Treatment Options for Chronic Heartburn

Learn about symptoms, risk factors and treatment for chronic heartburn and GERD

A middle-aged man with chronic heartburn has a thoughtful moment in a peaceful park setting.

by Dan I. Giurgiu, MD, F.A.C.S.

Heartburn is a common ailment experienced by many Americans each day. The intense burning discomfort in the chest or throat is the result of harsh stomach acid coming into contact with and irritating the delicate lining of the esophagus, the tube-like structure that connects the mouth to the stomach.

The exact symptoms and sensations of heartburn vary from person to person, but its most common symptom is often described as a burning or vague feeling of discomfort in the chest, just behind the breastbone.

Gastroesophageal reflux disease

Some people may not suffer from heartburn, but rather from a more serious condition known as gastroesophageal reflux disease, also known as GERD. This disease — most often characterized by frequent heartburn — affects an estimated five to ten percent of the global population.

Although common, GERD is often unrecognized or misunderstood. The unfortunate result is that this often very treatable disease goes undiagnosed.

In most patients, GERD results from transient relaxations of the “gate” or sphincter that keeps the lower end of the esophagus closed when a person is not swallowing food or liquids.

This often allows a reflux of corrosive stomach acid into the esophagus, causing injury. This transient relaxation happens a few times a day in people without GERD. Why it happens more frequently in GERD patients is unknown.

Avoiding GERD symptoms

Changes in diet and lifestyle may relieve GERD symptoms in some patients. Some methods that may offer relief include the avoidance of:

  • Stimulating foods such as coffee, alcohol, carbonated drinks, rich foods, spicy foods and acidic foods
  • Eating close to bedtime
  • Stooping, kneeling or bending over
  • Wearing tight clothes; not sleeping flat — elevate your head 6-8 inches; losing weight and not overeating

Medications are often very helpful in reducing the amount of discomfort that many GERD patients experience. However, for most patients, drug therapy provides relief — not a cure —- and is often required to be taken by the patient for his or her entire lifetime.

Laparoscopic fundoplication procedures

If the prospect of taking medication for the rest of your life is not attractive, or if medical therapy has failed to provide sustained relief, you may consider a surgical procedure called laparoscopic fundoplication.

The procedure, also called antireflux surgery, is done when other measures fail. Patients who respond well to medical therapy can expect to respond very well to surgery.

In addition, patients who have symptoms while on maximal medical therapy, or who are no longer willing to modify their lifestyle significantly, may be candidates for surgical treatment.

The laparoscopic fundoplication usually requires an overnight stay in the hospital, but depending on the patient, can be performed as an outpatient procedure. During this procedure, a surgeon re-creates the valve between your stomach and esophagus by wrapping the very top of the stomach around the lower part of the esophagus.

After going home, the patient is on a liquid or soft foods diet for two or three weeks. Patients may return to their usual activities, including work, within days of surgery.

After the procedure, symptoms and the need for medications are eliminated or greatly reduced. Patients consistently report a very high satisfaction rate after undergoing anti-reflux surgery.

Long-term treatment for GERD

GERD is a chronic disease, and treatment must be maintained on a long-term basis, even after symptoms are under control.

Aside from severe discomfort, if left untreated GERD can cause serious long-term health problems, including permanent damage to the esophagus, the development of ulcers, the formation of scar tissue and possibly cancer of the esophagus.

This Scripps Health and Wellness information was provided by Dan I. Giurgiu, MD, F.A.C.S., on staff at Scripps Memorial Hospital Encinitas.