day toprotect yourself from something
bad in the future. And they'llsay to me, you know, I don't
feel any better or worse if Itake this. And so it's
important for me to be able toclarify with them that I get
it. I know this doesn't make adifference how you feel. I'm
(13:52):
trying to protect you from thebad thing in the future.
Others, again, Prilosec is agood example. I got plenty of
patients who take a Prilosecevery day to prevent or lessen
the severity of theirheartburn. If they miss a
couple of days, they pay forit. You know, maybe I've looked
in their stomach, maybe Ihaven't. And, and I know that
they don't have any damage downthere. They're not at risk for
anything in the future, butit's okay for them to continue
(14:14):
to take that 'cause it doesmake 'em feel better. So I
think really clarifying what itis that you're shooting for and
understanding what the goals ofthat therapy are is important
in determining whether or notyou should stay on it.
Speaker 3 (14:25):
We're talking with Jake Matlock. He is the
division director ofGastroenterology here at
Hennepin Healthcare . And we'vebeen talking about disorders of
your stomach and esophagus.
When we come back, we're gonnatalk about ulcers, endoscopies,
and Jake's best tips forstaying healthy. Stay with us.
We'll be right back.
Speaker 2 (14:43):
You are listening to the Healthy Matters podcast
with Dr. David Hilden . Got aquestion or comment for the
doc, email us at Healthymatters@hcme.org or give us a
call at six one two eight seventhree talk. That's 6 1 2 8 7 3
8 2 5 5. And now let's get backto more healthy conversation.
Speaker 3 (15:06):
And we're back talking about your upper GI
tract with Dr. Jake Matlock.
Jake, what's a gastric ulcer?
Speaker 4 (15:13):
So as we were talking about earlier, the
stomach has a mucus lining thatprotects it from its own acid,
and sometimes that mucus canbreak down. And if that
happens, then the tissueunderneath the mucus gets
exposed to the acid and thattissue then becomes injured.
That injury impairs the abilityof the stomach lining to make
(15:35):
more mucus. And so it becomeskind of a self-perpetuating
cycle of inflammation, injuryand damage. And over time, the
acid will then eat away andcreate a divot in the lining of
the stomach. So an ulcer isreally like a divot or a chunk
that's taken out of the lining,exposing what's underneath the
lining, which is muscles andblood vessels and, and the
(15:57):
like. That number one can bevery painful. Uh, so many
patients who have ulcers will,will suffer a lot of, of pain
and and misery from them . Andnumber two can lead to worse
problems like bleeding fromulcers , uh, because the blood
Speaker 3 (16:11):
Vessels get
Speaker 4 (16:11):
Exposed because the blood vessels get exposed and
they're not acid resistant.
Yeah . So they , they will openup and bleed, or even if it's
very severe , uh, can wear ahole entirely through the
stomach and create what'scalled a , a perforation, which
is a surgical emergency. Soreally bad that can be very
Speaker 3 (16:27):
Serious. How does someone know they might have an
ulcer? What would be thesymptoms?
Speaker 4 (16:31):
So classically we think of ulcers as causing pain
in the upper part of your , uh,abdomen or stomach. So
somewhere underneath your ribcage. And that pain is
classically described as worsewhen your stomach is empty and
better when you put certainthings into it. Most notably,
things that are not acidic.
(16:52):
People who , uh, have kind ofconstant upper abdominal pain
that's achy and quality andthen, you know, maybe they'll
drink milk or toms or what haveyou , and , and that'll make it
a little better. But then onceyour stomach's empty again,
it'll come back. And over timethat aching pain will progress
and hopefully eventually , um,person will go and see somebody
about it. Are
Speaker 3 (17:13):
We all susceptible to this or who gets it? Um ,
you mentioned some, someunderlying factors that might
lead to
Speaker 4 (17:19):
It. So there are things that can make you more
at risk for getting it. Mostnotably there are medications
that you may be taking forother things. Uh, the most
noteworthy of those are, aredrugs from a class called
nonsteroidal anti-inflammatorydrugs. And that's a long-winded
way of talking about thingslike aspirin and Motrin and
ibuprofen, not Tylenol, but theother over-the-counter pain
(17:42):
medications can put you at riskfor this. There's also , uh, an
infection with a a , a bacteriacalled helicobacter pylori or h
pylori, which is a common causeof ulcer disease. It lives in
the mucus lining , uh, of yourstomach and breaks that mucus
lining down , uh, but makingyou more susceptible to ulcers.
(18:03):
There are certain conditionsthat can affect the blood flow
to the stomach's lining thatimpair its ability to make
mucus. Uh , the most common ofthose is smoking. The
Speaker 3 (18:12):
Other one more reason not to smoke.
Speaker 4 (18:14):
Yeah. Yeah. They're , they're seemingly endless.
Um, the other environmentalexposure that, that , uh, can
impair the stomachs lining andmaking more susceptible to
ulcers is alcohol. Uh , sopeople often ask about spicy
foods if that's a cause ofulcers and it , and it's really
not. It, it can cause you tofeel your ulcers mm-hmm .
if you have 'em .
(18:34):
And, and so spicy foods may bebringing to your attention
something that's alreadyhappening, but they're not the
driving cause or the underlyingcause of ulcer .
Speaker 3 (18:42):
That's an interesting distinction. I do
hear that all the time.
