Battling Heartburn

Learn more about chronic acid reflux—also known as GERD—and how to keep it in check.
Woman Lying On Sofa Looking Sick In The Living Room

 

Occasional heartburn after meals is normal and typically nothing to be worried about. But if you experience heartburn at least once a week and frequently regurgitate your food after meals, you may be among the 20 percent of people who suffer from chronic heartburn, also known as gastroesophageal reflux disease (GERD). Here, thoracic oncological surgeon Robert J. Korst, M.D., chief of Oncology Surgical Services at Valley-Mount Sinai Comprehensive Cancer Care and director of thoracic surgery at Valley Medical Group, answers common questions about GERD.

What causes GERD?

About 90 percent of GERD is caused by hiatal hernia, an internal hernia where an opening in the diaphragm allows the upper part of the stomach to bulge into the chest. This disrupts our normal anti-reflux anatomy, resulting in reflux. In the remaining 10 percent of cases there is no hiatal hernia. These patients simply have a loose lower esophageal sphincter for unknown reasons.

Who’s at risk?

Hiatal hernia is more common in obese people, and it runs in families. Hiatal hernias are more and more common due to the obesity epidemic.

How can I tell if I have GERD or just reflux?

The two classic symptoms of GERD are heartburn and regurgitation. Other symptoms such as a scratchy throat, hoarse voice, frequent throat clearing and mucus in the throat with cough, chest pain, shortness of breath, abdominal pain and/or nausea are more likely due to reflux.

How is GERD treated?

The first course of treatment is diet modifications, which means avoiding fatty foods, caffeine and chocolate. Spicy foods and alcohol are big offenders too. Second is administering medications that decrease acid production by the stomach, such as proton pump inhibitors and Histamine antagonists and antacids. Third are procedures that are done in a select minority of patients, such as laparoscopic hiatal hernia repair or other endoscopic procedures.

What types of surgery are available?

In select patients with large hiatal hernias or in patients who don’t want to take chronic medications, hiatal hernia repair can be considered. This is performed laparoscopically or robotically. There is also a new, minimally invasive technique that treats GERD called TIF (transoral incisionless fundoplication), which is a potential option in a select minority of patients. In TIF, a device with an endoscope (a long, flexible lighted tube with a camera) is inserted through the mouth and into the stomach, rather than via incision, to reconstruct the valve between the esophagus and the stomach.

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