Nearly everyone has felt the boiling sensation in the stomach and throat after a big meal. Most of the time the symptoms can be traced to the overindulgence and pass without concern in an hour or so often aided by downing an over-the-counter antacid. Changes in diet, losing weight, avoiding alcohol and smoking, and bypassing that post-meal nap for at least three hours could be simple home remedies to alleviate the fire.
Got GERD? That might be more serious. Gastroesophageal reflux disease (GERD) can make swallowing difficult and lead to chronic soreness in the throat and chest. Untreated, GERD destroys the lining of the esophagus over time and stifles the esophageal sphincter flap, which helps keep stomach acid out of the throat area. In some cases, GERD can lead to cancer of the esophagus. Hiatal hernia, in which the stomach pushes up into the chest area, also causes acid reflux.
Advancements in surgical techniques, like robotics and high resolution three-dimensional tests, along with numerous medications, can treat and cure the condition before it leads to cancer. But its estimated that 25 percent of the U.S. population suffers from GERD and the problem is growing.
On the run
Obesity is a significant risk and America is becoming more obese. Our lifestyles are more on the run, eating later at night and eating more when we go out to eat. Those are risk factors for acid reflux, says Dr. Pamela Garjian, subsection chief of endoscopy for Baptist Health in Miami.
An aging population also accounts for GERD cases, says Dr. Jamie Barkin, chief of gastroenterology at Mount Sinai and professor of medicine at the University of Miami.
They are taking medications that affect the esophagus, Barkin said, citing common arthritis pain relievers such as ibuprofen or naproxen, and bisphosphonates like Fosomax for osteoporosis.
This condition is known as pill-induced esophagitis, Barkin said, and it impacts all age groups.
Women who are anemic during their reproductive years often take iron supplements, as do teens who seek acne treatment. Athletes also seek relief with pain meds after a hard workout. All of these folks can experience acid reflux because of the drugs and supplements.
They really beat up the esophagus, Barkin said. The message is, if youre having symptoms, youve got to tell your physician what pills you are taking.
Normally, when food is consumed, it slides down the esophagus and into the stomach, where acids break it down so it can be digested. The lower esophageal sphincter muscle at the stomach entrance, a flap valve, is supposed to act as a gate and close after the food passes through to keep stomach acid away from the tender esophagus. When this system goes awry, acid boils up from the stomach into the throat a classic case of heartburn, that hot sensation centering around the breastbone and radiating toward the throat.
Some people mistake chest pains caused by weaknesses in the muscle walls of the esophagus for heart attack symptoms, as was the case with former University of Florida football coach Urban Meyer. He was ultimately diagnosed as suffering from esophageal spasms, which caused the pain, and difficulty in swallowing and regurgitation, said Dr. Baharak Moshiree, associate professor of medicine at the University of Miami.
Screenings can detect esophageal problems.
High resolution esophageal and three-dimensional anorectal manometry uses color topography to see and measure the areas of the esophagus as they contract, Moshiree said. We are able to see complete muscles from the upper esophagus into the lower part of the esophagus. We can see if the abnormalities are higher up or in the lower part. If acid in the stomach is coming into the esophagus, Impedance pH technology, using a probe, measures the acidity in the esophagus and how many times a patient has episodes and how long the acidity is in the esophagus.
With Impedance pH testing, a patient wears a catheter for 24 hours and returns to the doctors office the following day for assessment.
The Bravo capsule is another increasingly popular pH monitor, especially for younger patients who might have trouble adequately telling a parent or physician how often they are suffering pain, said Dr. Jesse Reeves-Garcia, director of the division of gastroenterology at Miami Childrens Hospital and clinical professor for pediatrics at the Florida International University Herbert Wertheim College of Medicine.
The Bravo sensor measures the frequency and duration of acid washing into the esophagus from the stomach over a two-day period. The capsule, which looks like a pencil eraser, is lowered into the esophagus through the mouth and attaches to the esophagus wall. A sensor transmits information via radio frequency to a computer for a doctor to analyze. The capsule simply passes through the GI tract and is eliminated within 48 hours.