Absolutely. People say, youknow, it's when I eat things,
but all these other things areequally important risk factors
for ulcers. Yeah. Okay. So howdo you diagnose it? How do you
diagnose all these things? For
Speaker 4 (18:55):
Some of them we can, we can make a diagnosis based
on a careful history talking topeople and maybe even a trial
of a medication to see if theyrespond to it. Sometimes that's
sufficient to say, yep , thisis what's going on and, and
here's how we're gonna fix it.
However, in a lot of , uh,circumstances it is, IM
important to actually look inthe stomach and swallowing tube
to see what's going on. In thesame way that it's important
(19:17):
for your cardiologist to pulltheir stethoscope out and
listen to your heart. As agastroenterologist, a lot of my
physical exam, a lot of what Ido to examine a person is
actually looking in theirintestinal tract at the organ
that we're worried about. Andso endoscopy with a flexible
scope is, is how a lot of thesethings are diagnosed. A lot
Speaker 3 (19:38):
Of people know about the colonoscopy, and if you
don't, I will refer you back tothe podcast episode earlier
this season with Dr. Matlock.
But what does endoscopy looklike for these conditions for
ulcers and reflux?
Speaker 4 (19:51):
So endoscopy refers to using a flexible tube with a
light and a camera at the endof it to go through your mouth
into your swallowing tube,stomach and small intestine to
look around. The tube that weuse is about the size of your
pinky. So it's smaller thanmost food that you would
swallow. It's got, as I said,has a light in a camera on one
(20:12):
end and a steering wheel on theother. To do this , uh, we do
typically sedate people. I'veknown people who've done it
without sedation. It's uncommonand I wouldn't , it
Speaker 3 (20:22):
Sounds uncomfortable, Jake. Good
Speaker 4 (20:23):
Grief. Yeah. I wouldn't recommend it, but it
has been done. But for most ofus , uh, to get an endoscopy,
we get some medications throughan IV that will sedate us, make
us very sleepy , uh, so thatwe're unaware or unconcerned
about anything that's going on.
And then the tube goes throughour mouth and down into the
stomach I can steer the tubethrough the entire swallowing
(20:45):
tube stomach and first part ofthe small intestine and look at
the lining of that entirestructure. With that, we can
tell if you have inflammation,damage from your reflux. We can
tell if you have ulcersequally. And maybe even more
important, we can see if youhave any evidence of
precancerous changes or even anactual tumor or cancer. So ,
Speaker 3 (21:06):
So it looks differently. You are looking on
a screen and, and it looksdifferently. Pre-cancerous
changes or esophagealinflammation, the , the effects
of reflux. You can see that
Speaker 4 (21:17):
Absolutely. And, and, and again, for many people
who have reflux, the effectsare nothing. The , their exam
will be normal . And that'ssometimes a little
disappointing for people 'causethey're, they're highly
symptomatic. They've , they'refeeling a lot of pain and you
got
Speaker 3 (21:31):
Nothing on
Speaker 4 (21:31):
Exam. And I tell 'em, everything looks normal.
That's actually good news andactually a pretty normal
finding as you know , as wewere talking about before, we
all have an imperfect valve tosome degree or another. And
when I tell people that theirexam is normal, that doesn't
mean they're not having reflux.
It means they're not sufferingdamage from it and they're not
at risk for future healthproblems from, it doesn't make
it any less miserable, but itmeans that there's not an
(21:54):
additional thing to worry aboutin terms of a future
consequence.
Speaker 3 (21:57):
What does an ulcer look like? So
Speaker 4 (22:00):
When I described it earlier as a divot, part of the
reason that I said that is'cause that's literally what it
looks like. If you think of a ,a tub of ice cream that you've
taken one spoonful out of andyou've got a , you know, a
little dent in the top of thattub of ice cream, that's kind
of what an ulcer looks like.
Now at the base of that dent,it's gonna look red and
inflamed and the edges aregonna be kind of heaped up and,
(22:21):
and angry looking . It's, it'snot subtle. It's easy to
recognize and, and , uh, you
Speaker 3 (22:27):
Probably think it looks cool. I've often teased
Jake about what he does for aliving. He puts tubes in and
looks inside your intestines.
And, and, and let's be honest,to the average listener, it
sounds a little bit, there's alittle bit of an eew factor .
So if you do find things onthese , uh, endoscopy exams,
there are treatments availableand people can , uh, do well,
(22:47):
right?
Speaker 4 (22:48):
Yeah. The overwhelming majority of
findings , uh, on an endoscopyare things that we can respond
to with alterations in aperson's medical regimen. Often
on a temporary basis, not aforever basis , uh, to get
those things to resolve orheal. There is typically , uh,
uh, also things that we can doto try to help people to
(23:09):
prevent them from coming back.
Uh , 'cause that's, that'sanother important factor. We
don't want you to be back inthe same circumstance a year
down the road.
Speaker 3 (23:15):
So many people have these things that we've been
talking about both reflux andulcers. And I really appreciate
you giving us some tips onthese topics. Before I let you
go, Jake, what tips would youleave our listeners about upper
GI health?
Speaker 4 (23:29):
So the most important thing I think that
all of us should think about interms of our upper
gastrointestinal tract healthis eating food, not chemicals.
Uh, you , you know, we, you andI were joking earlier about gas
station sushi and I , I'mguilty as charged. I pick it up
sometimes too , no questionabout it. But by and large, if
you're eating food that startsout as a whole food, like a
(23:51):
plant, and you're preparing ityourself, turning it into a
meal, you're gonna be betterserved. That's gonna give you
more of a plant-based diet.
It's gonna give you more fiber,which is, is good for your
entire digestive tract as wellas the rest of your body. Uh,
it's gonna limit your exposureto added sugars and other
chemicals and preservativeswhich have deleterious effects
on your health all around. Sothat's, that's the biggest
(24:14):
thing. Eat food, mostly plants.
