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Millions of people across the country experience heartburn, a burning sensation that starts in the chest and radiates up the throat. And while many people deal with the uncomfortable symptom with an over-the-counter antacid, it’s not something that should be ignored long-term.
It’s normal for the stomach to produce acid that aids in digestion. But if the esophageal sphincter (or valve) that is designed to prevent this stomach acid from splashing back up through the esophagus is weakened or too relaxed, it can cause acid reflux. Also known as gastroesophageal reflux disease (GERD), this condition is common and harmless for many people. However, it can lead to more serious problems if it’s ignored, including cancer in the esophagus. That’s why it’s important to alert your primary care provider if you have frequent heartburn—or any other symptom.
Not everyone with GERD has symptoms.
Nearly half of all patients with GERD don’t have any symptoms, which means it’s possible to have abnormal reflux and not even know it. Those that do have GERD symptoms most frequently report heartburn and a bitter taste in their mouth. These signs may worsen when you’re laying down or after eating certain foods, like those high in fat, caffeine, or tomato-based ingredients.
There are other more vague and less common symptoms, including:
- Phlegm in the throat
- Trouble swallowing
- Chest pain
Many people don’t bother mentioning heartburn to their doctor at regular check-ups, but over-the-counter medications only mask the underlying cause.
Even if medication relieves your heartburn, you should still get evaluated by a gastroenterologist.
Once you have reflux, it tends to be chronic, or repeated throughout your lifetime. There are several medications available for relieving mild, moderate, and severe heartburn, but these don’t necessarily fix the problem. Tums, for example, help to eliminate discomfort caused by GERD by making the acid less irritating. Similarly, Pepcid AC decreases the amount of acid your stomach makes which means there’s less acid to splash up. Many people think that if their symptoms are gone, then the reflux is too. While both of these medications may effectively help to manage symptoms, neither of them address the root cause.
GERD occurs because of an abnormality in the esophageal sphincter, or muscles between the esophagus and the stomach. If this valve relaxes too much, too frequently, or is weakened for some reason, acid will continue to backflow which can cause serious inflammation in the esophagus. In adults over the age of 40, this can lead to a precancerous condition called Barrett’s esophagus. If left unmonitored and untreated, this can lead to esophageal cancer.
Acid reflux, or #GERD, can lead to esophageal cancer, left untreated. On the #MedStarHealthBlog, our GI experts explain how you can treat it and minimize your cancer risk: https://bit.ly/3ybdjot.Click to Tweet
That’s why it’s important to let your doctor know about any frequent or recurring signs of GERD, even if your symptoms are managed. Your doctor may refer you to a gastroenterologist who can perform diagnostic tests and procedures to evaluate the severity of your condition and regularly monitor any changes to your esophagus.
Diagnostic tests allow your doctor to monitor for signs of long-term damage.
If you suspect you have acid reflux, your doctor may recommend conservative treatment options first to manage your symptoms. Mild symptoms may respond well to dietary modifications, like limiting foods that cause the esophagus sphincter to relax. They may also recommend avoiding eating before bed and elevating your head while you sleep, which can decrease symptoms.
For immediate and short-term relief, medications can help manage symptoms. If your symptoms respond well to antacids, we can presume you have acid reflux. But to definitively diagnose the condition, a gastroenterologist may perform endoscopy and/or pH tests.
Endoscopy is a procedure that is done while you’re sedated or asleep. It allows a doctor to evaluate the esophagus using an endoscope, a long, thin tube attached to a camera. The endoscope is gently placed in the esophagus through the mouth, allowing your gastroenterologist to check for signs of inflammation or damage that could lead to cancer.
If we don’t see anything suspicious, we move to pH testing, which measures whether stomach acid is moving from the stomach to the esophagus. There are two different types:
- The wireless Bravo capsule is a small capsule with a sensor the size of coin that measures pH data in the esophagus over two to three days. It’s inserted into the bottom part of the esophagus lining during an endoscopy, for which you’re sedated. It stays there for up to 96 hours as you return home, sending pH data to a small receiver recorder worn around your waist. It’s painless and gathers real-time data about your reflux before falling off on its own and passing through a bowel movement.
- Alternatively, a pH impedance catheter is lined with sensors and carefully inserted through the nose into the esophagus. It remains there for 24 hours, gathering information about the presence of any acid throughout the entire esophagus.
An accurate diagnosis is important for confirming that GERD is what’s causing your symptoms. For patients with severe symptoms or those who cannot or do not want to take medications, surgery may be the best treatment option. You’d only want to undergo surgery if you know definitively that it will address the cause of your problems.
Surgery is the only way to address the root cause of GERD.
If you have chronic acid reflux, surgery is an effective option for fixing the underlying cause. You may want to consider surgery, especially if:
- You don’t want to be on antacid medications
- You are allergic to antacid medications
- Your symptoms aren’t responding to antacid medications
- Your reflux is causing other health complications
The esophageal sphincter is meant to prevent acid from washing up the esophagus. If you have GERD, then we need to treat the source of the issue. Studies show that surgery is more than 90 percent successful in eliminating GERD long-term.
There are two minimally invasive procedures that we can perform through small incisions:
- Laparoscopic Nissen fundoplication is considered the “gold standard” approach. It involves taking the top of the stomach and wrapping it behind and around the esophagus.
- Laparoscopic magnetic sphincter augmentation (LINX) tightens the lower esophageal sphincter opening using linked titanium beads with magnetic centers.
Depending on your procedure, surgery may take one to three hours. Some patients can go home on the same day, while others stay in the hospital one night. You may experience some soreness briefly following surgery but this should disappear about 48 hours later. In addition, you’ll need to modify your diet to allow the esophagus to heal. Most patients will follow a liquid diet for two weeks to allow swelling to go down.
After two weeks, we’ll discuss your next steps at a follow-up visit. By this point, you’ll know if you’re “fixed.” In fact, many patients report the first night after surgery as one of their most restful ones since having the condition because symptoms disappeared. Many patients can resume normal eating at this point, although you’ll want to take small bites, chew thoroughly, and eat slowly as your body adjusts.
Watch our Facebook live interview below with doctors Patrick Jackson, MD, John Carroll, MD, and Angelica Nocerino, MD to learn more about acid reflux:
If you have acid reflux, it’s not your fault. But we need to treat it so it doesn’t become something worse.
For 90 percent of people with reflux, it’s a nuisance but not a health risk. However, for a small portion of the population over 40, it can lead to cancer. And, your risk of esophageal cancer isn’t necessarily tied to the severity or frequency of your symptoms. You can’t prevent GERD or the related complications, but you can seek help.
A gastroenterologist can help to identify and/or monitor any signs of Barrett’s esophagus in your 40’s before it leads to cancer in your 60’s or 70’s. They’ll also recommend the right treatment approach for you, considering your age, health, and symptoms. At MedStar Health, our team of experts work together through a multidisciplinary approach. This means doctors with training in different areas meet regularly to discuss your best treatment options. Then, one doctor presents our collective recommendation in one appointment so you don’t have to see eight different specialists.
Our gastroenterologists specialize in treating GERD and other conditions affecting the esophagus. We also have access to the latest technology, which allows us to accurately identify the cause of your issue and treat it with the least invasive, most effective approach. All of this care is delivered with you and your needs at the center, with compassion and empathy from your entire care team.
Don’t ignore your heartburn. We can help to get rid of it and ensure it doesn’t lead to something worse.