Are you troubled with heartburn, indigestion, difficulty swallowing, or tasting your food again after you've swallowed it? Other symptoms may include difficulty sleeping after eating, chronic coughing or wheezing, hoarseness or a sore throat at least once a month. You may have gastroesophageal reflux disease (GERD).

What is heartburn?

Heartburn is a harsh burning sensation, usually located in the center of your chest. The sensation may move through your upper abdomen, chest, throat, and/or neck.

What causes GERD?

Food passes from your mouth through the esophagus and through a valve called the lower esophageal sphincter (LES) into the stomach. The LES is a one-way valve permitting food to pass to the stomach. This valve normally prevents food from backing up or "refluxing" back into your esophagus. GERD occurs when the valve fails and stomach acids flow back and burn the lower esophagus. If reflux persists over time, the esophagus becomes irritated and inflamed, causing heartburn and sometimes damage to the esophagus.

What factors contribute to GERD?

"People are sometimes born with a weak valve," explains Horacio Asbun, M.D., F.A.C.S., medical director of the John Muir Advanced Laparoscopic Surgery Program. "Others may be affected by eating fatty or spicy foods, taking certain medications, drinking alcohol, smoking, wearing tight clothing, exercising hard, or changing body positions such as lying down or bending. Some develop a hiatal hernia when an opening in the diaphragm enlarges and allows a portion of the lower esophagus and upper stomach to move into the opening." What treatments are available?

You and your physician can work together to treat GERD through three progressive steps: lifestyle changes, drug therapy, and when needed, surgical intervention. The first step is to change your diet to reduce or ease symptoms. Certain foods can relax the LES or increase acid in your stomach. Avoid carbonated drinks, coffee, and tea; chocolate; citrus foods; fatty and fried foods; onions; peppermint; spicy foods; and tomatoes.

To relieve the symptoms of GERD, Dr. Asbun suggests the following steps:

• Eat several small volume meals daily instead of three large meals
• After eating, avoid bending over, lying down or sleeping for two to four hours
• Stop smoking and drinking alcohol (both increase stomach acid and irritation, and alcohol opens the LES)
• Maintain your recommended weight or lose weight if necessary
• Exercise regularly after speaking with your physician about an appropriate program
• Wear loose-fitting clothing and belts
• Raise the head of your bed six to eight inches with books or blocks, or put a wedge under the head of your mattress or sleep over several pillows

If your symptoms persist after lifestyle changes, drug therapy should be discussed with your physician. Using antacids can help to neutralize and decrease stomach acids and relieve symptoms. Your physician may also recommend H-2 blockers that must be used in a carefully prescribed manner. Also check with your physician about avoiding taking aspirin or anti-inflammatory drugs which can irritate the protective lining of your stomach. In addition to the H-2 blockers, your physician may prescribe more powerful medications (called proton pump inhibitors).

If you have a narrowing in your esophagus (start to have trouble swallowing), your physician may recommend one or several dilatation procedures to enlarge your esophagus. If you do not respond well to lifestyle changes, drug therapy, or you require dilatations procedures, you may consider undergoing a surgical procedure. Until recently, surgery involved a large abdominal incision, significant pain, a hospital stay of seven to ten days, and more than six weeks of recovery time. The new, minimally invasive technique using a laparoscope avoids a large abdominal incision. Pain is significantly less, and the length of a hospital stay averages two days. Many can return to work within two weeks. Your physician may recommend laparoscopic anti-reflux surgery.

What is laparoscopic anti-reflux surgery?

This recently developed surgical technique is performed on the esophagus and stomach with the patient under general anesthesia. As many as five small incisions are made in the abdomen. The laparoscope is attached to a camera that sends images to a video monitor. Through several tiny incisions, tissue in the abdomen is manipulated. This surgery is considered a safe and effective treatment for GERD when other medical management is insufficient. Many studies show most patients are either free of symptoms or have significant improvement of symptoms from GERD and usually do not require any further medications. If you are concerned about GERD, talk with your physician.

Healthy happenings

For more information about Heartburn/GERD, contact the staff at John Muir Health Advanced Laparoscopic Program at (800) 593-0093.

Upcoming Seminars

"What can you do about heartburn?"
Speaker: Horacio Asbun, M.D.
Medical Director, John Muir Advanced Laparoscopic Surgery Program

Learn about the causes of heartburn and how you can get relief from it through diet modification, medication, lifestyle changes, and in some cases, surgery. This free community education program is offered:

Tuesday, February 8
7 to 9 p.m.
John Muir Medical Center, Concord Campus

Call (925) 947-3333 for reservations.