Speaker 3 (24:15):
It's so interesting you say that because I have a
lot of specialists on thisshow. It's a theme that kind of
comes up. You didn't say cometo see me so I can put a scope
down your throat as the firstthing. Um, you talked about
what, what can lead to these?
And then your biggest tip is toput healthy whole foods in your
body, I find to be fascinatingand frankly spot on . So I I
(24:37):
really appreciate that. Allright . What else should we
keep in mind?
Speaker 4 (24:40):
Well, you know, keeping your digestive tract
moving in a , a forward , uh,manner is important. And the
best way to do that is to keepyour body moving. Uh , and
getting up, moving around is,is healthy. Not again, not only
for the rest of your body, butfor your digestive function.
Speaker 3 (24:55):
How about any other things people can do in their
lives, maybe non-medicaltreatments , uh, to prevent
reflux or the things we'vetalked about?
Speaker 4 (25:03):
Sure. So particularly with regards to
reflux, as we were talkingabout earlier, the thing that
drives reflux is the movementof gastric contents or stomach
contents up into the swallowingtube. And whereas we don't have
an easy way to fix the valve,we can take advantage of
gravity. And so things likemaking sure that you're sitting
upright when you eat, not lyingdown shortly after eating. For
(25:24):
some people, even raising thehead of their bed , uh, to a 20
to 30 degree angle to try touse gravity to keep things down
in the stomach can be helpful.
Uh, those are rarely home runtherapies that are really the
things that, that, that willcompletely solve a problem. But
they can help to some degree.
Speaker 3 (25:41):
I knew a guy who had a wedge put into under the
sheet of his bed, so it was,the thing was elevated 'cause
he had bad refluxes. There'sactually products people can
buy, but you don't even have todo that. Right. Can't you just
put a big book under theheadboard or
Speaker 4 (25:53):
Something? Yeah. I mean, I think the important
thing to understand there is,is that you wanna make sure
that you're not , uh, uh,crunching your abdomen. And so
it's probably not good to besleeping on two or three
pillows if that's the problemyou're trying to solve. 'cause
that's just gonna kind ofcompress your abdominal cavity
and, and change the pressure insuch a way that you might be
making things worse. Yeah . You
Speaker 3 (26:12):
Don't wanna bend at the waist sort of while you're
sleeping.
Speaker 4 (26:15):
Right. So putting a , we used to say phone books. I
don't think they make thoseanymore .
Speaker 3 (26:18):
I know the big old Minneapolis phone book. I
remember those. But
Speaker 4 (26:21):
A , a brick under the, the headboard of your bed
to, to, you know , raise thewhole bed or put the whole bed
at an angle is, is really moreof what you're going for. We've
Speaker 3 (26:29):
Been talking with Dr. Jake Matlock about reflux
disease ulcers and all thingsabout your upper intestinal
tract . Jake, thanks for beingon the show today. It's been a
great show. Yeah, it's
Speaker 4 (26:38):
Been fun. Thanks.
Speaker 3 (26:39):
Glad to have you on.
If you missed Dr. Matlock'sprevious episode with us, go to
the archives. He talks aboutyour lower intestinal trek . In
other words, your colon. You'renot gonna wanna miss that
episode. Thank you for joiningus for this episode, and I hope
you'll tune in next time. Inthe meantime, be healthy and be
well.
Speaker 2 (26:57):
Thanks for listening to the Healthy Matters podcast
with Dr. David Hilden . To findout more about the Healthy
Matters podcast or browse thearchive, visit healthy
matters.org. You got a questionor a comment for the show?
Email us at Healthymatters@hcme.org or call 6 1 2
8 7 3 talk. There's also a linkin the show notes. And finally,
(27:20):
if you enjoy the show, pleaseleave us a review and share the
show with others. The HealthyMatters Podcast is made
possible by Hennepin Healthcarein Minneapolis, Minnesota, and
engineered and produced by JohnLucas At Highball Executive
Producers are Jonathan, CTO andChristine Hill . Please
remember, we can only givegeneral medical advice during
this program, and every case isunique. We urge you to consult
(27:41):
with your physician if you havea more serious or pressing
health concern. Until nexttime, be healthy and be well .
Speaker 2 (00:04):
Welcome to the Healthy Matters podcast with
Dr. David Hilden , primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, healthcare
and what matters to you. Andnow here's our host, Dr. David
Hilden .
Speaker 3 (00:21):
Hi everybody. It's Dr. David Hilden, your host of
the Healthy Matters podcast.
Welcome to episode 19 where weare going to explore your upper
GI tract. You ask what that is?
Well , we're gonna find out. Soit's a holiday weekend and
hopefully you're gettingtogether with family and
friends, or you're enjoying theunofficial last few days of
summer. Many of those holidaygatherings revolve around the
(00:42):
grill and food that we allenjoy. However, for some of us,
these foods bring on heartburn,gastric reflux. Maybe some of
us can't even enjoy ourfavorite foods 'cause we're
suffering from ulcers. Ontoday's episode of the podcast,
I am joined once again bygastroenterologist, Dr. Jake
Matlock, who is gonna help usunderstand what all these
ailments are, what causes them,and the best ways to prevent
(01:04):
them. Thanks for being back onthe show, Dr. Matlock.
Speaker 4 (01:07):
Glad to be here, David.
Speaker 3 (01:08):
Okay, Jake, let's start talking about sort of the
basics. What causes upsetstomach or indigestion?
