Almost 18 million Americans suffer from chronic heartburn — not the occasional heartburn that can be treated with antacids, but the persistent heartburn that is more disruptive and may be a symptom of gastroesophageal reflux disease (GERD). Chronic heartburn can interrupt sleep, limit activities, restrict certain foods, and generally change the way you live your life.
- What Is GERD?
- GERD Symptoms
- Do You Have GERD?
- GERD Lifestyle Changes
- GERD Medications
- Laparoscopic GERD Surgery
- Laparoscopic GERD Surgery Side Effects
- Ask Your Doctor
What Is GERD?
Gastroesophageal reflux disorder (GERD) is a common condition that occurs when stomach acid moves back up the esophagus toward the mouth, rather than remaining in the stomach as it should. This causes the lining of the esophagus to become irritated and inflamed, which may lead to more severe symptoms if left untreated. Similar to occasional acid reflux, GERD is typically experienced right after eating — sometimes producing a more intense reaction at night – however, patients that are diagnosed with GERD suffer more frequently, often at least one to two times every week.
Over-the-counter or prescription medications may help to control GERD and ease symptoms, however those remedies may not be able to fix the cause. Individuals can be evaluated to determine if a surgical option, such as videoscopic surgery, may be recommended to fully address the condition.
At Suburban Surgical Care Specialists/Kane Center, our experienced Chicago-area general surgeons are committed to providing the least invasive procedures, whenever possible, with the latest technologies that will best serve the needs of our patients.
What Are the Symptoms of GERD?
Symptoms of GERD may vary for each individual, with some experiencing more symptoms than others. The most common signs someone has GERD include:
- Chest pain
- Noticeable acid or food regurgitation
- Feeling that something is stuck in the throat
- Trouble swallowing
- Chronic cough
- Hoarse-sounding voice
- Sleep issues
- Newly developed or worsening asthma
If the condition is not properly addressed, symptoms may become more severe and lead to serious health problems, such as an erosion, ulceration, or gastrointestinal (GI) bleeding.
Do You Have GERD?
Individuals can take the test below, which is based on an evaluation from the American College of Gastroenterology, to see if they might be suffering from GERD.
Do you frequently have one or more of the following:
- An uncomfortable feeling behind the breastbone that seems to be moving upward from the stomach?
- A burning sensation in the back of your throat?
- A bitter acid taste in your mouth?
- Do you often experience these problems after meals?
- Do you experience heartburn or acid indigestion two or more times per week?
- Do you find that antacids only provide temporary relief from your symptoms?
- Do you take the maximum dosage of over-the-counter medication?
- Are you taking prescription medication to treat heartburn and still having symptoms?
- Do you have trouble swallowing or persistent abdominal pain?
If you said “yes” to two or more of the above, you may have GERD. To know for sure, contact our practice for a complete evaluation.
What Lifestyle Changes Can Improve GERD?
Whether you have occasional or severe chronic heartburn, the following basic lifestyle changes may help you manage your discomfort and benefit your overall health:
- Avoid lying down 2-3 hours after eating
- Elevate the head of your bed 4-6″
- Maintain a healthy weight
- Make time for physical activities, such as walking
- Reduce stress by taking 15 minutes out of your day to relax or meditate
- Eliminate smoking and tobacco products
- Eat hard butterscotch or caramel candies (not peppermint)
- Wear looser-fitting clothes and looser belts around your waist
- Stay away from food and drinks that make heartburn worse
Additionally, certain medications can make heartburn worse because they either promote acid production, relax the lower esophageal sphincter (L.E.S.), or reduce saliva, such as:
- Painkillers, like aspirin, ibuprofen and naproxen
- Hormone progesterone (used in birth control pills and postmenopausal therapy)
- Anticholinergics (prescribed for high blood pressure)
- Tricyclic antidepressants (prescribed for depression)
- Calcium channel blockers (prescribed for high blood pressure)
- Theophylline (prescribed for asthma)
Be sure to ask your pharmacist or doctor if any of your current medications could be contributing to your heartburn.
What Medications Can Help GERD?
If you have frequent or severe heartburn, your doctor may prescribe a medication. Most over-the-counter medications are available at your local pharmacy, while prescription medications must be approved and directed by your physician.
- Over-the-counter antacids, like Mylanta®, neutralize stomach acid on contact and offer fast but short-lived relief from heartburn symptoms.
- Over-the-counter H2-blockers, like Pepcid AC®, last longer than antacids, suppress the amount of acid in your stomach, and can be taken before meals to prevent heartburn.
- Prescription proton-pump inhibitors reduce the amount of acid in the stomach and can be very effective for persistent cases of heartburn.
- Prescription prokinetics speed up the movement of food through the digestive tract and help strengthen the lower esophageal sphincter (L.E.S.).
Remember, whether you’re on medication or not, lifestyle changes such as eating nutritious foods, getting exercise, and managing stress are an important part of feeling better. We highly recommend talking to your doctor about choosing the best treatment plan.
