Peter Mavrelis, M.D., is a gastroenterologist in Merrillville, Ind., a town on the fringe of Chicago. He’s been practicing medicine for 25 years and specializes in treating heartburn and gastroesophageal reflux disease (GERD). He also is a clinical assistant professor at Indiana University in Gary where, every year for the past 20 years, he spends two weeks introducing new medical students to his field.
Mavrelis is a congenial man, and if you haven’t figured out from his name, of Greek descent. Although he didn’t recommend any heartburn-friendly recipes for dolmas or spanakopita, he had some helpful observations for people living with GERD.
See Dr. Mavrelis' office information.
Read an interview with one of Dr. Mavrelis' patients.
Reflux1: Why did you go into gastroenterology?
Dr. Mavrelis: I guess I chose gastroenterology because I’ve always been interested in digestion and the physiology of digestion. With today’s gastroscopes we have the ability to both diagnose and treat diseases. It’s the same with heartburn patients that we can treat endoscopically. These technologies make real differences in people’s lives. That’s one thing physicians like I do: Bridge the gap between drugs and surgery with endoscopic procedures.
Also, I like the types of people that develop problems in this area. As far as the specific condition heartburn is concerned, this occurs in all age groups: Youngsters, older people, teens. The largest group of people that have heartburn have no particular predisposing factor experience other than maybe being a little overweight. Other patients that tend to present with problems are pregnant women, vigorous exercisers and those with asthma. Obesity is also a really significant factor.
Reflux1: How prevalent is heartburn?
Dr. Mavrelis: Forty percent of Americans have heartburn one time a week. We define heartburn as a symptom of GERD, which is an umbrella diagnosis for problems associated with reflux.
It is a bothersome problem with the most common symptom being heartburn. Symptoms can range from sore throat and cough, to trouble sleeping at night and being awakened with coughing or chest discomfort. We also see patients with back pain as well as something called globus, which is a sensation where they feel like they can’t swallow.
Heartburn is just very, very common and has been around a long time. Grandma and grandpa were treating themselves with antacids years ago with Tums or baking soda, and those home remedies worked to some degree.
When I first started practicing 25 years ago, however, we didn’t have the treatments and drugs we do today. We saw the serious ulcers and strictures (or scars) in the esophagus; conditions we don’t see that much any more because of good progress in the field. The actual incidence of the disease has changed.
Reflux1: What concerns do patients most often express to you?
Dr. Mavrelis: The first thing they generally want to know is if their heartburn is a life-long problem. I tell them, “yes;” it’s chronic. Unless something changes with physiology – with your lower esophageal sphincter valve – you will continue having the problem.
Some ask if there is room to treat their problem non-medically. To that question I answer that there is definitely room for people to alter their lifestyles by eating smaller, more frequent meals and losing weight so they don’t have as many episodes of GERD.
The take home message I try to get out to patients is that GERD is common, it happens in all ages, and it’s easily treated with various treatments and medications. Also, small numbers of patients with GERD do get Barrett’s esophagus or chronic inflammation which can lead to esophageal cancer. So patients with GERD do need to see their doctor and get treated, because it may predispose them to having worse problems.
Reflux1: What drugs are available for GERD?
Dr. Mavrelis: The first drugs we had when I started practicing were called H2 blockers. Then about 15 years ago the proton pump inhibitors came out. They are very, very effective in treating heartburn, although they are expensive.
The proton pump inhibitors are the ones that people often find out about on TV commercials. These drugs are the number one revenue stream for drug companies worldwide. It’s a lot of money that’s spent on these drugs – big money. So that motivates the companies because a lot of people have GERD, and the market is huge.
That’s one reason I like procedural treatments for GERD because people have to pay around $150 per month for these medications. That’s a lot of money for most people, so if there’s a surgical or endoscopic treatment, it would be more cost effective.
Also, there is a group of people who don’t respond to the drugs or can’t tolerate them. So they are candidates for other procedural and surgical approaches.
Reflux1: What treatments are available for GERD that you like?
Dr. Mavrelis: About five years ago, a technique was developed to treat heartburn or GERD non-surgically. It’s called the Stretta technique and is an endoscopic procedure in which the physician goes down through the throat and into the esophagus. It uses radiofrequency current and small needles to actually tighten the lower esophageal sphincter and ablate the nerves. (Nerves in wall of esophagus control contraction and relaxation of the valve and also control sensations in the esophagus.) Stretta makes the patient’s pain go away. It’s sort of like a nerve block and small studies have shown that it has a durable response of up to five years.
Enteryx is another technique that has now been taken off the market. It was used to strengthen lower esophageal sphincter area by injecting a polymer. I did about 22 of these procedures and had good success, but there were incidents around the country where some patients developed complications. The procedure was very effective in treating GERD, but it was a more difficult technique to master than the Stretta.
The other approach is plication where we go down and pinch the folds of the stomach together to make the opening of the esophagus tighter. This is effective as well.
Reflux1: What treatment is available for Barrett’s esophagus?
Dr. Mavrelis: Ablation is a new treatment that uses radiofrequency to peel away a millimeter of tissue from the lining of the esophagus. Ablation may help a lot of people who are going down that road to esophageal cancer and reverse that trend.
I have done the procedure on around 25 patients using a technology called the HALO360, a device made by BÂRRX Medical.
Reflux1: How well are the procedures that gastroenterologists are exploring received by the medical community and patients?
Dr. Mavrelis: We use techniques that are evolving, and there are no long-term large studies completed yet. But in smaller trials what we do has been proven to be effective.
Patients are interested because of the chronic nature of heartburn and GERD.
While there are non-medical treatments that can be effective, it is very difficult to get people to lose weight, or not eat late at night or quit smoking. So behavior modification can help, but it’s difficult to get people to comply.