Speaker 4 (01:16):
Well, the short answer, David, is that there's
not one cause. As with many ,uh, symptoms that people have,
there are a number of thingsthat can cause you to have an
upset stomach. Some of them arepredictable and transient. Uh ,
I think all of us know thatthere's certain foods that
don't agree with us. And, and,you know, maybe we like those
foods and we choose to eat themsometimes and decide that, hey,
you know, it's worth it todayto have that hamburger or to
(01:39):
have that , uh, uh, chilipepper. Uh, others , uh, uh,
are more persistent and notnecessarily related to the
foods that we eat. And, andthat's, that's when things
start to get more concerningand potentially more serious.
Speaker 3 (01:52):
So some of it could be what we eat, but not all of
it. So with that gas stationsushi I had the other day, was
that, was that a good idea?
Speaker 4 (01:59):
Yeah. And then , and you may know that for you gas
station sushi is gonna upsetyour stomach and you may decide
today that's worth it for me.
'cause I really want that gasstation sushi. Mm-hmm.
know that about yourself , uh,it may not be a good idea to do
it all the time, but on anoccasion, you know, a dietary
indiscretion that you pay forfor , uh, an hour or so
(02:22):
afterwards is not the end ofthe world.
Speaker 3 (02:24):
I wanna delve into that. Um, and you use the term
that I use all the time. It'sthe doctor term dietary
indiscretion is, is the doctorterm for what we always say
that for . You probablyshouldn't eaten that, but
a local , uh, Mexican Americanrestaurant in Delta ,
Minneapolis that I've beengoing to for 40 years, and I'm
(02:44):
not gonna name it , um, but ithas the best salsa in the
world. Every time I eat thissalsa I have this. And I I've
even said to myself, it wasworth it. Yeah. So what is
happening to your stomach whenyou eat, say, a really spicy
food? Uh, uh, what is happeningin , uh, physiologically in
your body?
Speaker 4 (03:02):
So your stomach's a pretty hostile environment in
general. And , uh, you know,it's, it's basically a big bag
of muscle that is full of anacidic soup. And, and its job
is to take the food that youeat, whatever you decide to put
into it, break it down withacid, and then using the muscle
, uh, of the stomach wall tomix and grind and break those
(03:26):
particles of food into smallerparticles that can then be
transmitted down further intoyour digestive tract. Once you
get down further, that acidgets neutralized and, and the
magic of absorption happens.
But in that hostile environmentof the stomach, if you're
adding in more things that makethe environment more acidic or
(03:46):
more caustic, then the normalprotective lining of the
stomach may not be enough to,to fully protect you from
symptoms. Now, whether thosesymptoms signal something
that's actually causing damageis a whole nother question
entirely. But that's whatyou're feeling. Uh , when ,
when you get that heartburn,indigestion, acid reflux, upset
stomach. So
Speaker 3 (04:06):
Your stomach, why doesn't it get damaged
permanently by all this acid inthere? Why doesn't like self
digest itself?
Speaker 4 (04:13):
So your stomach lining secretes a , a mucus ,
uh, that coats the lining andprotects it from its own acid.
And there are things , uh, thatcan break down that mucus
lining and break down thatprotective barrier. Certain
medications can do it , uh, aninfection with a , an organism
called h pylori can do it. Uh ,but in general, your stomach is
(04:36):
able to coat its own lining andprotect itself from itself.
Speaker 3 (04:39):
So let's talk about that. The word heartburn Yeah.
Um, that people sometimes get.
Is that what we're talkingabout here? Or is that a
distinct separate thing? Andwhy do we call it that
Speaker 4 (04:48):
medical perspective, a separatething. It's often hard to
distinguish , uh, when you're,when you're talking to somebody
about symptoms. 'cause youknow, often , uh, what we are
experiencing as a person whenwe're having these symptoms is
pain. That's somewhere fromright underneath our breast
bone radiating up to somewherebetween our, our collarbones.
(05:10):
And, you know exactly where itis and exactly how long it
lasts and whether it movesaround. It helps us as
clinicians to, to give it alabel. I'm not certain that
those labels are thatmeaningful. Mm-hmm .
really what matters. And it's,and most of the symptoms are
felt to be, at least to somedegree, related to the acid in
(05:31):
the stomach. When we talk aboutheartburn, classically what
we're talking about is, is painrelated to the movement of
contents from your stomach upinto your esophagus or
swallowing tube. That, thattube that runs through your
chest from your mouth down toyour stomach. So
Speaker 3 (05:48):
Reflux.
Speaker 4 (05:49):
Yeah. Well , usually yes. Yeah . And, and , and
that, that structure, yourswallowing tube, your esophagus
doesn't have the same kind ofprotective mucus coating that
your stomach does. It's, it'snot well suited to be acid
resistant. So when it's exposedto the contents of your
stomach, it hurts.
Speaker 3 (06:07):
Right? So we're gonna delve into acid reflux as
a specific entity in just a fewminutes. But before we do,
there's all kinds of things youcan buy at the store. Plop,
plop, fizz . Fizz .
Speaker 4 (06:18):
Yeah . Soer . What a relief. Well ,
Speaker 3 (06:20):
What a relief it is.
Many of us remember thatcommercial not to like , uh,
tell one particular product,but there's that, there's Pepto
Bismol, there's all these otherthings, and we're gonna get
into some of them more as theshow wears on. But just lay the
, the groundwork for us onthose remedies. Are they
helpful?
