Understanding Gastroesophageal Reflux Disease

Welcome to our Patient Education page!

Our team of specialists and staff strive to improve the overall health of our patients by focusing on preventing, diagnosing and treating conditions associated with your digestive system. Please use the search field below to browse our website. You'll find a wide array of information about our office, your digestive health, and treatments available. If you have questions or need to schedule an appointment, contact our office.

Screening or Diagnostic Colonoscopy?

All colonoscopies, whether diagnostic or screening, are billed under the CPT/Procedure code 45378.  The diagnosis or reason for the colonoscopy is what determines if the procedure is diagnostic/surveillance or preventative/screening. 
 

Diagnostic/Surveillance Colonoscopy: 

The patient has past and/or present gastrointestinal symptoms, polyps, GI disease, iron deficiency anemia and/or any other abnormal tests OR the patient is currently asymptomatic (no gastrointestinal symptoms either past or present) but has a personal history of GI disease, personal and/or family history of colon polyps and/or colon cancer.  Patients in this category are required to undergo colonoscopy surveillance at shortened intervals (e.g. every 2-5 years). 

Insurance plans process these claims subject to the individuals deductible and co-insurance requirements.

Preventative Screening Colonoscopy:

The patient is asymptomatic (no gastrointestinal symptoms either past or present), age 50 or greater, has no personal or family history of GI disease, colon polyps, and/or cancer.  The patient has not undergone a colonoscopy within the last 10 years.

Insurance plans usually process these claims under the wellness benefit, payable at 100% if it is a benefit of the individual’s health insurance plan.

Frequently asked questions:

Who will bill me?

You may receive bills for your procedure from the physician, the facility, anesthesia, pathologist and/or laboratory. 

Can the physician change, add, or delete my diagnosis so that my procedure can be considered a preventative/wellness/routine screening?

NO!  The patient encounter is documented as a medical record from the information you have provided, as well as what is obtained during our pre-procedure history and assessment.  It is a binding legal document that cannot be changed to facilitate better insurance coverage.

What if my insurance company tells me that the doctor can change, add or delete a CPT or diagnosis code?

This happens a lot. Often the representative will tell the patient that if the “doctor had coded this as a screening, it would be paid at 100%."  A member services representative should never suggest a physician alter a medical record for billing purposes. 


FAQS - Frequently Asked Questions

Q: How long will my procedure take?
A: Plan to spend 2- 2 1/2 hours with us from the time you arrive until when you are released to go home. The procedures themselves are relatively quick.
- An upper endoscopy takes 8-10 minutes, depending on what is found and the need for biopsies.
- A colonoscopy usually takes about 20-25 minutes, again depending on the findings and need for polyp removal, biopsies, etc.
The rest of your stay involves going over the consent prior to the procedure, a physical assessment, taking vital signs, placing an IV and attaching you to a continuous monitor. After the procedure, you will stay under our observation until you are deemed ready to be driven home.
 
Q: Can I drive myself home after the procedure?
A: No. The anesthesia and sedation we use, while relatively short-acting, can have subtle effects for hours after your procedure. Possible drowsiness and delayed reaction times make driving potentially dangerous. Therefore, having someone drive you home is necessary. You may drive and return to normal activities the following day.
 
Q: How soon can I eat and drink after my procedure?
A: Usually immediately after you leave the office, unless you are told otherwise. It is best to avoid heavy meals for that day.
 
Q: Can I take routine medications the day of the procedure?
A: Please do not take any of your medications except those for blood pressure, heart and seizures unless otherwise instructed by your physician.
 
Q: Do I need antibiotics prior to my procedure for an artificial joint?
A: No. The American Society for Gastrointestinal Endoscopy has concluded that antibiotic use for a patient with an artificial joint is not necessary.
 
Q: What happens if I begin to vomit during my prep?
A: Wait 1-2 hours to allow your stomach to settle. Start to drink the solution at a slower pace- every 20-30 minutes. This will take longer but should keep you from vomiting the rest of the solution.
 
