How to Treat Reflux
By Alex Barkan, MD FACS
Gastroesophogeal Reflux Disease (GERD) is an under diagnosed disease commonly called heartburn often treated with over the counter medications. When patients experience the burning, they think it is a good idea to treat by themselves without realizing that damage can continue to occur without the intervention of a medical professional. Once the diagnosis of GERD is made, there are a few treatment options to try depending on the severity of the disease.
The first option is diet and lifestyle modifications. Patients are encouraged to change their eating habits to eat less spicy foods, avoid tomatoes, mint, mustard and citrus. They are advised to drink less caffeine, avoid alcohol, eat earlier in the evening and to eat smaller portions at each mealtime. Weight loss is imperative to lessen the pressure of the abdomen on the stomach. This allows less acid to be pushed up into the esophagus and decrease the burning sensations. If you are having similar symptoms you should consult with your primary care provider to determine if further intervention or testing is necessary.
The next option includes Proton Pump Inhibitors (PPIs) like Nexium, Prilosec and Aciphex or Prevacid. These limit the amount of an enzyme that is produced in the lining of the stomach that releases acid. They work to keep the acid level low, thereby limiting the amount of acid filled regurgitated stomach contents that can reflux back into the esophagus causing pain. There are some side effects therefore, self-treating without seeing a medical professional prior to initiating treatment is not advised.
New treatment options that have recently been introduced to the market are the endoscopic intervention, Stretta and surgical intervention, Linx. Both are options that are same day procedures that help to create a stronger sphincter at the base of the esophagus and the top of the stomach which stop the refluxing of acidic stomach contents. The Stretta procedure is done with the ablation (burning) of tissue to create a contracted area that narrows the opening between the esophagus and the stomach limiting the amount of acid filled stomach contents that can back flow into the esophagus. The Linx system is a ring that goes around the outside of the esophagus that is placed surgically with a magnetic ring that opens to let food pass through but then closes to keep the acid fill stomach contents from flowing back into the esophagus. Both of these options are offered at specialized facilities across the country. Websites are available to provide more information about each of these procedures and who can perform them.
The last option for the treatment for GERD is surgery. A Nissen Fundoplication is a commonly performed surgery that wraps the top portion of the stomach around the esophagus creating a new sphincter that keeps the acidic food mixture in the stomach where it belongs and out of the esophagus. This operation is most commonly performed laparoscopically and is considered a very successful treatment for severe GERD. To find a qualified surgeon in your area who performs Nissen Fundoplications you can look on the SAGES.org website for more information.