Speaker 4 (06:36):
So they are helpful and, and choosing amongst them
and when it's appropriate touse one versus the other is the
tricky part. And, and, youknow, the marketing that , uh,
goes along with it doesn't,doesn't make that choice any
easier for people. I think ,uh, what all of the medicines
do, and, and here I'm talkingabout Tums , ALCA , seltzer,
(06:57):
Malo , uh, Pepcid , Prilosec ,omeprazole, all of these things
are medications that areintended to change the balance
of the acidity in whatever isin your stomach. None of them
change the fact that thingsreflux up into your esophagus.
They don't alter that at all.
They just change what's in thesoup. What's important to
(07:19):
understand about the drugs ishow much they can change what's
in the soup and how quicklythey can change it. So
something like Alca Seltzer orToms or Rolaids , those are
products that are bufferingagents. They can rapidly change
an acid into a less acidicmixture. So they work quickly.
So if you've
Speaker 3 (07:39):
Got within
Speaker 4 (07:39):
Minutes. Minutes, yeah. Yeah . So if you want, if
you want relief right now,that's where you should go. If
you've got some time, if you,you know, can wait 15 minutes,
30 minutes, an hour, you mightwant to go with a medication
like Pepcid or Ranitidine.
These are medications that havealso been around for a long
time. They also reduce theacidity , uh, of your stomach
(08:01):
secretions, but they takelonger to work. And then the ,
the most popular and andprobably most potent drugs that
we have are, are a class ofdrugs called proton pump
inhibitors. And omeprazole orPrilosec, the most common of
those, those are the mosteffective at reducing the acid
content of your stomach. Butthey take a long time to work.
(08:21):
Typically, they reach maximaleffect after a period of a few
days of exposure. And so if youwant relief right now, pop in a
PRIs X , probably not your mosteffective , uh, move.
Speaker 3 (08:33):
That's a good time for me to pivot then to gerd,
gastroesophageal RefluxDisease. Many people experience
this, you've touched on italready, but tell us a little
bit what is happening in acidreflux disease?
Speaker 4 (08:47):
All of us have a barrier between our esophagus
or swallowing tube and ourstomach. And that barrier is
very smart, but imperfect.
Speaker 3 (08:56):
Hey, I think mine's perfect. Yours
Speaker 4 (08:57):
Is perfect.
Everybody else's is smart, butimperfect
mean by that is it's, it'ssmart in that it has, this
barrier has to open when youswallow food to allow food to
get into your stomach. Mm-hmm .
then rapidly close after thefood passes. What I mean by
imperfect is that nobody'sbarrier completely prevents
(09:19):
contents of the stomach frommoving up into the esophagus.
All of us have that happen tosome degree with some
frequency. Some of us,particularly if the contents of
our stomach are particularlyacidic or caustic, will feel
that when it happens. Now, whenthat happens, our esophagus
responds by, by squeezing and,and pushing things back down
(09:40):
into the stomach. And, and thatsqueezing and pushing function
can become impaired. So we maynot do that as well as we did
when we were 18. And some of ushave a more imperfect valve.
And so we get more frequentepisodes of stuff washing back
up into our esophagus. And ifit's enough to bother us enough
to bring us to the attention ofa healthcare professional, we,
(10:01):
we may get labeled as havingGERD or reflux disease. Um ,
but it's, it's really a problemof, of quality, not quantity
necessarily.
Speaker 3 (10:10):
So how do you know if it's serious, if, if, if
some of us every now and thenget a little upset tummy, a
little indigestion and a littleheartburn, but it happens
really rarely. Maybe it's notso serious, however, it can be.
Right? How do you know whenit's serious? There
Speaker 4 (10:24):
Are certain alarm features that we look for, that
signal the need to look into ita little more deeply. So as you
said, if you get a little bitof heartburn every once in a
while, you know, it passes withsome time. Or maybe by drinking
something that's non acidiclike some milk. Or you take a
tums and it goes away and thenyou don't think about it for
(10:45):
several weeks until you have,you know, more of that gas
station sushi perhaps. Thenit's probably nothing to worry
about. We do start to getworried if it's persistent,
it's happening more than once aweek. It's happening really
without an identifiabletrigger. If you've lived your
whole life and it's neverhappened to you before, and now
all of a sudden it's happeningall the time, if it's a
(11:06):
significant change for you ,that's concerning. And then
other things which are a littlebit more obvious, you know, if
you're throwing up blood or ifyou are, you know, losing 20
pounds without trying to, or iffood's getting stuck and is not
going down , uh, and you're notable to get food to your
stomach, those are things thatwould bring most people to the
doctor. But if, if not, that's,that would be recommended.
(11:27):
Okay.
Speaker 3 (11:27):
So what happens in chronic acid reflux disease if
you don't treat it?
Speaker 4 (11:32):
So it, it depends on how frequently it's occurring
and how much acid the esophagusis being exposed to. Uh, some
people can have occasionalheartburn or , or acid reflux
for their entire lives, decidethey're just gonna live with it
and do fine. That doesn't makeme happy. There are things we
can do to make people feelbetter that, that, that I wish
that they would let us help 'emwith. But it's not necessarily
(11:54):
something that shortens yourlife or ends your life or leads
to problems. The concern,though, is that for some
people, it, it does do thosethings. And so if you have
persistent acid exposure and itis a, a, a problem that is
causing you symptoms on afrequent basis, getting it
evaluated is probably a goodidea. And the things that we
would be worried about would beburns to the esophagus from
(12:16):
acid scarring from repeatedcycles of burns and healing and
burns and healing the creationof strictures or narrowings
from scar tissue build up inthe esophagus. And even
occasionally the developmentof, of cancers of the esophagus
from chronic inflammation. Now,and I don't wanna be alarmist,
those cancers are not terriblycommon, but they do occur And,
(12:37):
and talking to a healthcareprofessional about your
symptoms and trying to figureout do they merit further
evaluation is probablyimportant if you're, if they're
continuing to bother you. We'regonna
Speaker 3 (12:46):
Talk about how you do diagnose these things and
about what's an endoscopy andall that after the break.
