You just enjoyed one of your favorite meals – and yes, you realize it was heavy on the spices and fat, but it was oh so good that you couldn’t resist. Just when you sit back and utter a satisfied sigh, the warning signs begin. You feel that uncomfortable pain and burning in your stomach, abdomen, chest or throat. Without something to relieve the symptoms, the discomfort can quickly escalate to full on chest pain. And, the pain doesn’t stop when you leave the table. It can follow you to bed, where it only gets worse, making a good night’s sleep practically impossible.
What you are experiencing is very likely acid reflux or heartburn, also known as GERD (gastroesophageal reflux disease). Heartburn usually isn’t serious, but if you find yourself in agony after meals several times a week, or are experiencing a cough, hoarseness and difficulty swallowing, it could be time to see a doctor about the causes of your discomfort and potential treatments. Over time persistent heartburn can lead to damage of the lining of the esophagus including bleeding, inflammation and difficulty swallowing. Without treatment the result of this damage can become serious.
To answer common questions about acid reflux and its causes, as well as the latest treatments, Well-Being spoke to Shuja Yousuf, M.D., Gastroenterologist with Merit Health in Brandon and Pierre De Delva, M.D., Thoracic Surgeon and Assistant Professor, at University of Mississippi Medical Center.
Q. What causes acid reflux?
A. Acid reflux occurs when the esophagus comes in contact with too much stomach acid over a period of time. “A muscular valve called the lower esophageal sphincter is designed to prevent reflux of stomach contents from splashing up into the esophagus,” explains Dr. Yousuf. “However when this valve becomes weak or if there is a significant hiatal hernia, stomach acid is allowed to reach the lining of the esophagus causing a burning sensation.”
Q. What factors can make a person at higher risk for developing acid reflux?
A. The following are some of the most common risk factors for heartburn or acid reflux: • Having a hiatal hernia • Eating large meals or lying down right after a meal • Being overweight or obese • Eating a heavy meal and lying on your back or bending over at the waist • Snacking close to bedtime • Eating foods such as citrus, tomato, chocolate, mint, garlic, onions, or spicy or fatty foods • Drinking beverages such as alcohol, carbonated drinks, coffee, or tea • Smoking • Being pregnant • Taking aspirin, ibuprofen, certain muscle relaxers, or blood pressure medications
Q. When should you see a doctor about your acid reflux?
A. When symptoms of heartburn are not controlled with modifications in lifestyle and over-the-counter medicines are needed two or more times a week, or symptoms remain unresolved on the medication you are taking, you should see your doctor. “Heartburn symptoms can mimic the symptoms of a heart attack in certain patients, especially those with risk factors for heart disease such as hypertension, high cholesterol, diabetes, smoking, family history of heart disease and older age. Prompt medical attention is advised in such cases,” adds Dr. Yousuf.
Q. What happens if acid reflux is allowed to continue unchecked by medications or lifestyle changes?
A. If acid reflux is not controlled, quality of life can be affected. Persistent reflux can lead to inflammation and scarring of the esophagus. “The damage persistent reflux can do to the esophagus can cause strictures and can lead to difficulty in swallowing,” Dr. Yousuf continues. “Acid can go further up in the esophagus towards the throat and affect vocal cords causing voice issues. In some cases, inflammation can progress and potentially lead to a pre-cancerous condition called Barrett’s Esophagus, which in some cases can develop into esophageal cancer. Patients who have Barrett’s Esophagus need regular follow up and surveillance endoscopies.”
“About 20% of people have acid reflux, 40-50% of these have good symptom control with medications,” Dr. Pierre de Delva.
Q. How is acid reflux treated?
A. Infrequent acid reflux may be controlled with lifestyle modifications to reduce or eliminate risk factors for the condition, and the proper use of over-the-counter medicines. For more frequent acid reflux, prescription medications called H2 receptor antagonists (H2 blockers), like Zantac, Tagamet and Pepcid and proton pump inhibitors (PPIs), such as Prilosec, Nexium and Prevacid, may be needed. These medications help to reduce the stomach acid that tends to worsen symptoms, and work to promote healing.
Q. Are there surgical solutions to acid reflux?
A. Surgical measures to prevent reflux can be considered if other measures fail or complications occur such as bleeding, recurrent stricture, or metaplasia (abnormal transformation of cells lining the esophagus), which is progressive. A surgical technique called Nissen Fundoplication, can be done laparoscopically and involves wrapping the upper curve of the stomach around the esophagus. The lower portion of the esophagus passes through a tunnel of the stomach, creating a new barrier to reflux.
According to Dr. de Delva, who specializes in reflux and swallowing problems, only about 1 percent of GERD sufferers end up being referred for that procedure. About 60 percent are well controlled on medication, but there’s a gap of patients who aren’t. Providers aren’t ready to refer them for surgery because of the perception that the side effects of a Nissen aren’t worth it, and because reflux isn’t life threatening.
Dr. de Delva is now performing a new kind of acid reflux surgery approved by the FDA in 2012, which uses the LINX® reflux management system to keep stomach acids from traveling up the esophagus. The LINX surgery is designed to target the gap population. It’s done laparoscopically, and generally requires a one-night hospital stay.
“The LINX is a series of titanium beads with magnetic cores connected together as a small bracelet with titanium wires. The surgeon implants the bracelet around the esophagus to increase the tone of the valve that normally prevents stomach acid from traveling up the esophagus,” notes Dr. de Delva. “The normal pressure generated by swallowing expands the magnets of the device and allows the sphincter to open and close.”
“It’s gone through a rigorous research process. Five-year data shows about 90 percent of patients are satisfied, and it’s designed to be just as good as the other procedure, but without the side effects, such as gas, bloating, the inability to vomit, and the feeling of food being stuck in the throat or chest,” de Delva added.
Candidates for the LINX procedure must have measurable reflux (determined by a PH study); normal swallowing function; somewhat maintained anatomy of the esophagus, with only early structural problems, and must not be allergic to titanium.
Pierre de Delva, M.D., Thoracic Surgeon and Associate Professor at UMMC, received his Doctor of Medicine degree from the Emory University School of Medicine. He completed a residency in general surgery and thoracic surgery at Massachusetts General Hospital, and also completed two externships, one at the Mayo Clinic in general thoracic surgery and one at the University of Pittsburgh Medical Center in minimally invasive esophageal surgery. Dr. de Delva specializes in minimally invasive lung and esophageal procedures.
Shuja Yousuf, M.D., Gastroenterologist with Merit Health Medical Group, is a graduate of the University of Kashmir, Govt. Medical College in Kashmir, India. He completed his residency at Temple University/St. Luke’s Hospital in Bethlehem, PA, and his fellowship in Gastroenterology was completed at the University of Mississippi Medical Center. Dr. Yousuf specializes in the diagnosis and treatment of gastrointestinal conditions such as diverticulitis, GERD and irritable bowel syndrome (IBS) and performs colonoscopies for colon cancer screening.