Why Doesn’t My Gastroenterologist Understand My Acid Reflux?

For 50 years, the gastrointestinal specialist (GI) has been the go-to doctor for acid reflux affecting the esophagus, so-called GERD, which is associated with heartburn and indigestion. GIs have made billions of dollars performing endoscopies in their ambulatory surgery centers (ASCs), demonstrating a profound conflict of interest … and profoundly not for the benefit of patients. 

The GI endoscopy ship has sailed. For every patient with GI esophageal disease, there are 10 Respiratory Reflux (aka LPR) patients. GIs have no tests or treatments for Respiratory Reflux (RR), which tends to be silent reflux … no heartburn or indigestion. And more than 80% of people with RR have completely normal esophageal “upper” endoscopies

It’s time to abandon the GI “heartburn business model.” GIs know virtually nothing about RR, but they do, however, overutilize expensive resources for their own gain. If you are scheduled for a Bravo test, impedance/pH monitoring, esophageal manometry, or upper endoscopy, you should know that those tests are useless for diagnosing RR. And as far as endoscopy goes …

In 1999, an alternate technology, Transnasal Esophagoscopy (TNE), became available and clearly should have become the preferred (superior) alternative to sedated GI endoscopy for screening the esophagus and stomach for acid reflux. The TNE procedure is performed with an ultra-thin flexible instrument that can be painlessly put through the nose to examine the throat, esophagus, and stomach. You can walk out under your own power and go back to work or home. TNE should replace sedated endoscopy by the GI. And BTW, in addition to Joan Rivers, since 1975, GIs have killed approximately 50,000 patients! TNE is more accurate and much safer, duh … no one ever is harmed.

Patients with RR have normal esophageal examinations most of the time. You might ask how could a person have RR with a normal esophageal examination. The answer is that the esophagus is robust, and up to 50 reflux episodes a day won’t harm the esophagus; however, one reflux episode in the throat each night, or even several RR events per week, can cause terrible problems in the respiratory system … everything from laryngitis, chronic cough, ear, and sinus problems, shortness of breath, and other breathing problems.

Today, most people with acid reflux, have Silent Nocturnal Respiratory Reflux (SNoRR) in which silent reflux occurs during the night leading to symptoms during the day. Again, the GI has nothing, no test or treatment for people with this problem. 

Back to TNE. GIs sabotaged the proliferation of this procedure. Unfortunately, Medicare reimbursement for TNE was drastically lowered, making it no longer a viable office-based procedure. In the past, it was office-based with no facility fee, and Medicare payment was reasonable. But after 2014, the reimbursement for TNE became roughly $120 … but the facility fee roughly $1800.

Yes, what happened here is that the GIs destroyed their competition. Today, they have a monopoly… is antitrust litigation an option? I don’t know. The TNE procedure should have replaced the GI procedure, but the GIs, through Medicare, made it not worthwhile for physicians to perform TNE in their offices as it was intended. And BTW, there is no reason why Primary Care Physicians, Nurse Practitioners, or Physician Assistants could not perform TNE.

In summary, sedated GI endoscopy of the esophagus and stomach for respiratory reflux diagnosis is useless and dangerous. The GI model of acid reflux is entirely out of date — too expensive, too dangerous, and add killing TNE, the competition, to the equation … seemingly unethical.

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