Before we do that, one lastquestion about treatments.
People take medications ongoingfor a long period of time and
they can get relief of theirsymptoms. Is there any problem
with doing that, takingmedications for the long term ?
Speaker 4 (13:05):
So I think the important thing if you're gonna
be taking a medication for thelong term is understanding what
it is that you're doing, whyyou're taking it. And with
medications for upper digestiveproblems, there are two
separate reasons to be on them.
One is to make you feel better,to make the symptoms go away,
and that's fine. The other isto try to protect you from some
future bad thing, some badhealthcare consequence of not
(13:29):
being on the medicine. Thosegoals are not always aligned
with one another. So somepeople have conditions of their
upper digestive tract, and I'lltell 'em, you know, you need to
take this pill every day toprotect yourself from something
bad in the future. And they'llsay to me, you know, I don't
feel any better or worse if Itake this. And so it's
important for me to be able toclarify with them that I get
it. I know this doesn't make adifference how you feel. I'm
(13:52):
trying to protect you from thebad thing in the future.
Others, again, Prilosec is agood example. I got plenty of
patients who take a Prilosecevery day to prevent or lessen
the severity of theirheartburn. If they miss a
couple of days, they pay forit. You know, maybe I've looked
in their stomach, maybe Ihaven't. And, and I know that
they don't have any damage downthere. They're not at risk for
anything in the future, butit's okay for them to continue
(14:14):
to take that 'cause it doesmake 'em feel better. So I
think really clarifying what itis that you're shooting for and
understanding what the goals ofthat therapy are is important
in determining whether or notyou should stay on it.
Speaker 3 (14:25):
We're talking with Jake Matlock. He is the
division director ofGastroenterology here at
Hennepin Healthcare . And we'vebeen talking about disorders of
your stomach and esophagus.
When we come back, we're gonnatalk about ulcers, endoscopies,
and Jake's best tips forstaying healthy. Stay with us.
We'll be right back.
Speaker 2 (14:43):
You are listening to the Healthy Matters podcast
with Dr. David Hilden . Got aquestion or comment for the
doc, email us at Healthymatters@hcme.org or give us a
call at six one two eight seventhree talk. That's 6 1 2 8 7 3
8 2 5 5. And now let's get backto more healthy conversation.
Speaker 3 (15:06):
And we're back talking about your upper GI
tract with Dr. Jake Matlock.
Jake, what's a gastric ulcer?
Speaker 4 (15:13):
So as we were talking about earlier, the
stomach has a mucus lining thatprotects it from its own acid,
and sometimes that mucus canbreak down. And if that
happens, then the tissueunderneath the mucus gets
exposed to the acid and thattissue then becomes injured.
That injury impairs the abilityof the stomach lining to make
(15:35):
more mucus. And so it becomeskind of a self-perpetuating
cycle of inflammation, injuryand damage. And over time, the
acid will then eat away andcreate a divot in the lining of
the stomach. So an ulcer isreally like a divot or a chunk
that's taken out of the lining,exposing what's underneath the
lining, which is muscles andblood vessels and, and the
(15:57):
like. That number one can bevery painful. Uh, so many
patients who have ulcers will,will suffer a lot of, of pain
and and misery from them . Andnumber two can lead to worse
problems like bleeding fromulcers , uh, because the blood
Speaker 3 (16:11):
Vessels get
Speaker 4 (16:11):
Exposed because the blood vessels get exposed and
they're not acid resistant.
Yeah . So they , they will openup and bleed, or even if it's
very severe , uh, can wear ahole entirely through the
stomach and create what'scalled a , a perforation, which
is a surgical emergency. Soreally bad that can be very
Speaker 3 (16:27):
Serious. How does someone know they might have an
ulcer? What would be thesymptoms?
Speaker 4 (16:31):
So classically we think of ulcers as causing pain
in the upper part of your , uh,abdomen or stomach. So
somewhere underneath your ribcage. And that pain is
classically described as worsewhen your stomach is empty and
better when you put certainthings into it. Most notably,
things that are not acidic.
(16:52):
People who , uh, have kind ofconstant upper abdominal pain
that's achy and quality andthen, you know, maybe they'll
drink milk or toms or what haveyou , and , and that'll make it
a little better. But then onceyour stomach's empty again,
it'll come back. And over timethat aching pain will progress
and hopefully eventually , um,person will go and see somebody
about it. Are
Speaker 3 (17:13):
We all susceptible to this or who gets it? Um ,
you mentioned some, someunderlying factors that might
lead to
Speaker 4 (17:19):
It. So there are things that can make you more
at risk for getting it. Mostnotably there are medications
that you may be taking forother things. Uh, the most
noteworthy of those are, aredrugs from a class called
nonsteroidal anti-inflammatorydrugs. And that's a long-winded
way of talking about thingslike aspirin and Motrin and
ibuprofen, not Tylenol, but theother over-the-counter pain
(17:42):
medications can put you at riskfor this. There's also , uh, an
infection with a a , a bacteriacalled helicobacter pylori or h
pylori, which is a common causeof ulcer disease. It lives in
the mucus lining , uh, of yourstomach and breaks that mucus
lining down , uh, but makingyou more susceptible to ulcers.
