Digestive Diseases

Heartburn

Many people experience an uncomfortable, burning sensation in the stomach or chest at least once a month, often after eating certain kinds of food. For most, it's an occasional experience that is easily relieved with an over-the-counter antacid. For some, however, heartburn is a constant condition that affects virtually all aspects of life-what to eat, how to sleep, and even what clothes to wear. If symptoms occur frequently, or especially if symptoms occur on a daily basis, the patient should be examined by a primary care physician or gastroenterologist.

Although the majority of symptoms experienced as heartburn result from excessive stomach acid, other conditions, including a heart attack, can sometimes exhibit similar symptoms. People who experience heartburn symptoms that cannot be relieved through antacids should seek immediate emergency medical attention.

GERD

GERD (gastroesophageal reflux disease) is the medical term for a chronic condition that  causes heartburn symptoms. People with GERD experience stomach acid moving back into the esophagus (the tube that leads from the throat to the stomach) and into the throat. Certain foods can trigger release of extra acid or relax the sphincter to allow acid back into the esophagus. These foods include coffee and alcohol, chocolate and mint, citrus fruit, fried foods and other foods high in fat and spicy and/or tomato-based food. Pregnancy, unhealthy weight, and smoking, can increase a person's chances of developing GERD.

The most common sign of GERD is a recurring sensation of heartburn in the middle of the chest. GERD can also cause throat irritation or other problems, such as the feeling of a lump in the throat, trouble swallowing, hoarseness, worsening of a cough, or wheezing, which can lead to asthma-like symptoms or chronic cough.

Diagnosis

GERD is often diagnosed from signs and symptoms alone, but a variety of techniques to examine the esophagus and stomach are used when necessary.

A gastroenterologist may perform an endoscopy, in which a small scope with a camera is passed into the esophagus and stomach to provide images of these organs. A biopsy may also be taken to examine the lining of the esophagus and stomach in order to determine whether the GERD is caused by other medical conditions.

Treatment

The first step in treatment of GERD is for the patient to make lifestyle changes. At NYPBMH, dietary counseling with a nutritionist offers valuable information about ways to reduce or eliminate GERD symptoms.

If symptoms persist even after dietary and lifestyle changes, medical therapy is the next step. There are multiple medication options available, such as proton pump inhibitors (such as omeprazole) or H2 blockers (such as ranitidine). However, as is the case with most medications, there are side effects. Because of the side effects, close follow-up with a gastroenterologist is very important. Some of these medications are not recommended for long-term use, and if long-term use is necessary, routine blood tests may be necessary as well.

In severe cases, when GERD cannot be treated with medications, or when the only alternative is continuous drug therapy, patients may opt to have the condition surgically corrected. The traditional surgical procedure, known as Nissen fundoplication, involves a stomach incision, a hospital stay of six to ten days and a recovery period of six to eight weeks. As a result, surgery has typically been limited to those patients with extreme or life-threatening conditions.

However, a modified laparoscopic Nissen technique makes it possible to perform the same operation in a minimally invasive manner. This procedure is quick, and requires only a few small surgical incisions. Most patients go home in one or two days, and, in most cases, can return to work and other normal activities within a week.