Heartburn can be extremely uncomfortable, even painful. It is also very common. According to the American College of Gastroenterology, an estimated “60 million Americans experience heartburn at least once a month and some studies have suggested more than 15 million Americans experience heartburn symptoms each day.” Of course, the term “heartburn” is a misnomer and does not involve the heart, but rather the stomach and esophagus, and is actually a symptom of acid reflux and GERD.

Acid reflux and GERD: an explanation

Acid reflux generally occurs when the lower esophageal sphincter (LES)—a circular muscle that connects the esophagus and stomach, and that tightens after food passes into the stomach—becomes weak and allows the stomach acid that digests your food to move backwards into the esophagus. Not designed for digestive acids, the lining of the esophagus is far more sensitive than that of the stomach. The resulting pain can be so severe that it is sometimes mistaken for a heart attack. Acid reflux can cause symptoms as wide ranging as:

• bad breath
• sore throat
• cough
• dysphagia (the feeling of having food stuck in your throat)
• regurgitation
• nausea or vomiting
• tightness in the chest
• black or bloody stool

Gastroesophageal reflux disease (GERD) develops when acid reflux becomes a more serious and chronic problem. Whereas acid reflux is normally sporadic and affects most people at some point, a GERD diagnosis is common if acid reflux causes esophageal inflammation or occurs more than twice a week for a sustained period of time. Prolonged damage to the lining of the esophagus from acid reflux can result in esophageal cancer.

What causes GERD?

While Gastroesophageal reflux disease always results from a weakened or dysfunctional lower esophageal sphincter and can occur in people of all ages, GERD can have a number of different causes. The most common causes of GERD are:

• obesity or being overweight, the result of increased pressure on the abdomen.
• pregnancy, also as a result of increased pressure on the abdomen.
• smoking, or being exposed to secondhand smoke
• consuming alcohol
• hiatal hernia, which occurs when the upper portion of the stomach bulges through an opening in the diaphragm and lowers pressure on LES
• esophageal dysmotility, which causes difficulty swallowing, and can result from dysfunction of the upper esophageal sphincter (UES), the body of the esophagus, or the LES.

Getting tested for GERD and related disorders

Getting tested for GERD at Door County Medical Center is easy. We use the Bravo™ reflux testing system—a minimally invasive test that assesses whether acid from the stomach is moving past the LES and into the esophagus. With the Bravo system, a small capsule, which monitors pH levels for 48 hours, is placed on the esophageal wall. Once the capsule has been attached, you can go about your day as normal, while the capsule transmits pH data to the Bravo unit. The testing process is comfortable and the results can help your doctor to better determine an appropriate treatment plan going forward.

If it is determined that reflux is being caused by esophageal dysmotility, esophageal manometry is usually required. With this procedure, a small tube, called a manometry catheter, is passed through your nose, down your esophagus and into your stomach. Sensors on the tube determine the function of the esophageal muscle and the LES by measuring pressure while swallowing small amounts of water. The test usually lasts between 10 and 15 minutes, after which, the tube is removed.

An esophagram—an x-ray that assists in exploring the anatomy of the esophagus and stomach—can also be used to establish whether a hiatal hernia is present and to help determine its size.

DCMC can help you manage your reflux symptoms

Every case of acid reflux and GERD is different, and treatment options also vary from person to person. Often, the root causes of GERD, and the management of symptoms, can be addressed with lifestyle changes, including:

• Losing weight: The increased abdominal pressure caused by excessive weight often results in stomach acid leakage and backflow. Reducing your overall body mass index (BMI) will also reduce pressure on your abdomen and decrease the likelihood of leakage and backflow.
• Changing diet: Even if you are not overweight, changing what you eat can drastically change your reflux symptoms. Reducing fatty foods and avoiding spicy and acidic foods can greatly reduce many of the most common symptoms—like heartburn and chest tightness—associated with acid reflux and GERD.
• Quitting smoking: The active chemical in tobacco—nicotine—causes the LES to relax, allowing stomach acid to pass through into the esophagus.
• Quitting alcohol consumption: While it is still unclear why alcohol consumption worsens the symptoms of GERD, studies have shown that it can increase stomach irritation and inflammation, and impairs LES function.

Medications, both over-the-counter and prescription, can help control acid reflux and GERD as well. Common medications include:

• Antacids: These medications counteract the acid in the stomach with alkaline chemicals. Examples include: Tums, Rolaids and Mylanta.
• H2 Blockers. A group of medications that reduce the amount of acid produced by the stomach. Examples include: Pepcid and Tagamet.
• PPIs: Proton Pump Inhibitors block the cells (called parietal cells) that produce stomach acid. Examples include: Omeprazole and Nexium.

Medical procedures

For more serious cases of GERD, where lifestyle changes and medications have proven ineffective, surgery may be required. For such cases, Door County Medical Center now offers several minimally invasive procedures for GERD.

The Heller myotomy is a minimally invasive procedure that addresses esophageal dysmotility and dysphagia. With a Heller myotomy, a small incision is made to the muscular layer of the lower portion of the esophagus and upper portion of the stomach, opening and relieving pressure on an overly tight lower esophageal sphincter.

Botox injections are an excellent alternative for patients with esophageal disorders that don’t want to, or can’t have, a minimally invasive procedure. Botox injections assist in relaxing the esophageal body or LES by interfering with nerve signals to the esophageal muscle tissue. Like the Heller myotomy, this procedure allows food to more easily pass through to the stomach.

Fundoplication is a type of surgical procedure that attaches the uppermost part of the stomach (the fundus) to the lower esophageal sphincter in order to increase pressure on that muscle, reduce a potential hiatal hernia, and restore the natural, physiological anatomy of the LES. The Heartburn & Reflux Center of Door County offers two types of minimally invasive, laparoscopic fundoplication procedures, which are performed robotically with the da Vinci Xi Surgical System:

• A Nissen Fundoplication is used when a large hiatal hernia is also present. It has minimal side effects and eliminates the need for long-term medical therapy. This fundoplication takes approximately 1.5 hours and requires an overnight stay. Patients are required to follow dietary restrictions for approximately 2 weeks after surgery
• A Transoral Incisionless Fundoplication, or TIF, is used when a hiatal hernia is not present or is small. It is performed through the mouth using an endoscope—the same equipment that attaches the Bravo capsule to the esophagus. This eliminates the need for incisions, leaving no scars, and reducing pain, recovery time and adverse side effects. The TIF procedure is performed in the outpatient setting, which means that in selective cases, a post-operative hospital stay may not be required. This procedure is covered by many insurance plans and also backed by numerous scientific studies, which show that for up to 8 years (97 months) after the procedure, esophageal inflammation is eliminated and most patients are able to stop using daily medications to control symptoms.

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Don’t let recurring heartburn go unchecked. As noted above, recurring and chronic heartburn can lead to more serious health issues down the road. If you, or someone you know, is experiencing heartburn on a regular basis, or the symptoms of heartburn have begun to impact quality of life, contact Door County Medical Center’s Heartburn & Reflux Center at: 920-746-1060. For more information on the different options for treatment the Heartburn & Reflux Center offers please visit our website at: https://www.dcmedical.org/medical-services/heartburn-reflux-center-of-door-county.