(18:03):
There are certain conditionsthat can affect the blood flow
to the stomach's lining thatimpair its ability to make
mucus. Uh , the most common ofthose is smoking. The
Speaker 3 (18:12):
Other one more reason not to smoke.
Speaker 4 (18:14):
Yeah. Yeah. They're , they're seemingly endless.
Um, the other environmentalexposure that, that , uh, can
impair the stomachs lining andmaking more susceptible to
ulcers is alcohol. Uh , sopeople often ask about spicy
foods if that's a cause ofulcers and it , and it's really
not. It, it can cause you tofeel your ulcers mm-hmm .
(18:34):
And, and so spicy foods may bebringing to your attention
something that's alreadyhappening, but they're not the
driving cause or the underlyingcause of ulcer .
Speaker 3 (18:42):
That's an interesting distinction. I do
hear that all the time.
Absolutely. People say, youknow, it's when I eat things,
but all these other things areequally important risk factors
for ulcers. Yeah. Okay. So howdo you diagnose it? How do you
diagnose all these things? For
Speaker 4 (18:55):
Some of them we can, we can make a diagnosis based
on a careful history talking topeople and maybe even a trial
of a medication to see if theyrespond to it. Sometimes that's
sufficient to say, yep , thisis what's going on and, and
here's how we're gonna fix it.
However, in a lot of , uh,circumstances it is, IM
important to actually look inthe stomach and swallowing tube
to see what's going on. In thesame way that it's important
(19:17):
for your cardiologist to pulltheir stethoscope out and
listen to your heart. As agastroenterologist, a lot of my
physical exam, a lot of what Ido to examine a person is
actually looking in theirintestinal tract at the organ
that we're worried about. Andso endoscopy with a flexible
scope is, is how a lot of thesethings are diagnosed. A lot
Speaker 3 (19:38):
Of people know about the colonoscopy, and if you
don't, I will refer you back tothe podcast episode earlier
this season with Dr. Matlock.
But what does endoscopy looklike for these conditions for
ulcers and reflux?
Speaker 4 (19:51):
So endoscopy refers to using a flexible tube with a
light and a camera at the endof it to go through your mouth
into your swallowing tube,stomach and small intestine to
look around. The tube that weuse is about the size of your
pinky. So it's smaller thanmost food that you would
swallow. It's got, as I said,has a light in a camera on one
(20:12):
end and a steering wheel on theother. To do this , uh, we do
typically sedate people. I'veknown people who've done it
without sedation. It's uncommonand I wouldn't , it
Speaker 3 (20:22):
Sounds uncomfortable, Jake. Good
Speaker 4 (20:23):
Grief. Yeah. I wouldn't recommend it, but it
has been done. But for most ofus , uh, to get an endoscopy,
we get some medications throughan IV that will sedate us, make
us very sleepy , uh, so thatwe're unaware or unconcerned
about anything that's going on.
And then the tube goes throughour mouth and down into the
stomach I can steer the tubethrough the entire swallowing
(20:45):
tube stomach and first part ofthe small intestine and look at
the lining of that entirestructure. With that, we can
tell if you have inflammation,damage from your reflux. We can
tell if you have ulcersequally. And maybe even more
important, we can see if youhave any evidence of
precancerous changes or even anactual tumor or cancer. So ,
Speaker 3 (21:06):
So it looks differently. You are looking on
a screen and, and it looksdifferently. Pre-cancerous
changes or esophagealinflammation, the , the effects
of reflux. You can see that
Speaker 4 (21:17):
Absolutely. And, and, and again, for many people
who have reflux, the effectsare nothing. The , their exam
will be normal . And that'ssometimes a little
disappointing for people 'causethey're, they're highly
symptomatic. They've , they'refeeling a lot of pain and you
got
Speaker 3 (21:31):
Nothing on
Speaker 4 (21:31):
Exam. And I tell 'em, everything looks normal.
That's actually good news andactually a pretty normal
finding as you know , as wewere talking about before, we
all have an imperfect valve tosome degree or another. And
when I tell people that theirexam is normal, that doesn't
mean they're not having reflux.
It means they're not sufferingdamage from it and they're not
at risk for future healthproblems from, it doesn't make
it any less miserable, but itmeans that there's not an
(21:54):
additional thing to worry aboutin terms of a future
consequence.
Speaker 3 (21:57):
What does an ulcer look like? So
Speaker 4 (22:00):
When I described it earlier as a divot, part of the
reason that I said that is'cause that's literally what it
looks like. If you think of a ,a tub of ice cream that you've
taken one spoonful out of andyou've got a , you know, a
little dent in the top of thattub of ice cream, that's kind
of what an ulcer looks like.
Now at the base of that dent,it's gonna look red and
inflamed and the edges aregonna be kind of heaped up and,
(22:21):
and angry looking . It's, it'snot subtle. It's easy to
recognize and, and , uh, you
Speaker 3 (22:27):
Probably think it looks cool. I've often teased
Jake about what he does for aliving. He puts tubes in and
looks inside your intestines.
And, and, and let's be honest,to the average listener, it
sounds a little bit, there's alittle bit of an eew factor .
So if you do find things onthese , uh, endoscopy exams,
there are treatments availableand people can , uh, do well,
(22:47):
right?
