ACID REFLUX IS COMMON, BUT SHOULDN'T BE IGNORED

Most people suffer from heartburn now and then. The uncomfortable burning sensation behind the breastbone or in the throat might result from overindulging at a meal, or eating spicy foods at night. Most times it can be alleviated with antacids, but for some, heartburn may be a sign of a serious underlying condition.

Chronic heartburn is the No. 1 symptom of gastroesophageal reflux disease, commonly known as GERD or acid reflux. More than 60 million Americans experience acid reflux at least once a month and it seems to be on the rise, mainly due to higher obesity rates, inactivity and Americans’ love affair with high-fat foods*. Dr. Stephen VanWylen, medical director of surgical services at Holland Hospital, explains why GERD should not be taken lightly, and the treatments available to relieve symptoms – or prevent them in the first place.

What is GERD?

GERD is a common disease in which stomach acids reflux, or flow back, from the stomach into the esophagus. This occurs when the lower esophageal sphincter, a muscle which acts as a one-way valve to let food enter the stomach, has become weakened or relaxed, allowing stomach juices to splash back up.

Although symptoms are common and rarely serious, acid reflux shouldn’t be ignored. In some cases, persistent exposure of the delicate tissue of the esophagus to stomach acids can cause inflammation and eventual scarring, leading to difficulty swallowing. A small percentage of GERD patients develop an esophageal ulcer or a potentially serious condition called Barrett’s esophagus, which can develop into cancer.

How can I find out if I have GERD?

In addition to heartburn, symptoms of GERD include regurgitation (or the feeling of acid backing up into the throat or mouth), hoarseness, difficulty swallowing, and stomach discomfort. For occasional symptoms, many people find relief from over-the-counter antacids and modifications in lifestyle such as losing weight, sleeping with the head elevated, and avoiding caffeine, alcohol, and spicy or fatty foods. You should consult a doctor if those treatments don’t provide lasting relief or if you have heartburn on two or more days a week.

Doctors sometimes diagnose GERD based on symptoms, or by performing an endoscopy to visually examine the esophagus for inflammation or ulcers. However, the most accurate way to determine if you have acid reflux is to test the pH levels in your esophagus. For this, Holland Hospital physicians employ two techniques that measure pH levels as you go about your daily activities:

• Bravo pH monitoring system – a wireless capsule the size of a pill is attached to the esophageal wall to record acid reflux occurrences over a 48-hour period;
• Impedance pH study – a soft wire probe inserted through the nose collects data on reflux over a 24-hour period. Because it also measures non-acid content, the probe can detect reflux occurrences even while a patient is on GERD medication. Holland Hospital was the first hospital in West Michigan to use this state-of-the-art diagnostic tool in 2008.

If one of these tests confirms that a patient has GERD, treatment options include medication and surgery. About nine out of 10 GERD patients are very satisfied with medicines like proton pump inhibitors which control symptoms by minimizing acid.**  However, if medication is not effective or increased dosages are needed for continued relief, or if patients wish to avoid the cost and inconvenience of long-term dependency on medication, surgery to anatomically correct the problem may be preferred.

What surgical options are available?

The aim of surgery is to eliminate acid reflux by tightening the sphincter muscle between the esophagus and the stomach. For 15 years, the gold standard has been laparoscopic Nissen fundoplication, in which the top of the stomach is wrapped around the bottom of the esophagus to reinforce the existing valve. This minimally invasive procedure has a long track record of success, with over 90 percent of patients free of acid reflux after one year and only a few reports of recurrence years later.

Now, a new incisionless surgery option is also available at Holland Hospital in which the esophageal valve is reconstructed using a device that is inserted into the stomach through the patient’s mouth. Benefits include a shorter recovery time (one week, although many patients feel well enough to return to work the next day) and the elimination of side effects such as bloating experienced by a small number of laparoscopic-surgery patients.

TIF, short for transoral incisionless fundoplication, has been performed thousands of times worldwide and has a high satisfaction rating; however, it is not for everyone. Those with a significant hiatal hernia – not uncommon in GERD patients – and certain other conditions are not candidates.

Both procedures take about one hour under general anesthesia and usually require a one-night hospital stay.

Don’t ignore acid reflux

Whether through lifestyle changes, medication or surgery, I can’t stress enough that it is essential for people with acid reflux to become symptom-free. If you have persistent symptoms, please take them seriously and talk to your doctor.

* Source: www.webmd.com/heartburn-gerd.
** Source: Medical therapy of GERD, 2007, Current Opinion in Gastroenterology.