Adults can swallow the capsule; children are generally anesthetized for about 10 minutes for insertion, Reeves-Garcia said.
Now the mother doesnt feel shes crazy, the mother was correct. Her kid had symptoms and we can associate these symptoms, he said. Now, we can be more specific.
Keith Tyler would not seem a candidate for GERD. At 68, the Homestead sales and marketing professional has stayed in shape from 40 years of tennis play and considers himself a pretty tough guy.
But Tyler had to undergo surgery in May at Baptist Hospital in Miami to repair a hiatal hernia and to treat his acid reflux. A hiatal hernia happens when the diaphragm separates from the chest allowing the stomach to move above the diaphragm and into the chest. The resulting displacement allows stomach acids to reflux, or erupt over the banks akin to storm water over a levee, into the esophageal area. This condition can also lead to a rise in blood pressure because the incorrect positioning puts pressure on the internal organs the case for Tyler.
I noticed my stomach had become terribly distended to the point where I was doing a good impression of a woman in her third trimester. If I accidently bumped into something, like a sharp object, as Inspector Clouseau used to say, I would blow up, Tyler said, chuckling.
But it was no laughing matter.
I didnt know what it was. I thought it was gas but I had high blood pressure and terrible acid reflux to the point where I could not lay down. I would be on the computer at 4 a.m. because going horizontal was not an option.
No matter what Tyler ate, hed suffer the burn.
Doctors determined that surgery was required.
One means of surgery, done through laparoscopy, sews the upper part of the stomach around the lower part of the esophagus to shore up the sphincter muscle. Dr. Anthony Gonzalez, chief of surgery at Baptist Hospital, was able to perform surgery on Tyler using one of the newer advancements robotic 3D visualization with a 360-degree field of vision.
That allows us to deal with larger, complex operations in a much simpler fashion in a minimally invasive way, Gonzalez said.
Hiatal hernia repair can be accomplished with the robot via four quarter-inch incisions, and, in some cases, one single incision. Both options allow for fewer complications and a quicker recovery.
The surgery was over in a day and I was out the next day, Tyler said.
Upon release, patients are instructed to consume easily digestible foods like soups and other soft items. I only made one mistake, Tyler said. You have to drink soup. I got so sick of eating soup I could write a book. My wife had cooked herself a steak and the aroma of that steak was wafting over to my side of the table. I cut off five small pieces. That was unbelievably painful so I learned my lesson.
Gonzalez also points toward a transoral incisionless procedure for select patients with smaller hiatal hernias. This surgical option uses the EsophX device, which is introduced into the body through the mouth rather than abdominal incision and affords 270 degrees of movement, he said. Recuperation is quick with an overnight stay, usually for nausea, he said.
This method manipulates tissue folds to form a stronger reflux valve.
Esophageal ablation to treat Barrett syndrome abnormal changes in the cells of the esophagus is another minimally invasive, outpatient procedure that removes the damaged outer layers of the lining of the esophagus that can put a patient at risk for developing cancer. During ablation, the tissue is heated, thus killing the undesired cells lining the esophagus. The Halo ablation procedure uses radio frequencies to eradicate the cells.
Barrett is a precursor to cancer, said Dr. Barry Migicovsky, chief of gastroenterology at Memorial Regional in Hollywood. Cancer has to be found relatively early so we can do endoscopy, scoop out the tissue, and do radiofrequency ablation to remove the abnormal cells. Once we eradicate Barrett, patients have to be put on meds indefinitely; if not, this cycle will start all over again.
The best medicinal treatment options are proton pump inhibitors (PPIs) such as Nexium, Dexilant and Prilosec, said Garjian of Baptist. The medications are generally effective and work very well.
But long-term use of the meds can increase chances for osteoporosis by interfering with the absorption of calcium and vitamin B12.
We dont know what other vitamins can be affected as well yet, Garjian said, adding that lifestyle changes, like proper diet and exercise, might be a persons best bet at warding off acid reflux.
It does go away for some people so lifestyle modification is very important.
A previous version of this article inadvertently left out the first name and title of Dr. Anthony Gonzalez, chief of surgery at Baptist Hospital.
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