Feel a burning sensation behind your sternum after a meal? Have difficulty or pain when swallowing food? You may be suffering from the effects of acid reflux.
Reflux occurs when your esophageal sphincter—the muscle barrier between the stomach and your esophagus—stops functioning properly and contents of your stomach, including your stomach acid, re-enter your esophagus.
Chronic reflux, or gastroesophageal reflux disease (GERD), can affect quality of life and lead to long-term complications, including a higher risk for esophageal cancer in some cases. To mark GERD Awareness Week (Nov. 23-29), we posed a few common questions about GERD to University of Minnesota Health Thoracic Surgeon Eitan Podgaetz, MD, MPH.
What are the symptoms of gastroesophageal reflux disease (GERD)? Why does acid back up into the esophagus?
We all produce acid in the stomach. Having that acid is normal and we actually need it and other enzymes to digest food and kill some of the bacteria we ingest. The lining of the stomach that protects the stomach wall from the acid is different from the lining of the esophagus, which gets irritated or burnt when exposed to stomach acid. When stomach acid travels back up the esophagus, you may suffer symptoms.
We typically associate several common symptoms with GERD. These include chronic heartburn and regurgitation and chest pain. The vast majority of patients come in with these problems. But patients can also experience a variety of less common symptoms, including difficulty swallowing food (dysphagia), a hoarse voice, indigestion, a sour taste in the mouth, unexplained coughing, asthma and dental problems.
Which foods should I avoid if I have heartburn? Conversely, which foods or drinks would lessen my discomfort during heartburn?
A lot of our food recommendations follow common sense. People with reflux should avoid irritants like citrus, acidic foods, chocolate, coffee, alcohol or smoking. Often, people will drink milk because they think that will coat the esophagus and make the heartburn better. That method does help on a short-term basis, but the consumption of milk will lead to the production of more stomach acid during the digestion process, which may lead to more problems later. GERD sufferers should stay well hydrated, keep their heads elevated after eating and avoid food before bedtime.
When should I see a doctor about my heartburn?
We recommend seeing a doctor if your heartburn happens two or more times a week, or if your heartburn gets worse or interferes with your daily activities.
Anyone with a GERD diagnosis who has trouble controlling reflux with over-the-counter or prescription medications should see a doctor. If you have trouble swallowing food, or are vomiting blood, you should see a doctor.
What treatment options do I have for my reflux?
Reflux management options usually start with diet modifications—smaller meals, no food immediately before your bedtime—and Proton Pump Inhibitor (PPI) medications. But long-term reliance on GERD medications can cause other side effects, such as an elevated risk for C. difficile infections, pneumonia, osteoporosis and malabsorption. Patients who would like relief from medications—or who cannot control their reflux with medications—may be candidates for surgery. There are two common surgical options for reflux management: laparoscopic Nissen fundoplication and the LINX® procedure. During fundoplication, surgeons will wrap a portion of the stomach around the esophagus to recreate the esophageal sphincter, which has excellent long-term outcomes if performed at high-volume, experienced centers with dedicated reflux surgeons.
Some patients may be better suited for a LINX® system—a magnetic titanium ring that is wrapped around the esophagus to augment the esophageal sphincter. At the end of the day, your surgeon will help you select the better surgical option.
How can the Heartburn and Reflux Program at University of Minnesota Medical Center help?
Chronic heartburn can cause long-term complications, like Barrett’s esophagus—a change in the lining of the esophagus that can put patients at an increased risk for esophageal cancer. We have an excellent approach to reflux care that improves patient satisfaction and outcomes. Our dedicated gastroenterologists, radiologists, thoracic surgeons and weight loss surgeons meet once a week to discuss patient care and decide upon the best treatment for each patient. We’ve put together a unique and comprehensive one-stop shop for GERD patients.