Q: I have my period. Can I still have my colonoscopy?
A: Yes. This will not interfere with your procedure. You may use a tampon during the procedure.
 
Q: Do I have to drink all of my prep?
A: Yes. You want your colon completely cleaned out. This allows the physician to find and treat the smallest and flattest polyps.
 
Q: I’m diabetic. What precautions should I take?
A: If you are diabetic, we will give you special instructions. You will need to let us know ALL of your medications and doses. You should check your blood sugars periodically throughout the day of the prep and the procedure. Since you are on clear liquids, your blood sugar will tend to drop faster than normal. To avoid this, be sure to include some liquids with sugar.
 
Q: What if I forget to stop my blood thinners?
A: Please contact the office.
 
Q: Can I take over the counter medications with my prep?
A: Most over the counter medications are acceptable except fish oil, aspirin, Motrin, Advil, ibuprofen, Aleve, naprosyn, naproxen or iron supplements. Tylenol will not interfere with your procedure.
 
Q: Is it OK to drink alcohol?
A: NO! We strongly suggest that you avoid all alcohol before your procedure as it can cause dehydration and may thin your blood.
 
Q: Can I brush my teeth?
A: Yes.
 
Q: Can I chew gum or suck on hard candy?
A: Yes, but no red candy or candy with soft centers. Nothing after midnight.
 
Q: What can I take for a headache?
A: Tylenol or Extra-Strength Tylenol only.

This information was developed by the Publications Committee of the American Society for Gastrointestinal Endoscopy (ASGE). For more information about ASGE, visit www.asge.org.

This information is intended only to provide general guidance. It does not provide definitive medical advice. It is important that you consult your doctor about your specific condition.

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Gastroesophageal reflux occurs when contents in the stomach flow back into the esophagus because the valve between the stomach and the esophagus, known as the lower esophageal sphincter, does not close properly.

What is Gastroesophageal Reflux Disease (GERD)?

Gastroesophageal reflux occurs when contents in the stomach flow back into the esophagus. This happens when the valve between the stomach and the esophagus, known as the lower esophageal sphincter, does not close properly.

What are the symptoms of Gastroesophageal Reflux Disease?

Common symptoms of gastroesophageal reflux disease are heartburn and/or acid regurgitation. Heartburn is a burning sensation felt behind the breast bone that occurs when stomach contents irritate the normal lining of the esophagus. Acid regurgitation is the sensation of stomach fluid coming up through the chest which may reach the mouth. Less common symptoms that may also be associated with gastroesophageal reflux include unexplained chest pain, wheezing, sore throat and cough, among others.

What causes Gastroesophageal Reflux Disease?

Gastroesophageal reflux disease (GERD) occurs when there is an imbalance between the normal defense mechanisms of the esophagus and offensive factors such as acid and other digestive juices and enzymes in the stomach. Often, the barrier between the stomach and the esophagus is impaired by weakening of the muscle (lower esophageal sphincter) or the presence of a hiatal hernia, where part of the stomach is displaced into the chest. Hiatal hernias, however, are common and not all people with a hiatal hernia have reflux. A major cause of reflux is obesity whereby increased pressure in the abdomen overcomes the barrier between the stomach and the esophagus. Obesity, pregnancy, smoking, excess alcohol use and consumption of a variety of foods such as coffee, citrus drinks, tomato-based products, chocolate, peppermint and fatty foods may also contribute to reflux symptoms.

An endoscope is a medical device used by expert physicians to look inside the digestive tract. An upper endoscopy allows the physician to examine the lining of the upper part of the gastrointestinal (GI) tract, which includes the esophagus, stomach and duodenum (first portion of the small intestine). The expert physician controls the movement of the flexible tube using the endoscope handle.

 

How is Gastroesophageal Reflux Disease diagnosed?

When a patient experiences common symptoms of gastroesophageal reflux disease, namely heartburn and/or acid regurgitation, additional tests prior to starting treatment are typically unnecessary. If symptoms do not respond to treatment, or if other symptoms such as weight loss, trouble swallowing or internal bleeding are present, additional testing may be necessary.

