STORY BYIf you can’t leave the house without first checking your purse or pocket for your antacids, you’re a member of a very large club.
As many as 60 million Americans experience heartburn and other symptoms of acid reflux each month. More than a fourth of those people have a more severe, chronic disorder known as Gastroesophageal Reflux Disease (GERD).
Acid reflux is so prevalent that Prilosec, a top-selling drug worldwide, became available over-the-counter this week, clearing the way for millions of patients to seek relief from heartburn without a prescription from their doctors.
“Acid reflux can limit patients’ lifestyles significantly,” says Erik Wilson, M.D., a surgeon at The University of Texas Medical School at Houston who specializes in a minimally-invasive technique to correct problems that cause heartburn.
“Patients may suffer for years and years without any relief. They sleep in recliners, because if they lie down, content from their stomachs comes up,” he says. “They always have a bad taste in the back of their throats.
“Reflux is also linked to adult-onset asthma, and in severe cases, the acid can cause changes in the lining of the esophagus, which can lead to cancer,” Wilson says.
If you answer "yes" to two or more of the following questions, you may have Gastroesophageal Reflux
Disease, or GERD.
If you suspect you may have GERD, the first step is to consult a physician, who can properly diagnose the problem.
Source: The International Foundation for Functional Gastrointestinal Disorders.
The occasional, mild heartburn can be treated effectively with the plop-plop-fizz-fizz of an antacid. Prescription medication can put out more frequent, fiery symptoms.
Even still, Wilson says, the drugs only stop acid from forming in the stomach. They don’t stop stomach content from rising to the back of the throat. They also don’t fix the root of the problem, which is a defective lower esophageal sphincter.
As a result, patients who require medication often have to take it every day for the rest of their lives, Wilson says.
The valve at the end of the esophagus is designed to let food into the stomach and keep it there. If the valve is compromised, stomach acid and partially digested food can creep back up the esophagus.
Eating large portions, munching before bedtime, drinking carbonated, caffeinated, fruity or alcoholic beverages; and certain foods, such as spicy dishes or citrus fruits, can exacerbate symptoms.
Those who smoke, are overweight, stressed or wear tight-fitting clothes or belts are at increased risk for developing acid reflux. Certain medications, including some antibiotics and aspirin, may be the culprit behind some patients’ heartburn.
Pregnancy or a hiatal hernia, which is a hole that allows a portion of the stomach to enter the chest cavity, also can cause acid reflux.
A surgical solution is not for everyone, Wilson says, but if chronic heartburn is severe enough to limit a patient’s livelihood and the patient doesn’t want to take daily medication to control symptoms, he or she may want discuss it with a physician.
Wilson, one of five UT colleagues who are part of Minimally Invasive Surgeons of Texas, offers a procedure called the Nissen fundoplication that alleviates chronic heartburn. Similar to putting a hotdog in a bun, surgeons take the most upper portion of the stomach and wrap it around the esophagus to reinforce the valve.
The surgery is done through five tiny incisions in the abdomen. It usually takes about an hour, and patients usually go home the next day.
As with any surgery, there are risks, such as injury to the spleen, stomach or esophagus. To reduce such risks, Wilson, who has performed more than 150 of these surgeries to stop acid reflux, advises that patients choose an experienced surgeon.
After surgery, patients may have difficulty swallowing. Physicians prescribe them a liquid diet for the first 2-3 weeks, and if the condition known as dysphagia continues, the surgeon can put a scope down the patient’s throat to gently dilate it.
Repairing the valve keeps acid and food down. It also may keep gas down, making it difficult for patients to burp. They may experience gas bloat until the body adjusts. “Basically you are creating a more normal body physiology. The body has been used to gulping down air and refluxing for years,” Wilson says. “It can take a while, maybe even a few months, for the body to acclimate.”
For most patients, the temporary side effects of the surgery go almost undetected. “Usually within a few days, they are saying, `You have changed my life.’ They are so happy because they aren’t refluxing anymore,” Wilson says.
For more information or to schedule an appointment, call 832-325-7125.
UPDATED: 9-18-2003
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Dr. Erik Wilson is assistant professor of surgery at the UT Medical School.
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