Heartburn

MetroSouth Medical Center Introduces the Heartburn Clinic

Had it With Heartburn?  Relief is Here.  855-4REFLUX

The MetroSouth Heartburn Clinic is a program which provides multidisciplinary, comprehensive care for patients suffering from mild, moderate or severe heartburn and reflux, also referred to as gastroesophageal reflux disease (GERD). Optimal medical management is typically the treatment of choice. Qualified and highly experienced physicians are available to discuss the benefits and risks associated with the latest medications as well as both traditional and innovative surgical procedures.

In many instances, mild heartburn can be effectively treated with over-the-counter medicines. However, patients suffering from persistent heartburn twice a week or more should be evaluated by a qualified medical professional. Untreated heartburn can lead to serious medical conditions, including Barrett’s esophagus and esophageal cancer. MetroSouth is here to help. Highly experienced gastroenterologists are available for consultation at the MetroSouth Heartburn Clinic.

In addition to heartburn, common symptoms associated with reflux (GERD), include:

  • Hoarseness or sore throat 
  • Frequent swallowing or difficulty swallowing
  • Asthma or asthma-like symptoms 
  • Pain or discomfort in the chest  (Click here to learn more about heartburn vs.  heart attack)
  • Sleep disruption (unable to sleep lying down) 
  • Excessive clearing of the throat 
  • Persistent cough

Normally, after swallowing, a valve between the esophagus and stomach opens to allow food to pass, and then it closes to prevent stomach contents from “refluxing” back into the esophagus, causing a burning sensation in the chest. For people who suffer from GERD, the valve is dysfunctional and unable to prevent acid from refluxing into the esophagus.

Dr. Kevin Dolehide, gastroenterologist with the MetroSouth Heartburn Clinic offers explanations and tips for heartburn sufferers in a recent video blog post.  To view the video, click here.

Taking the first, important step, is seeking help at the MetroSouth Heartburn Clinic. There, our experts will discuss many treatment options with you, including:

  • Diet and lifestyle modification - to learn more visit http://healthconnect.metrosouthmedicalcenter.com/2010/11/recipes-heartburn/
  • Histamine Receptor Antagonists (H2 blockers - available over the counter) – Examples include Pepcid, Tagamet and Zantac. These medications may lose their effectiveness over time. They also do not address the underlying cause of the reflux, which is an anatomical defect.
  • Antacids (available over the counter)
  • Proton Pump Inhibitors (PPIs – available via prescription) – Examples of these medications include Nexium, Prilosec and Protonix and like H2 blockers, they may lose their effectiveness over time. Also, these PPIs do not address the anatomical cause of the reflux and therefore life-long medication therapy is very common. Recently, studies have suggested potentially serious side effects from long term u se of PPIs. This research is ongoing and should be discussed with a physician.  To learn more about the potential long-terms risks fo PPIs, visit http://healthconnect.metrosouthmedicalcenter.com/2010/12/heartburn-medications/
  • Promotility Agents (available via prescription)

Studies have suggested that approximately 25% of patients have persistent or refractory reflux who don’t respond to medical management. In these cases, the specialists at the MetroSouth Heartburn Clinic will perform additional diagnostic testing to determine whether patients are appropriate for surgical intervention. These tests may include:
 

24 h pH study

24-hour pH monitoring is the most sensitive test for detection of excessive acid in the esophagus. As the name implies, 24-hour pH studies measure acid exposure in the esophagus over a 24-hour period. This test can accurately measure whether or not reflux or GERD is present. The 24-hour pH test is administered by a gastroenterologist endoscopically by clipping a capsule to the esophageal lining. The capsule located in the esophagus detects pH changes. It sends radio frequency signals to a small data recorder that can be worn around the waist. With this you can record for one or two days. The data is then downloaded and analyzed for the severity of acid reflux into the esophagus.
 


