Heartburn or gastroesophageal reflux (GERD) is typically caused when the acidic contents of the stomach reflux into the esophagus. Heartburn is a burning sensation located in the upper abdomen and behind the sternum which may radiate up the esophagus to your mouth. When stomach contents reflux up the esophagus, patients may experience difficulty swallowing (dysphagia), pain with swallowing (odynophagia), chest pain, chronic cough, hoarseness, increased salivation (water brash) or a perception of a lump in the throat (globus). Heartburn may be the result of recurrent sinusitis, asthma, pneumonia or dental disease. In many cases, heartburn results from overeating, alcohol, peppermint, tobacco, caffeine and fatty, fried, greasy foods. The diagnosis of acid reflux or chronic heartburn is typically made based on symptoms and response to therapy for heartburn. Acid reflux is routinely treated with acid blocking medications. It’s important rule out other conditions that cause symptoms similar to heartburn. Borland Groover physicians may recommend further evaluation to ensure an accurate diagnosis and eliminate the possibility of heart disease or other health concerns..
Your doctor’s evaluation for chronic heartburn may include:
Upper endoscopy in which a small flexible endoscope with a camera at the tip is passed down your esophagus, stomach and small intestine. A biopsy of tissue may be taken during your exam for GERD or Chronic Heartburn if abnormalities are found.
Acid measurement may also be obtained for heartburn or GERD diagnosis. This test for heartburn can be done by inserting a small flexible catheter through the nose and esophagus for 24 hours. At the Borland Groover also offers 48 hour pH monitoring with the Bravo capsule. This Bravo capsule is about the size of a Motrin tablet and is placed in the esophagus during your upper endoscopy. It will transmit acid information to a recorder you wear over a two day period.
Esophageal manometry is a method to determine if the muscle contractions in the esophagus are coordinated and functioning properly. It can also measure length and pressure within the lower esophageal sphincter.
Complications of heartburn/gastroesophageal reflux may include strictures or areas of narrowing in the esophagus. This can occur when there is prolonged inflammation within the esophagus. Heartburn may cause difficulty in swallowing, particularly solids. Ulcers (breaks extending through the normal esophageal mucosa) may occur. In some, the normal squamous cells of the esophagus are replaced by cells often found in the stomach known as intestinal cells. This condition is called “Barrett’s Esophagus” and is associated with a 40x increase in the risk of developing adenocarcinoma of the esophagus. It is important to note that only a small portion of patients with heartburn will develop Barrett’s Esophagus and an even smaller proportion will develop esophageal adenocarcinoma.
Acid suppressing medications include antacids, histamine blockers and for more severe symptoms the proton pump inhibitors. Lifestyle makes a difference. Weight loss, smoking cessation, avoiding large meals at night can reduce symptoms of chronic heartburn.
Finally, surgery for GERD or Chronic Heartburn is an option for those who don’t have success on acid suppression therapy. Surgery for Gerd or “Nissen fundoplication” is procedure that involves the surgeon to wrapping the upper part of the stomach around the lower esophagus. Surgery for GERD makes it less likely for patients to have acid reflux and symptoms such as difficulty swallowing (dysphagia), pain with swallowing (odynophagia), chest pain, chronic cough, hoarseness, increased salivation (water brash) or a perception of a lump in the throat (globus).
For additional information please visit:
1. Kaltenbach, T, Crockett, S, Gerson, LB. Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach. Arch Intern Med 2006; 166:965.
2. Hirano, I, Richter, JE. ACG practice guidelines: esophageal reflux testing. Am J Gastroenterol 2007; 102:668.
3. DeVault, KR, Castell, DO. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol 2005; 100:190.
4. Fass, R, Sontag, SJ, Traxler, B, Sostek, M. Treatment of patients with persistent heartburn symptoms: a double-blind, randomized trial. Clin Gastroenterol Hepatol 2006; 4:50.
5. Salminen, PT, Hiekkanen, HI, Rantala, AP, Ovaska, JT. Comparison of long-term outcome of laparoscopic and conventional nissen fundoplication: a prospective randomized study with an 11-year follow-up. Ann Surg 2007; 246:201.