Ketan Kulkarni, MD

Heartburn: Normal or Problem?

Ketan Kulkarni, MD

Heartburn is one of the most common digestive symptoms that a person can experience. One in five people have heartburn at least once a month. It is usually described as a burning pain that is located behind the breastbone and can move upward to the throat. Heartburn is one manifestation of GERD, or gastroesophageal reflux disease. GERD occurs when stomach contents or acid flows back into the esophagus.

Occasional heartburn is normal. However frequent or more persistent heartburn can become troublesome and lead to a diagnosis of GERD. Additional manifestations of GERD include regurgitation, difficulty swallowing or sore throat. GERD can also result in esophagitis, chronic cough, hoarseness or even lung problems. Some individuals can have silent reflux, or manifestations of GERD in the absence of classic heartburn. Chronic GERD has been linked to Barrett’s esophagus, a condition in which the normal lining of the esophagus is damaged and can predispose to the development of esophageal cancer. A variety of factors are known to increase the risk for GERD, the most common being obesity, smoking, presence of a hiatal hernia, and pregnancy. It is important to realize that while heartburn is most commonly associated with GERD, heartburn can sometimes also be a symptom of a more serious condition. People may mistake heart related pain for reflux. Worsening heartburn or difficulty swallowing can be a sign of esophageal cancer. Gallstones can also result in symptoms that mimic heartburn. Therefore it is important for individuals with more than occasional heartburn to be evaluated by a doctor.

The most common tests used to evaluate patients with heartburn or symptoms of GERD include a barium esophagram and endoscopy. An esophagram is an x-ray test that allows your doctor to see a silhouette of your esophagus, stomach and upper intestine. An upper endoscopy is an outpatient procedure during which a thin flexible tube with a camera is utilized to directly visualize the upper gastrointestinal tract while one is sedated and comfortable. In some cases pH monitoring in the esophagus is needed to help direct therapy.

Evaluation by a doctor will help to determine if you have any significant consequences as a result of GERD and what treatment should be undertaken. Lifestyle changes such as eating smaller meals, elevating the head of your bed, losing weight, avoiding heavy evening meals and quitting smoking can help control GERD in many people. Foods that are known to trigger heartburn include spicy foods, acidic fruits and vegetables, chocolate, caffeine and fatty foods, to name a few. For patients who have more persistent symptoms, your doctor may recommend medications that reduce stomach acid production. In certain individuals surgery may be an option as well.

If you are experiencing any digestive system issues, please contact your primary care physician, or Regional Gi to schedule an appointment with a Gastroenterologist. Call 869-4600 or visit us at


Ketan Kulkarni, MD

Testing for colorectal cancer without the colonoscopy

By: Ketan Kulkarni, MD

A new noninvasive test to detect colon and rectal cancer is offering hope that more people will be willing to be screened, driving down the rates of these cancers. Cologuard is the first stool DNA colorectal cancer screening test to be approved by the Food and Drug Administration.

The test is a potentially exciting advancement that could one day change the way we screen for colorectal cancer—but not yet. Many questions remain about the optimal use of stool-based testing, which detects the presence of red blood cells and DNA mutations that may be indicative of cancer.

In the trial upon which the FDA based its approval,  Cologuard was very sensitive for the detection of cancer, but it found less than half of all advanced adenomas (precancerous polyps) and even a smaller percentage of regular adenomas. People who have a positive result are advised to have a colonoscopy.

Additional limitations of stool-based DNA testing include the fairly high false positive rate, the complexity of the test itself, the lack of well-defined screening intervals, and the greater cost when compared to current stool immunochemical tests.

Colorectal cancer is the third most common cancer and the second leading cause of cancer-related deaths in the United States among cancers that affect men and women, according to the Centers for Disease Control and Prevention.

The CDC estimates that at least 60 percent of colorectal cancer deaths could be prevented if everyone age 50 or older had the recommended screenings—fecal occult blood test, sigmoidoscopy, or colonoscopy.

The gold standard for colorectal cancer screening is still colonoscopy, in which your doctor uses a flexible tube to examine the inside of your colon. It’s been successful at lowering cancer deaths by not only detecting cancer at earlier stages, but by also detecting precancerous polyps. Your doctor can remove these polyps during the colonoscopy and prevent cancer.

Current guidelines call for testing to start at age 50 in those individuals without a family history, but about half of all eligible people haven’t been properly screened with one of the recommended tools.

The approval of Cologuard holds much promise as a screening option that is noninvasive, can produce reliable results and provide a better patient experience. However we’ll need more data to determine how accurate Cologuard will be in the “real world”, outside the context of a clinical trial, before it becomes standard practice.