ZurMed: Dr. Gurram Krishna

Dr. Gurram Krishna is a Gastroenterologist working in Brooklyn Hospital as the Associate Program Director for Gastroenterology. In this episode, Dr. Guram Krishna discusses his specialty and more.

Host: What are your areas of expertise?

Dr. Gurram Krishna: I focus mostly on interventional gastroenterology which relates to advanced endoscopies and such. I also take care of pre-and-post liver transplant patients and strive to offer a spectrum of GI tract healthcare at Brooklyn Hospital.

Host: Can you tell us about a common condition, heartburn reflux disease?

Dr. Krishna: Heartburn is associated with a burning feeling in the chest. It usually happens after you eat, it’s one of the most common GI tract symptoms, and it can be cured by just taking tums. It’s not always dangerous but it can land you in the Emergency Room if doctors think it’s a symptom of something more serious and underlying like heart disease. Age also makes a difference. If someone under 40 reports having heartburn, it’s probably not serious. However, if someone over 40 or 50 gets it repeatedly, it could be an issue. If someone feels pressure, pain down their arm, and are sweaty, alongside having heartburn it could be a sign of an impending heart attack. If you get heartburn when you exercise, like walking upstairs, we know that’s not caused by heartburn, it’s caused by heart disease.

Host: Once you know someone has GERD—Gastroesophageal Reflex Disease—how do you treat them? 

Dr. Krishna: We start off with lifestyle modification. Reflux is caused by the relaxation of the sphincter is the valve that covers the food pipe to the stomach. To prevent this, people should eat at least three to four outs before going to sleep. Avoiding chocolate, caffeine, and alcohol can also help prevent reflux. Ingesting peppermint can also cause problems with acid reflux.

Host: Why does reflux act up more at night and what can be done to quell it?

Dr. Krishna: At night we are lying flat so there is less gravity. If the pain gets bad, you can put a pillow under your body or put a wedge under the bed so you’re able to lie back but not completely flat. That can help draw the acid back down into the stomach so you can sleep.

Host: Aside from foods, what can cause heartburn?

Dr. Krishna: Stress, being overweight, and certain medications can cause problems. That said, certain drugs can also help treat acid reflux. Although Tums can help healthy people with mild occasional heartburn, I try to avoid it for patients with more serious and chronic cases. We give more serious cases H2RA Blockers which are histamine to receptor blockers that decrease acid. These medications shut down the acid pump and calm everything down. That’s why we rarely ever operate due to ulcers anymore whereas that was very common in the 1970s and 1980s.

Host: When do you decide to give a patient an upper endoscopy where you put a camera down into their stomach to investigate the causes of their GERD symptoms?

Dr. Krishna: We do this when patients are not responding to typical acid reflux treatment. We get worried that their problems could be caused by adenocarcinoma which is cancer of the lower esophagus. Acid reflux itself is a risk factor for developing cancer of the food pipe. It often starts out as what is known as Barrett’s esophagus that can be diagnosed with a biopsy. 

Host: How do you treat Barrett’s esophagus and what are the warning signs of serious problems? 

Dr. Krishna: Mostly, we find ways to suppress the acid. We also make sure the patient doesn’t have a condition known as hiatal hernia where a bit of the stomach slips up. Acids can be suppressed via medicine and then we monitor the patients and follow up with endoscopies every three years. Food sticking, difficulty swallowing, feeling weak, losing weight, and absence of appetite are all very big alarm signs. When acid comes up it can cause the narrowing—or strictures, in medical jargon—of the esophagus which can cause these symptoms. However, these same symptoms can also be signs of cancer. If you have any of these symptoms alongside a history of acid reflux, it is a red flag. 

Host: Can you tell us about Eosinophilic esophagitis (EoE)?

Dr. Krishna: EoE affects young people more than a lot of other gastronomic conditions. Most of the EoE patients I see come into the ER because of food impactions, meaning that food is literally stuck in their throats and they cannot get it out. Obviously, it’s dangerous and a choking hazard. EoE is caused due to problems with the mucosa which is the lining of the esophagus. If someone’s mucosa looks abnormal, we take a biopsy. If they have EoE we can usually treat it effectively with steroid-based medication and lifestyle modification. Eating things like nuts, soy, milk, and eggs aggravates EoE so we suggest that patients eliminate those things from their diet. We also suggest that they visit an allergist to make sure that they don’t have allergies that are adding to the ailment. We can also treat EoE by asking patients to swallow the spray from an inhaler. 

Host: Can you tell us about a condition called Achalasia?

Dr. Krishna: Achalasia is a condition characterized by difficulty swallowing and pain in the chest. It’s a failure of the lower esophagus isn’t relaxing. The valve is clamped down, it’s not letting food enter into the stomach, and so pressure builds. Eventually, the food will go down but food can get very packed up which can make breathing very difficult.

Host: What is Pseudo-Achalasia?

Dr. Krishna: Pseudo-Achalasia is when a tumor, usually a cancerous one, mimics Achalasia.

Host: How do you treat Achalasia?

Dr. Krishna: We can use medications in pill forms, inject Botox, or go in surgically and cut out the portion of the muscle that is problematic. Years ago, the Heller Myotomy surgery was very common where the muscle was cut laparoscopically so the tension was relieved and all the food would go down. However, now we can reach the esophagus through the mouth without cutting the patient. It’s called a POEM Prasena and it causes less scars, less risk of infection, less time to heal, and better results! POEM actually stands for “per oral endoscopic myotomy.”