Heartburn or “gastroesophogeal reflux disease” (GERD) is very common. As a matter of fact nearly everyone has it to some degree but most are unaware of it, or it is only minor. Only when it becomes more frequent or severe do people seek relief. A “burning sensation,” pressure under the breastbone in the middle of the chest, or acid taste in the mouth are most common symptoms.
Reflux can be manifest by a persistent cough, asthma or waking up at night choking or with an acid taste. Occasionally people have food return up to their mouth without any “burning.” This is known as “solid regurgitation.”
It can occur with bending over after eating and can be made worse by any of the following risk factors listed below.
There are relatively easy first line steps to take if you have heartburn. avoiding these things when possible will help:
- Chocolate, coffee, peppermint, greasy or spicy foods, tomato products and alcoholic beverages
- Being overweight
- Eating within 1-2 hours before laying down to sleep g Some medications
When these issues are eliminated as much as possible then medical treatment can be helpful. There are over-the-counter medications or stronger treatments with a prescription from your healthcare provider. Your doctor can help you determine the best options for you.
For symptoms that persist despite medical and conservative treatment attempts, there are very successful surgical options. The most common effective surgery is a Laparoscopic Nissen Fundoplication. This operation involves wrapping part of the stomach around the lower end of the esophagus and is highly successful in reducing or eliminating heartburn symptoms. In my practice, essentially all of the heartburn surgeries have been Laparoscopic or what some people call “minimally invasive,” or “microsurgery” where ve pencil size incisions are used to allow skinny instruments to move in and out through the abdominal wall. This technique allows faster recovery time with less pain.
In trying to decide when to consider having this operation people usually want to know:
How successful is the procedure?
Are my symptoms bad enough to consider surgery?
How much will it cost?
What is my recovery time, or how long will I be out of work?
What are the risks and potential complications?
These questions are all addressed in a consultation and most of the answers are individualized depending on a person’s symptoms, health insurance plan, usual activities and overall health.
The operation requires half of the patients to stay overnight—the remainder go home in a few hours. Reflux for almost all patients stops immediately with no need to continue medication. The likelihood of a complication is very low.There is no limit to activity after surgery but careful progression is advised. I recommend most people be off work for a week from full-time desk work. It may take longer with more physically active jobs.