Speaker 4 (22:48):
Yeah. The overwhelming majority of
findings , uh, on an endoscopyare things that we can respond
to with alterations in aperson's medical regimen. Often
on a temporary basis, not aforever basis , uh, to get
those things to resolve orheal. There is typically , uh,
uh, also things that we can doto try to help people to
(23:09):
prevent them from coming back.
Uh , 'cause that's, that'sanother important factor. We
don't want you to be back inthe same circumstance a year
down the road.
Speaker 3 (23:15):
So many people have these things that we've been
talking about both reflux andulcers. And I really appreciate
you giving us some tips onthese topics. Before I let you
go, Jake, what tips would youleave our listeners about upper
GI health?
Speaker 4 (23:29):
So the most important thing I think that
all of us should think about interms of our upper
gastrointestinal tract healthis eating food, not chemicals.
Uh, you , you know, we, you andI were joking earlier about gas
station sushi and I , I'mguilty as charged. I pick it up
sometimes too , no questionabout it. But by and large, if
you're eating food that startsout as a whole food, like a
(23:51):
plant, and you're preparing ityourself, turning it into a
meal, you're gonna be betterserved. That's gonna give you
more of a plant-based diet.
It's gonna give you more fiber,which is, is good for your
entire digestive tract as wellas the rest of your body. Uh,
it's gonna limit your exposureto added sugars and other
chemicals and preservativeswhich have deleterious effects
on your health all around. Sothat's, that's the biggest
(24:14):
thing. Eat food, mostly plants.
Speaker 3 (24:15):
It's so interesting you say that because I have a
lot of specialists on thisshow. It's a theme that kind of
comes up. You didn't say cometo see me so I can put a scope
down your throat as the firstthing. Um, you talked about
what, what can lead to these?
And then your biggest tip is toput healthy whole foods in your
body, I find to be fascinatingand frankly spot on . So I I
(24:37):
really appreciate that. Allright . What else should we
keep in mind?
Speaker 4 (24:40):
Well, you know, keeping your digestive tract
moving in a , a forward , uh,manner is important. And the
best way to do that is to keepyour body moving. Uh , and
getting up, moving around is,is healthy. Not again, not only
for the rest of your body, butfor your digestive function.
Speaker 3 (24:55):
How about any other things people can do in their
lives, maybe non-medicaltreatments , uh, to prevent
reflux or the things we'vetalked about?
Speaker 4 (25:03):
Sure. So particularly with regards to
reflux, as we were talkingabout earlier, the thing that
drives reflux is the movementof gastric contents or stomach
contents up into the swallowingtube. And whereas we don't have
an easy way to fix the valve,we can take advantage of
gravity. And so things likemaking sure that you're sitting
upright when you eat, not lyingdown shortly after eating. For
(25:24):
some people, even raising thehead of their bed , uh, to a 20
to 30 degree angle to try touse gravity to keep things down
in the stomach can be helpful.
Uh, those are rarely home runtherapies that are really the
things that, that, that willcompletely solve a problem. But
they can help to some degree.
Speaker 3 (25:41):
I knew a guy who had a wedge put into under the
sheet of his bed, so it was,the thing was elevated 'cause
he had bad refluxes. There'sactually products people can
buy, but you don't even have todo that. Right. Can't you just
put a big book under theheadboard or
Speaker 4 (25:53):
Something? Yeah. I mean, I think the important
thing to understand there is,is that you wanna make sure
that you're not , uh, uh,crunching your abdomen. And so
it's probably not good to besleeping on two or three
pillows if that's the problemyou're trying to solve. 'cause
that's just gonna kind ofcompress your abdominal cavity
and, and change the pressure insuch a way that you might be
making things worse. Yeah . You
Speaker 3 (26:12):
Don't wanna bend at the waist sort of while you're
sleeping.
Speaker 4 (26:15):
Right. So putting a , we used to say phone books. I
don't think they make thoseanymore .
Speaker 3 (26:18):
I know the big old Minneapolis phone book. I
remember those. But
Speaker 4 (26:21):
A , a brick under the, the headboard of your bed
to, to, you know , raise thewhole bed or put the whole bed
at an angle is, is really moreof what you're going for. We've
Speaker 3 (26:29):
Been talking with Dr. Jake Matlock about reflux
disease ulcers and all thingsabout your upper intestinal
tract . Jake, thanks for beingon the show today. It's been a
great show. Yeah, it's
Speaker 4 (26:38):
Been fun. Thanks.
Speaker 3 (26:39):
Glad to have you on.
If you missed Dr. Matlock'sprevious episode with us, go to
the archives. He talks aboutyour lower intestinal trek . In
other words, your colon. You'renot gonna wanna miss that
episode. Thank you for joiningus for this episode, and I hope
you'll tune in next time. Inthe meantime, be healthy and be
well.
Speaker 2 (26:57):
Thanks for listening to the Healthy Matters podcast
with Dr. David Hilden . To findout more about the Healthy
Matters podcast or browse thearchive, visit healthy
matters.org. You got a questionor a comment for the show?
Email us at Healthymatters@hcme.org or call 6 1 2
8 7 3 talk. There's also a linkin the show notes. And finally,
(27:20):
if you enjoy the show, pleaseleave us a review and share the
show with others. The HealthyMatters Podcast is made
possible by Hennepin Healthcarein Minneapolis, Minnesota, and
engineered and produced by JohnLucas At Highball Executive
Producers are Jonathan, CTO andChristine Hill . Please
remember, we can only givegeneral medical advice during
this program, and every case isunique. We urge you to consult
(27:41):
with your physician if you havea more serious or pressing
health concern. Until nexttime, be healthy and be well .
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