Heartburn occurs when stomach acids splash back into your esophagus. If heartburn, also called gastroesophageal reflux, occurs more than twice a week, you may have a condition known as gastroesophageal reflux disease (GERD).
GERD — one of the leading digestive disorders in the United States — sends more than 18 million people in search of medical help each year. Persistent heartburn and regurgitation of stomach acids are among the first symptoms of this progressive disease, which can lead to more serious problems if left untreated, including esophageal cancer.
Unfortunately, GERD often goes undetected until it becomes a more serious condition, says Dr. Shaun C. Daly, a gastrointestinal surgeon who specializes in GERD at the UCI Health Digestive Health Institute (DHI).
“What’s striking is that one in five adults suffer from heartburn symptoms,” says Daly. “It’s a very common disease and yet only about one percent of people with heartburn symptoms will consult a gastroenterologist or gastrointestinal surgeon for treatment. When it comes to this disease process, early detection really is the key.”
Catching GERD early
Daly explains that GERD is a disease that gets progressively worse. There are four major levels.
- Uncomplicated GERD — with no damage or side effects observed to the esophagus.
- Esophagitis — an inflammation of the esophagus graded from A to D, with D being the worst.
- Barrett’s esophagus — a thickening of the lower esophageal mucosal lining to protect the esophagus from chronic inflammation that may lead to a pre-cancerous condition called Barrett’s dysplasia.
- Esophageal cancer — the end stage of the disease.
Early symptoms of GERD to watch for include:
- Food regurgitation
- Sour taste in the mouth
- Hoarseness, voice changes
- Chronic cough
- Sinus problems
“If you’re suffering from any of these symptoms, it’s really important to break the disease progression as early as possible before it becomes dysplasia or esophageal cancer,” Daly emphasizes.
Diagnosing the situation
Esophageal disease specialists at the UCI Health Comprehensive Heartburn Center can provide the most complete evaluation, proactive care and innovative treatments to dramatically lessen your symptoms — or eliminate GERD altogether.
“GERD symptoms — burning in the chest, nausea, dry cough — can be very nonspecific and could be related to many conditions,” Daly says. “It’s important to get a comprehensive exam.”
Tests and other procedures may be suggested for a more definitive diagnosis and to determine the extent of the problem. They include:
- X-ray of the upper digestive tract — Also called a barium swallow, this test involves drinking a chalky liquid to coat the lining of the esophagus, stomach and upper intestine (duodenum). A series of X-rays can reveal in silhouette the shape and general condition of these organs.
- Upper endoscopy — A thin, flexible tube equipped with a light and a camera is inserted down the throat to inspect the esophagus and stomach for signs of inflammation or complications of acid reflux, such as Barrett's esophagus. During the procedure, the doctor may collect tissue samples for testing.
- Acidity monitoring — An ambulatory acid (pH) test uses a monitor device to measure when, how much and for how long stomach acids regurgitate into the esophagus, usually for a 48-hour period. The monitor can be a thin, flexible catheter inserted through the nose into the esophagus called a pH impedance test or a microchip with the BRAVO™ capsule test inserted during an endoscopy. The microchip sends data wirelessly to a pager-sized receiver. Correlating the patient's symptoms and posture with data on the amount of acid refluxing into the esophagus can help make an accurate diagnosis.
- Esophageal manometry — A thin, flexible catheter equipped with pressure sensors is threaded through the nose and into the esophagus to measure the strength and coordination of muscle movement. The test helps determine how well your lower esophageal sphincter and other muscles are working when you swallow water.
Once GERD is accurately diagnosed, dietary and lifestyle changes are usually prescribed to prevent pain and heartburn from affecting normal activities. These include:
- Losing weight, if necessary. Extra pounds put pressure on the abdominal area.
- Eating smaller meals more slowly. This allows food to move more quickly through the digestive system.
- Avoiding foods and drinks that worsen symptoms. Heartburn can be triggered by fried or fatty foods, alcohol, chocolate, peppermint, garlic, onions or caffeine.
- Staying upright after eating. Wait at least three hours after a meal to nap or go to bed.
- Quit smoking. Smoking has been shown to loosen the esophageal sphincter.
- Elevate the head of your bed six to eight inches with blocks or a wedge. Pillows alone are insufficient.
Over-the-counter or prescription medications may also be recommended, such as antacids, H2 blockers (Pepcid AC, Tagamet or Zantac) or proton pump inhibitors (Prilosec, Nexium, Prevacid).
However, studies have shown that long-term use, especially proton pump inhibitors, is associated with serious side effects, including osteoporosis-related hip fractures.
“In general, being on PPI’s for more than 10 years carries a significant risk of decreased bone density, especially in postmenopausal women,” says Daly.
Expert, innovative care
When medications no longer adequately control acid reflux, other procedures may help prevent further damage to the esophagus.
UCI Medical Center is the only healthcare provider in Orange County and Southern California to offer three minimally invasive alternatives to standard surgical treatment for GERD. These FDA-approved procedures strengthen the muscle that prevents stomach contents from refluxing, or washing back, into the esophagus. They are:
- Stretta®. This outpatient, endoscopic procedure uses radiofrequency energy to heat the esophageal muscles, which causes them to thicken. This helps restore the natural barrier that prevents acid reflux. In clinical trials, more than 80% of patients who underwent the Stretta procedure were able to quit medications such as proton pump inhibitor for at least four years.
- Transoral Incisionless Fundoplication (TIF® with EsophyX®). A physician, using a high-definition camera attached to the endoscope, positions the device within the lower esophageal sphincter muscle to create a sturdy anti-reflux valve and prevent any backwash of stomach acids. It can also be used to repair a hiatal hernia to control reflux in many patients.
- LINX® Reflux Management System. This minimally invasive surgical procedure uses a tiny bracelet of magnetic titanium beads to surround and compress the lower esophageal sphincter — the valve that normally prevents stomach fluids from refluxing into the esophagus .
Sometimes, a minimally invasive procedure called fundoplication is performed to reinforce the lower esophageal sphincter and prevent reflux. It is performed with a laparoscope, using only a few small incisions to accommodate tiny surgical instruments, a small video camera and light source.
The GERD team at DHI includes board-certified and fellowship-trained gastroenterologists, interventional gastroenterologists and gastrointestinal surgeons, all of whom are experienced in the full range of GERD treatment, from lifestyle changes and medications to specialized minimally invasive procedures.
“I can’t stress enough how important it is to get any GERD symptoms evaluated and treated as early as possible to prevent the more serious consequences as the disease progresses,” Daly says.