The following originally ran in the Jan. 24 Wichita Eagle “Doc Talk” column.
Most people suffer from occasional heartburn, also called gastroesophageal reflux disease or GERD. This often is resolved with over-the-counter anti-acid medication, avoiding overeating or limiting intake of specific foods. For some people, however, GERD can be a daily battle.
What causes reflux?
Your stomach has specialized cells that produce a layer of mucus to protect it from the low pH of stomach acid. However, your esophagus does not have such a layer. Between your stomach and esophagus lies your lower esophageal sphincter. This should act as a one-way valve into your stomach. Gastroesophageal reflux occurs when acid from your stomach comes in contact with your esophagus. This can happen for many different reasons. Anything that raises pressure in your stomach or lowers the tone of your esophageal sphincter can lead to reflux. Alcohol, caffeine and chocolate are common offenders.
How do I know if it’s reflux?
While reflux can give you pain in your chest, it is important to know when there could be something more ominous going on. Often, treatment for heart attack (myocardial infarction) is delayed because patients think they may just have reflux, which will pass. Reflux pain usually is described as a burning sensation at the base of the breast bone. There often is an associated bad taste in the mouth and the sensation of needing to swallow or drink water. Reflux is not associated with a feeling of chest tightness or pressure, shortness of breath, tingling in the upper extremities, sweating or palpitations. If you experience any of these symptoms, you should seek emergency medical attention immediately.
What are signs of more advanced disease?
Over time, your esophagus can become scarred from the acid exposure, which can cause narrowing in your esophagus. Liquids often will pass easily, but solid food may be difficult to move past the scar tissue. If you have difficulty swallowing, bring it to the attention of your physician. This should prompt further testing.
What are the treatment options?
Reflux should initially be treated with lifestyle modifications. Avoid eating three to four hours before bedtime, elevate the head of your bed 6 inches higher than your feet and avoid alcohol, chocolate and caffeine, especially around bedtime. If your symptoms persist after these modifications, treatment with an anti-acid medication usually is the next step. In the past two decades, medications for reflux have been refined and are excellent at controlling the symptoms. However, patients must take these medications daily or twice daily in order to control symptoms.
When is surgery an option?
Surgery is indicated for patients who have incomplete resolution of their symptoms or have signs of ongoing esophageal injury (narrowing, ulcer or pathologic changes) despite medical therapy with anti-acid medications. In young patients who will require therapy for more than 10 years, surgery is a more cost-effective choice than medication. Patients also must be healthy enough to undergo general anesthesia.
What tests can I expect prior to surgery?
Most patients will need to undergo a battery of tests prior to having surgery for reflux. An endoscopy to visualize your esophagus and a biopsy of any concerning areas should be performed. Often, a pH probe study also will be done to evaluate the severity of your reflux. Your physician also may order a manometry test, which measures the actual pressures within your esophagus and lower esophageal sphincter. The test also evaluates how well you can swallow. Surgery often can be done with minimally invasive techniques using a camera and small incisions for instruments.
If you are experiencing GERD on a regular basis, it is important to talk to your primary care doctor about your symptoms and concerns.
