What is Heartburn
According to the American College of Gastroenterology, an estimated 15 million American’s experience heartburn symptoms every day. Over the counter medications can help calm the symptoms for some people, but often aren’t a lifetime solution and can mask more severe underlining conditions.
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Heartburn is related to Gastro Esophageal Reflux Disease (GERD), also called Reflux Disease, which is progressive and can lead to more severe illnesses. GERD can progress from heartburn to more severe issues, such as:
• Barrett’s Esophagus (the presence of precancerous tissue in the lower esophageal area)
• chest pain
• chronic cough
• dental erosion
• Esophageal Cancer
• sore throat
Regular check-ups with your physician are critical to determining whether or not your heartburn symptoms require further diagnosis. The Broward Health Coral Springs Heartburn Center offers a personalized, multidisciplinary approach to diagnosing and determining the best treatment plan for your unique situation. If over the counter medications are not providing enough long-term relief, consider contacting us to help you determine your best non-surgical or surgical treatment options.
If you are experiencing symptoms of Reflux, it may mean the Lower Esophageal Sphincter (LES) muscle in your esophagus is weak. This one-way valve allows food and liquid to pass into the stomach but prevents contents from flowing back into the esophagus. If weak, the muscle could allow harmful acid and bile to enter the esophagus. The result is a burning sensation known as heartburn. Over time, this acid and bile can wear away the lining of the esophagus leading to inflammation and painful irritation.
Many people who take medications for GERD still have symptoms, primarily because they don’t actually have reflux. A proper diagnostic test is the best way to identify the cause of any discomfort and choose the proper treatment plan. The best treatment options can only be determined after a full evaluation of the function of the esophagus and determining the severity of gastroesophageal reflux.
Diagnostic procedures are available at BHCS Heartburn Center
pH Testing – This procedure measures the material from the stomach that refluxes up into the esophagus, including gas, liquids and solids. A thin, soft, flexible tube is inserted through the nose into the stomach and taped in place. A small device attached by a thin wire records the information over a 24-hour period. The patient wears a small recording device for a typical day, indicating any symptoms and activities. More specific information is written in a diary. The results help determine if symptoms are really from GERD or not. This procedure is painless and requires no anesthesia.
Bravo 48-hour pH testing – is similar to the 24-hour pH test, but only measures acid fluid. Anesthesia is required, as an endoscopy is required to check the placement of the tube. It records data for 48 hours and is wireless. The patient also keeps a diary, recording symptoms, as well as eating and times lying down. The resulting score helps to quantify the level of acid reflux and if its caused by GERD.
Esophageal Manometry –This test is used to assess the pressure and motor function of the esophagus and is essential in evaluating how well the muscles of the esophagus move food into the stomach. It measures:
- How often swallows fail
- Strength and organization of contractions of the esophagus
- Function of the muscular valves at the top and bottom of the esophagus
- How well the swallowed bolus clears the esophagus
- The size of hiatal hernias
This test is used to diagnose symptoms often confused with reflux, as the treatment for an abnormal esophagus often differs from the treatment for reflux disease.
A topical anesthetic is applied to the nose to improve comfort, but no anesthesia or special monitoring is needed. When the catheter is inserted, the patient is asked to swallow 10 times, and then the probe is removed. The complete procedure takes 15-20 minutes.
EGD/Upper GI Endoscopy – a long scope with a camera at the end is used to view the inner lining of the esophagus and stomach. A flexible tube is inserted using anesthesia. Upper endoscopy cannot detect GERD, but it can identify pouches, narrowing ulcers and tumors of the esophagus, stomach and duodenum (part of small intestine). A portion of the lining can be removed (biopsy) and sent to a pathologist to evaluate for inflammation or cancerous cells.
This is an essential test to rule out cancer and is often recommended as the first diagnostic test for patients with recurrent symptoms of GERD.
