Baton Rouge Clinic Health Library

Diseases & Conditions > What Can I Do About Heartburn?

     Published: 11, 2006

If you suffer from heartburn on a regular basis, you are not alone. Approximately one-third of Americans have heartburn at least once a month, with 10% experiencing it nearly every day. This epidemic leads people to spend nearly $2 billion a year on over-the-counter antacids alone. Prescription medications for heartburn are some of the most prescribed medicines in the U.S. So if you have suffered long enough with heartburn, what do you do next? The cause of heartburn, its treatment and the results of that treatment will be discussed below.

What is Gastroesophageal Reflux Disease (GERD)?

Heartburn and GERD are used interchangeably. GERD is acid refluxing or “backing up” from your stomach into your esophagus, which is the long tube that connects your mouth to your stomach. Acid in the stomach may cause burning pain that is felt in the upper part of the abdomen or behind the breastbone in the chest. In some cases, the acid can reflux into the neck and even the back of the mouth. Other symptoms may include vomiting, difficulty swallowing, chronic coughing and wheezing.

What causes GERD?

GERD is caused by the malfunction of a valve-like structure where the esophagus joins the stomach. When you swallow, the food will travel down the esophagus through this one-way “valve” and into the stomach. This valve may have a lower pressure than normal or open at inappropriate times allowing acid and food from your stomach to be displaced into the esophagus. The stomach may also be displaced into the chest (commonly known as a hiatal hernia) where there is lower pressure resulting in reflux.GERD can be aggravated by other factors including obesity, slow stomach emptying, weak muscular contractions in the esophagus, exercise, pregnancy, smoking, many foods and some medications.

Can GERD cause me problems?

Most people with occasional GERD will not have long-term damage associated with reflux. Those people who have recurring episodes of GERD (several times a week), those with daily episodes and especially those with constant reflux are prone to damaging the lining of their esophagus. Chronic irritation of the esophagus by stomach acid may lead to a change in the character of the esophagus lining. Over a long period of time, this may lead to esophageal cancer. Scarring and narrowing of the lower esophagus, bleeding and ulceration may also occur. Patients who experience regurgitation may aspirate stomach contents into their lungs leading to pneumonia.

How is GERD treated?

There are several ways to treat reflux disease. The simplest is lifestyle changes. Your diet should be changed to avoid foods that are known to give you reflux. Avoid eating food late at night to limit reflux when lying down. Prop up the head of your bed to prevent night-time reflux. Take over-the-counter antacids when symptoms occur. Losing weight, decreasing alcohol consumption and limiting smoking may also help.

Treatment with medication is the next option if lifestyle changes do not work. There are a variety of medications that aid in decreasing acid secretion in the stomach. H2 blockers are effective at blocking acid production in the stomach and will reduce-reflux symptoms in most patients. Proton-pump inhibitors are very effective at blocking acid production and will rid most people of any reflux symptoms. Both of these types of medications are available over-the-counter and as prescription. This therapy should be discussed with your doctor.

Surgical therapy is usually reserved for patients who fail medical therapy and lifestyle changes. There are a small percentage of people who continue to have severe reflux symptoms even after receiving optimal medical therapy. Some people may not be able to take acid blocking medicines for long periods of time due to drug side effects. Some patients do not want to take one or two pills for acid reflux each day for the rest of their lives. Others that suffer from asthma, hoarseness or chronic cough, along with their reflux, may not improve with medication. All of these patients are good candidates for anti-reflux surgery.

What is Anti-Reflux Surgery?

Several different types of procedures are done to decrease and in most cases stop GERD. There are several different endoscopic procedures that have come along in recent years, but there is little information about their long-term efficacy. Laparoscopic (surgery involving small incisions, a small video camera and other instruments) and open surgery to control reflux has been around for some time now. The open procedure has existed for many years and the laparoscopic procedure for less than 20 years. Both operations provide relief from reflux, but there is a much quicker recovery after the laparoscopic surgery.

The surgery involves wrapping the top of the stomach around the bottom of the esophagus in the abdomen. This helps to reinforce the “valve” between the esophagus and stomach. If there is a hiatal hernia (an enlarged opening in the diaphragm allowing the stomach to slip into the chest) present, it will also be repaired.

Most people are able to resume normal activity a couple of weeks after surgery. The opening between the esophagus and stomach is narrowed by the operation and does make eating and drinking a slower process for several weeks after surgery. Almost all patients are off of reflux medications on the day of surgery and most will have long-term relief from reflux without medication.

How do I find out more?

If you suffer from GERD and you would like to initiate treatment, please call your primary care physician for evaluation. If you are being treated for GERD and medication does not seem to be working, please consult with your physician about changing your medication or getting a referral to a surgeon who has experience doing anti-reflux surgery.

James A. Froelich, MD, FACS
Specializing in Surgery

The Baton Rouge Clinic, AMC, offers this information as a courtesy service. Please remember that medical knowledge is always evolving and we cannot represent that any of our information is absolutely current. Please consult a physician before taking any medical action based on information gathered from this or any website.