by Mark Sherman and Cheryl Olson, Surgeons
Some people say it feels like a hot pressure in the chest, or a fire that starts behind the breastbone and spreads upward. Others experience an acidic taste, like food coming back up the throat and into the mouth.
But everyone seems to agree that gastroesophageal reflux disease, or GERD, is uncomfortable and frustrating.
Also called acid indigestion or heartburn, GERD is a digestive disorder that affects the lower esophageal sphincter (LES), the muscle that connects the esophagus and the stomach.
Normally, the LES opens to allow food to pass into the stomach, and closes to prevent food and acidic stomach juices from flowing back into the esophagus, which is known as reflux. If the LES is weak or closes improperly, GERD can result.
Symptoms can last up to several hours and are often worse after eating or lying down.
GERD affects nearly 25 million adults in the U.S. every day, and more than 60 million feel its discomfort at least once a month. Obesity and pregnancy can also increase the risk of GERD; almost half of pregnant women suffer from it.
Dietary choices also may affect GERD; some people find that chocolate, peppermint, spicy or fatty foods, coffee and alcoholic beverages may contribute to symptoms.
Another culprit may be a condition known as hiatal hernia, which can weaken the LES. Hiatal hernia occurs when the upper part of the stomach moves up into the chest through a small opening in the diaphragm muscle that separates the stomach from the chest.
Studies have suggested that hiatal hernia can lead to the retention of acid and other substances, which can then flow back into the esophagus.
Hiatal hernias can be caused by coughing, vomiting, or sudden physical exertion that increases pressure in the abdomen; they are especially common in people over age 50, and usually do not require treatment unless they lead to complications or cause severe GERD.
Depending on the cause and severity of GERD, some people may obtain relief from symptoms by taking over-the-counter or prescription antacids to remove acid from the esophagus, or a reflux medication to reduce the amount of acid produced during digestion.
However, long-term use of these medications can inhibit the absorption of important minerals such as calcium, and patients still may have to avoid certain foods. Moreover, medications don’t resolve the underlying anatomical problems with the LES that cause acid reflux.
In chronic and severe cases, surgery may be needed to correct the anatomical problems that cause GERD.
A surgical procedure known as fundoplication strengthens the valve between the esophagus and stomach, which stops acid from backing up into the esophagus as easily.
Fundoplication is traditionally performed through an incision in the abdomen or chest, and may be done laparoscopically in some patients.
Recently, a new “incisionless” surgery based on the principles of fundoplication has become available. EsophyX Transoral Incisionless Fundoplication or EsophyX TIF is performed transorally (through the mouth).
The procedure reduces a small hiatal hernia and creates a one way valve between the stomach and esophagus, restoring the natural, physiological anatomy to prevent GERD. EsophyX TIF generally takes less than an hour, and most patients can return to work the next day or within a few days.
Because no incision is needed, there is reduced pain, shorter recovery time and no visible scar. Patients may expect to experience some discomfort in their chest or nose and throat for the first few days (sometimes up to a week), and should restrict physical activity for the first week and follow dietary guidelines while the tissue heals.
Recent studies have shown that EsophyX can reduce patients’ dependency on medications and dramatically improve quality of life; 70 percent of patients have remained symptom-free after two years, and most patients can eat and drink foods they avoided for many years.
For the millions of Americans diagnosed with GERD and not fully satisfied with their treatment options, EsophyX may offer an excellent alternative. If you are interested in this option, talk to your physician.
This Scripps Health and Wellness information was provided by Dr. Mark Sherman and Dr. Cheryl Olson, both surgeons at Scripps Memorial Hospital La Jolla.