What Does Laparoscopic Surgery for GERD Involve?
Chronic heartburn or GERD is usually caused by the weakening of a valve above the stomach, allowing acids to reflux up into the esophagus. Laparoscopic surgery actually addresses the malfunctioning valve, “fixing” chronic heartburn in most cases. In this procedure, a surgeon wraps part of the stomach around the lower esophageal sphincter, which improves the performance of the sphincter preventing the reflux of acids from the stomach into the esophagus and eliminating heartburn.
A laparoscopic procedure is a less invasive alternative to traditional (open) surgery, as much smaller incisions are made to accommodate small tubes called “trocars.” The trocars create a passageway for special surgical instruments and a laparoscope — a fiberoptic instrument used to examine and transmit images from within the body to a video monitor, allowing the surgeon to see the operative area. Since the incisions are small (only about the size of a dime), scarring tends to be greatly reduced. Additionally, patients who are appropriate candidates for a laparoscopic procedure usually experience shorter hospital stays. Although surgery for chronic heartburn is often done laparoscopically, a surgeon may still recommend open surgery as the best procedure to improve the patient’s condition.
A comparison of laparoscopic GERD surgery vs open surgery:
- 4-6 dime-sized incisions
- Hospital stay of 2-3 days
- Recovery period of 7-13 days
- Singular 7″ incision
- Hospital stay of 9 days
- Recovery period of 28 days
Studies show that over 90% of patients are symptom-free after a laparoscopic surgical procedure to correct gastroesophageal reflux disease. Of those patients studied, the quality-of-life assessment has been the most dramatically improved outcome variable.
Keep in mind that laparoscopic surgery is typically only an option for selected patients with severe chronic heartburn that still disrupts their lives, despite lifestyle modifications and appropriate medication, and shouldn’t be considered until all other measures have been tried. Other heartburn sufferers who may benefit from laparoscopic surgery include younger patients (50 years or younger) facing a lifetime of medications, patients who find medications a financial burden, patients who are noncompliant with their drug regimen, and patients who prefer a single intervention to long-term therapy. Diagnostic testing is critical for all patients to document the disease and determine whether surgery is an appropriate option.**
Before surgery, a diagnostic evaluation must be made to ensure that gastroesophageal reflux is the underlying cause of the patient’s symptoms. This is usually done with 24-hour esophageal pH monitoring, endoscopy, and/or a manometry test.
If you have tried over-the-counter or prescription-strength medication without relief, see your doctor or gastroenterologist. Only your doctor can best determine whether you are a candidate for a laparoscopic surgical procedure to fix gastroesophageal reflux. If they confirm you may benefit from the procedure, you will then be referred to a surgeon. Your local medical center also can help you find a surgeon skilled in the laparoscopic procedure.
What Are the Side Effects of Laparoscopic GERD Surgery?
As with any surgery, there are risks associated with anesthesia, medication, bleeding, and infection. If complications occur during the operation, your doctor may choose to perform open surgery instead. Side effects more specific to laparoscopic GERD surgery may include:
- Inability to eat a full meal
- Feeling full after only a small amount of food
- Difficulty swallowing
- Gas and bloating
- Burping or belching
- Vomiting, nausea, and/or diarrhea
Generally, side effects should subside within about four weeks following the procedure. When compared with pre-surgical symptoms, *97% of the patients surveyed reported overall satisfaction with the decision to undergo surgery for GERD.
It is important to note, the proper approach to surgery for gastroesophageal reflux (GERD) requires four careful considerations:
- Documentation of reflux as the cause of the patient’s symptoms
- Understanding the underlying cause
- Identification of those patients who should have the procedure
- The meticulous performance of the appropriate anti-reflux procedure
*Attention to these considerations will result in successful anti-reflux surgery in over 90% of all patients.
Questions to Ask Your Doctor
The best way to understand your medical options is to ask a professional. Below are questions that may serve as a helpful guide when speaking to your physician or surgeon.
Questions to ask your physician:
- Could surgery be the answer for me? Why?
- What are my alternatives?
- Can you recommend a surgeon who performs the videoscopic or laparoscopic procedure?
- If surgery is for me, what are the next steps?
If videoscopic or laparoscopic surgery is right for you, your doctor may refer you to a surgeon who can better address your concerns. These additional questions may help.
Questions to ask your surgeon:
- Are you board certified?
- How many times have you performed this procedure?
- What have the outcomes been?
- What are the complications and/or side effects?
- What should I do to prepare for the surgery?
- What can I expect following surgery?
- Can you give me the name of one of your patients who has had the procedure so I can talk to him/her?
Learn More About GERD
For more information about GERD relief, or to find out if surgery is a recommended option for your condition, please contact us to schedule a consultation.
Medical Resources for GERD
**Castell DO, Brunton SA, Earnest DL, et al. GERD: management algorithms for the primary care physician and the specialist. Practical Gastroenterology. 1998;22(4):18-46.