Upper endoscopy is a test in which a small tube with a light at the end is used to examine the esophagus, stomach and duodenum (the first portion of the small intestine). Before this test, you will receive medications to help you relax and lessen any discomfort you may feel. An upper endoscopy allows your doctor to see the lining of the esophagus and detect any evidence of damage due to GERD. A biopsy of tissue may be done using an instrument similar to tweezers. Obtaining a biopsy does not cause pain or discomfort.

Another test, known as pH testing, measures acid in the esophagus and can be done by either attaching a small sensor into the esophagus at the time of endoscopy or by placing a thin, flexible probe into the esophagus that will stay there for 24 hours while acid content is being measured. This information is transmitted to a small recorder that you wear on your belt. X-ray testing has no role in the initial evaluation of individuals with symptoms of reflux disease.

How is Gastroesophageal Reflux Disease treated?

Reflux symptoms sometimes disappear if dietary or lifestyle excesses that cause the symptoms are reduced or eliminated. Avoiding these items may reduce your discomfort:

In an upper endoscopy, the physician passes a thin, flexible tube called an endoscope through your mouth and into the esophagus, stomach and duodenum.
  • coffee
  • citrus drinks
  • tomato-based products
  • carbonated beverages
  • chocolate
  • peppermint
  • fatty or spicy foods
  • eating within three hours of bedtime
  • smoking
  • excess alcohol consumption
  • excess weight gain

Propping up the head of the bed at night may be helpful.

Should symptoms persist, over-the-counter antacids may decrease discomfort. Antacids, however, only work for a short time and for this reason, they have a limited role in treating reflux disease. Histamine H2 receptor antagonists (such as cimetidine, ranitidine, nizatidine, and famotidine) decrease acid production in the stomach. These medications work well for treating mild reflux symptoms and are quite safe, with few side effects. They are available over the counter at a reduced dose, or at a higher dose when given by prescription by your doctor.

Proton pump inhibitors (such as omeprazole, lansoprazole, dexlansoprazole, pantoprazole, esomeprazole, and rabeprazole) are all highly effective in treating reflux symptoms. These medications act by blocking the final step of acid production in the stomach and are typically taken once or twice daily prior to meals. For reflux symptoms that occur frequently, proton pump inhibitors are the most effective medical treatment. These medications typically work well, are safe and have few side effects. There may possibly be an increased risk of certain side effects with high doses or with long-term use (over one year), however. You should discuss this with your doctor if you require long-term use or high doses.

Symptoms of gastroesophageal reflux disease sometimes disappear if certain items are eliminated from the diet

Prokinetics, or medications that stimulate muscle activity in the stomach and esophagus, are sometimes provided for the treatment of reflux disease. The only available drug in the market is metoclopramide, which has little benefit in the treatment of reflux disease and has some side effects, some of which can be serious.

Surgery should be considered in patients with well-documented reflux disease who cannot tolerate medications or continue to have regurgitation as a primary symptom. If symptoms persist despite medical treatment, a comprehensive evaluation should be completed prior to considering surgery. The surgery for treating reflux disease is known as fundoplication. In this procedure, a hiatal hernia, if present, is eliminated and part of the stomach is wrapped around the lower end of the esophagus to strengthen the barrier between the esophagus and the stomach. The operation is typically done via a laparoscope, an instrument that avoids a full incision of the stomach. Due to the complexity of this surgery, it is important to seek a skilled surgeon who has experience in performing this procedure and can discuss the risks and benefits of the procedure.

When should I see my doctor?

You should see your doctor immediately if you have symptoms such as unexplained weight loss, trouble swallowing or internal bleeding in addition to heartburn and/or acid regurgitation. Symptoms that persist after you have made simple lifestyle changes also warrant a visit to your doctor. In addition, if you use over-the-counter medications regularly to reduce symptoms such as heartburn or acid regurgitation, you should consult a physician to determine the best course of treatment for you.

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