Heartburn, Reflux & GERD

• Nicotine (cigarettes)
• Fried or fatty foods
• Chocolate
• Coffee
• Citrus fruits and juices
• Peppermint
• Pregnancy
• Lying flat
• Hiatus hernia
• Certain prescription medications

• Chronic bleeding and anemia.
• Scar formation and narrowing of the lower esophagus ehich may cause swallowing difficulty. A stricture usually can be treated by dilatation.
• Barretts Esophagus, which occurs when long-term reflux irritates the lower esophagus so that the stomach lining actually grows into the esophagus. In these cases, there is a small, but definite, risk of a subsequent malignancy. Barrett's Esophagus requires periodic monitoring with endoscopy to detect early cancer states. The BARRX ablation procedure is a safe and effective treatment for Barrett's Esophagus, you can read more here.
• Lung problems when reflux of stomach fluid trickle into the breathing tubes, causing wheezing, bronchitis and even pneumonia. This often occurs at night when a patient is lying down.

• Eat smaller and more frequent meals.
• Avoid eating before going to bed.
• Eliminate excessive bending, lifting, abdominal exercises, girdles and tight belts, all of which increase abdominal pressure and provoke reflux.
• If overweight, lose weight. Being overweight promotes reflux.
• Eliminate the use of nicotine (cigarettes), fatty foods, alcohol, all coffees (yes-including decaf), chocolate and peppermint.
• Elevate the head of the bed 8" to 10" by placing pillows or a wedge under the upper part of the mattress. In this way, gravity keeps stomach juices out of the esophagus while the patient sleeps. It is not enough to use two pillows under the head.
• Prescription medications - check with the physician regarding side effects of prescription drugs. Some drugs actually lower the strength of the LES muscle. These include anti-spasmotics (Levsin, Librax, Bentyl), calcium channel blocks (Procardia, Cardizem, Calan, Isoptin), anti-depressants (Elavil, Doxepia) and others.

• Upper GI Endoscopy- The patient is mildly sedated and a flexible videoscope is inserted into the esophagus to visually inspect it and the stomach
• Upper GI Series- The patient drinks liquid barium and x-rays are taken of the esophagus and stomach showing how they function..
• Esophageal manometry- This test measures the pressure within the esophagus, especially the LES pressure.
• 24 hour Ambulatory combined pH (acid)and impedance Monitoring- Ambulatory combined pH and impedance monitoring, called the Sleuth System is the new gold standard for objectively assessing nonacid as well acid reflux activity and can confirm significant gastroesophageal reflux disease. Studies show that patients with persistent symptoms on medical therapy have nonacid reflux 40% of the time. pH and impedance reflux monitoring is usually performed prior to any antireflux procedure and is used to diagnose difficult or atypical reflux cases. A tiny tube is placed through the nose and into the esophagus (food tube) above the lower esophageal sphincter. The test runs for 24 hours and measures the number of times acid enters the esophagus. Wireless technology called The BRAVO System is also available. Click here to learn more about BRAVO. BRAVO is a wireless transmitting capsule which is placed usually following endoscopy. It will measure acid reflux activity only for 48 hours and the capsule will usually fall off within 3 to 5 days and is passed. Bravo offers longer data collection times and better patient comfort, but is limited in that it only measures acid reflux activity and will not measure nonacid reflux. The newer Sleuth pH-impedance reflux testing that measures nonacid and acid reflux is available through Greenwich Village Gastroenterology at St. Vincent's Hospital in Manhattan (New York).

• Other Treatments include:
  Antacids- These can and should be used more often. Generally, antacids should be taken 30 to 60 minutes after eating and at bedtime. Liquids are preferred to tablets, with the strongest being Maalox II, Mylanta II, Gelusil II and Extra Strength Riopan.
• Alginic Acid and Antacids- Two products, Gaviscon and Algicon, place a layer of foam over the fluid in the stomach to prevent reflux. These tablets should be chewed well and used 30 to 60 minutes after eating and at bedtime.
• Drugs- Medicines are now available that effectively reduces and even eliminates the secretion of stomach acid and increases the strength of the LES muscle. These medicines represent the most important method of treating reflux next to surgical or futuristic nonsurgical methods of correcting reflux. Other medications such as Reglan ( generic- metoclopramide), and Urecholine (generic- bethanecol) directly increase the strength of the LES muscle. Unfortunately, these drugs have certain adverse side effects and are not always helpful. Propulsid (generic- Cisapride) has been taken off the market due to it's cardiac side effects.
• Endoscopic Surgery- Surgery can treat reflux. Those patients who are dependent on acid lowering agents may entertain an antireflux procedure. There are few patients who do not repsond to medical therapy and benefit from antireflux prcedures. Generally, however, a failure of medical therapy is not an indiction for surgery. Prior to any corrective procedure, a patient must undergo an extensive evaluation. The objective of this surgery is to strengthen the LES muscle. Successful surgery greatly relieves and can correct severe reflux and heartburn. A method of performing anti-reflux surgery is by laparoscopic technique whereby the surgery is accomplished through tiny holes in the belly button and upper abdomen. Recovery is quicker with this technique. However, the procedure is still an invasive surgery which has certain inherent risks and potential complications, and requires the use of general anesthesia. This operation should only be performed by qualified surgeons thoroughly familiar with it.