However, reflux may be missed by EGD alone; therefore, your doctor may recommend other diagnostic tests as well.
Barium Swallow – this X-ray test provides a close look at the back of the mouth and throat (pharynx) and esophagus. The patient swallows a chalky white substance known as barium, which coats the inside of the upper GI. The barium absorbs X-rays and looks white on film, which helps to highlight the organs and their inside linings. It shows the motion of swallowing to help in the diagnosis of any GI tract disorders.
Computed tomography (CT) Scans – use x-ray equipment and computer processing to produce two-dimensional images of the body. You lie on a table that passes through a tube-like opening in a large machine. These images allow physicians to look for tumors and examine lymph nodes and bone abnormalities.
Radiofrequency Ablation – radiofrequency energy or heat is used to remove abnormal or unwanted cells. A special device is placed on the end of the endoscope and introduced into the esophagus.
Surgical Treatment Options
The following minimally invasive surgical treatment options are typically performed laparoscopically or robotically, both offering quicker recoveries and more aesthetically pleasing results.
Hiatal Hernia Repair
The majority of patients suffering from GERD have a hiatal hernia, a difficult condition to diagnose via an EGD or Upper GI test. With a Hiatal Hernia, the muscles supporting the esophagus as it passes through the diaphragm have separated. They no longer support the esophagus at the area of the hiatus. In a repair procedure, sutures are used to bring these muscles back together. This repair helps to reinforce the reflux barrier and prevent stomach contents from flowing back into the esophagus.
In many cases, a patient having an anti-reflux operation, such as Nissen Fundoplication or magnetic sphincter augmentation, will also have a hiatal hernia repair.
Paraesophogeal Hernia Repair
These larger hernias are less common but may be more cause for concern. Asymptomatic hernias can often be safely observed and may not require surgery. However, when symptoms such as chest pain, upper abdominal pain or difficulty swallowing exist, a repair may be needed. Most paraesophageal hernias can successfully and safely be repaired laparoscopically.
The Nissen Fundoplication
In this procedure, the fundus or upper, floppy portion of the stomach is wrapped around the lower esophageal sphincter to support the LES and help prevent reflux. Patients follow a mostly liquid diet for a few weeks post-surgery.
A variation of the Nissen Fundoplication, this procedure involves a partial wrap of the stomach, a 270-degree wrap around the esophagus.
Magnetic Sphincter Augmentation
This a small, flexible ring of magnets that opens to allow food and liquid down, then closes to prevent stomach contents from moving up. It supports the LES to prevent reflux at the source and does not require alteration to the stomach. Patients usually resume normal activities and diet within a few days.
Roux-en-Y (roo-en-wy) Reconstruction
This gastric bypass surgery is a type of weight-loss surgery that involves creating a small pouch from the stomach and connecting the newly created pouch directly to the small intestine. After gastric bypass, swallowed food will go into this small pouch of stomach and then directly into the small intestine.
TIF or Transoral Incisionless Fundoplication
This minimally invasive endoscopic procedure is performed using an endoscope through the mouth. It creates, without incisions, a new valve. The stomach is wrapped around the esophagus without disrupting the stomach’s blood supply or nerves. There is often less difficulty swallowing food and pain with swallowing, as well as less bloating and gaseousness, than with some of the other treatments for GERD. This procedure may be a good option for patients with esophagus abnormalities, small hiatal hernias or who may need additional stomach procedures in the future. Studies have shown that more than 85% of patients who completed this procedure were able to remain off medications. Patients with larger hiatal hernias, may be able to have this procedure along with the minimally invasive repair.
Most patients may return home the day of surgery and resume normal activities within a few days.
This is a procedure for patients with Achalasia, a disease that makes it difficult to pass food or drink from the esophagus into the stomach. The surgeon cuts and separates the esophageal sphincter muscle to relieve some of the pressure. Sometimes a partial Fundoplication will be done at the same time to prevent post procedure reflux.