That burning sensation: What you need to know about heartburn

If you’ve ever experienced heartburn – also known as Gastroesophageal Reflux Disease or GERD – you know how uncomfortable it can be. [Twenty percent of Americans* are affected by] GERD. Besides heartburn, GERD symptoms can fall into two categories. Typical symptoms include regurgitation, bloating, or an acidic taste in the back of the mouth. Less common symptoms include asthma, persistent coughing, shortness of breath and even recurrent pneumonia. These less frequent symptoms are often misdiagnosed and the root cause never recognized.

Treatments: masking symptoms vs. treating the cause.
According to the National Institutes of Health (NIH), more than 64 million prescriptions were written in the U.S. for GERD medications in 2012 and dozens of over-the-counter heartburn remedies are available at most pharmacies. These medications range from antacids and H2 blockers to proton pump inhibitors (PPIs).

“Medications don’t treat reflux, they hide it,” said Wilson Tsai, M.D., Director of Eden Medical Center’s Esophageal and Thoracic Program. “People take medications and feel better, so they think the problem is gone. More than 90 percent of my patients with esophageal cancer were told by their doctors to take their PPIs and they’d be fine. Meanwhile, the root cause was getting worse.”

Dr. Tsai said that people who suffer from reflux for more than a month should see their doctor for a complete workup. “PPIs should only be used to treat symptoms for a few weeks,” he explained. “Long-term use of PPIs can lead to osteoporosis and bone fractures, and they have a number of dangerous drug interactions.”

Patients are often told to reduce the symptoms of GERD by losing weight or avoiding foods and beverages that contribute to heartburn, such as tomatoes, coffee and alcohol. Dr. Tsai agrees that losing weight can decrease the pressure in the abdomen that can cause a hiatal hernia, which is diagnosed through endoscopy or an esophagram. However, he believes that lifestyle changes only go so far in reducing symptoms of reflux.

Stopping reflux at the source: a new procedure at Eden Medical Center.
For many years, the standard surgical treatment for GERD has been fundoplication, a laparoscopic procedure in which the top of the stomach is sewn around the esophagus to reduce reflux. In 2012, the U.S. Food and Drug Administration (FDA) approved the LINX™ Reflux Management System. The LINX device consists of a series of titanium beads, each with a magnetic core, connected to create a ring. The ring is then surgically implanted around the lower esophageal sphincter to prevent stomach contents from backing up into the esophagus. In clinical studies, the LINX system eliminated severe reflux in 100 percent of patients, and 93 percent of patients reported a significant decrease in the need for medications.

Eden Medical Center will soon begin offering the LINX procedure to its patients. “LINX implantation takes about ten minutes and will be performed laparoscopically on an outpatient basis,” explained Dr. Tsai, who added that highly specialized training is required to perform the procedure. He was careful to point out, however, that patients with esophageal changes or precancerous conditions such as Barrett’s Esophagus (a condition in which the lining of the esophagus is replaced by tissue similar to the lining of the intestine) are not candidates for the LINX procedure.

The bottom line: consult your doctor.
“Acid reflux is a mechanical problem, not a chemical one,” Dr. Tsai explained. “We all have stomach acids, but when they flow back up into the esophagus, it’s a clear sign that something is not functioning correctly. The problem needs to be fixed at the source, not masked with medications.”

Have you been suffering from persistent heartburn? Contact the Heartburn Center of California for an evaluation. 

*American Society for Gastrointestinal Endoscopy

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Posted July 29, 2014