Manometry

Esophageal manometry is a test that provides information regarding the muscle function of the upper and lower esophageal sphincters or muscles. Esophageal manometry can be a helpful diagnostic tool in several different circumstances. Patients with stubborn acid reflux disease, for example, may undergo manometries in order to assess the strength or weakness of the lower esophageal sphincter muscles. Manometry is also helpful in confirming adequate esophageal contractions or motility before moving forward with surgery for acid reflux disease. There are several alternative approaches to the treatment of acid reflux disease which include tightening up the esophageal sphincter. It is important to understand the relative strength or weakness of this muscle before proceeding with the procedure.

Manometry is performed by a qualified gastroenterologist by placing a thin probe through the nose into the esophagus. The nose is numbed with a local anesthetic. Patients may be asked to swallow to engage the esophagus. As the esophagus squeezes on the tube, these pressures are transmitted to a computer analyzer that records the pressures. The physician can evaluate the recordings to determine if they are normal and in turn determine if the esophagus is working properly prior to surgical intervention.
 


Surgical Options

Surgical options are not required to treat most patients. For the minority of patients that have persistent heartburn, even after lifestyle modifications and optimal medical management, a surgical approach to correcting the anatomy of the esophagus may be an option. Just like there are various medications that may be used to treat heartburn, there are also several surgical approaches patients can consider. Both approaches are offered through the MetroSouth Heartburn Clinic.

Fundoplication (conventional Nissen surgery)

Nissen fundoplication is a procedure where general surgeons perform laproscopic surgery that strengthens the valve muscle between the stomach and the esophagus preventing stomach acids from being forced back up into the esophagus. The surgery is performed in the hospital under general anesthesia and typically includes a 4-5 day hospital stay. Patients commonly resume daily activities after two weeks.

The Nissen fundoplication surgery is considered to be the traditional gold standard solution to treat heartburn and acid reflux that has not responded to medications. Despite it’s prominence, a recent study found that only 50 percent of patients undergoing the procedure are symptom-free after 5 years.
Like all surgical interventions, there are risks and long-term side effects which need to be taken into consideration. Some patients undergoing the Nissen fundoplication surgery suffer from long-term complications, including swallowing difficulties, abdominal bloating and diarrhea. In addition, the inability to belch is a common complaint after this procedure. Belching allows the body to dispel excess gas that develops within the stomach. In lieu of belching, patients may find an increased rate of flatulence.

Another drawback from this surgery is the availability of additional interventions should the initial procedure be unsuccessful. Unlike with the EsophyX procedure described below, patients undergoing Nissen fundoplication do not reserve the ability to pursue other surgical options.
 

Incisionless EsophyX Procedure (TIF – transoral incisionless fundoplication)

Like the Nissen procedure, the EsophyX TIF (transoral incisionless fundoplication) is a procedure which corrects the underlying cause of acid reflux. It is a completely incisionless procedure which reconstructs the antireflux barrier between the stomach and the esophagus. It is performed through the mouth, under general anesthesia, and typically takes between 30-45 minutes. Most patients go home the day after surgery and return to work within a few days.

In clinical studies, 79% of patients undergoing TIF remained off daily PPIs (proton pump inhibitors) and 70% experienced a total elimination of heartburn at five years after incisionless surgery.
Patients undergoing the TIF with EsophyX reserve the possibility of future surgical options and revisions, if they have a relapse of symptoms. In addition, the procedure is significantly less invasive than the

 

Specialists at the MetroSouth Heartburn Clinic

Had it with Heartburn? Relief is Here. Call 1-855-4REFLUX to make your appointment today. Visit the MetroSouth Heartburn Clinic within the MetroSouth Medical Center at 12935S. Gregory Street, 2nd Floor.

Gastroenterologists
Rafiq Ahmed, MD
Kevin Dolehide, DO
Mahesh Vadali, MD
Paul Vanderbilt, MD

General Surgeons
Felipe Gracias, MD
Ramon Manglano, MD