Everyone occasionally has heartburn. This occurs when stomach acid flows backward into the esophagus, the food pipe that carries food to the stomach. People usually experience heartburn after meals as a burning sensation or pain behind the breast bone. Often, regurgitation of food and bitter-tasting stomach acid accompanies heartburn. Antacids or milk temporarily relieves heartburn for most people
To understand heartburn, let us look at the body's anatomy. The esophagus carries food and liquid to the stomach. A sphincter, or muscular valve, is located at the end of the esophagus at the border between the esophagus and stomach. Known as the lower esophageal sphincter (LES) this muscle contracts much the same as the anus does. The sphincter should maintain a certain pressure to keep the end of the esophagus closed so that stomach juices are not admitted. The LES muscle should only open when food is passed into the stomach.
However, the LES muscle does not always work perfectly. It is felt that the problem is with inappropriate, transient relaxations of this sphincter valve that result in reflux. Sphincter function can be easily overcome by a number of factors, the most common being eating a large meal. Along with swallowed air, a large meal causes an upward pressure in the stomach to rise, thereby overpowering the LES muscle. Other factors that reduce the LES pressure and allow reflux are:
Gastroesophageal Reflux disease, also known as GERD, is commonly known as heartburn or regurgitation. It is quite common, with 10 percent of the population experiencing them daily. Twenty-five percent of pregnant women have heartburn. Even though heartburn is common, it is rarely life threatening. Severe cases, however, can result in injury to the lower esophagus that requires treatment. GERD is considered significant when occurring 2 times weekly or more. Untreated reflux can lead to esophageal cancer thereby making it a serious condition.
The esophagus passes through a muscle, called the diaphragm, which separates the lungs from the abdomen. When the opening in the diaphragm enlarges, a portion of the stomach can protrude (herniate) through it into the chest. This is called a hiatal hernia. A persistent hiatal hernia may produce significant heartburn. Many people with a hiatus hernia do not experience heartburn. However, 40-50% of patients with a hiatal hernia have reflux. A hiatal hernia and GERD can occur independently from one another.
Besides heartburn, the other major problems that can develop with reflux are:
The primary tests used to diagnose reflux are:
General measures the patient can take to reduce reflux are:
This procedure, referred to as EsophyX involves the use of devices that intensify and remodel the antireflux barrier at the level of the lower sphincter valve between the esophagus and stomach. The approach to this type of surgery is through the mouth and without any cutting or incisions in the abdominal wall. The EsophyX employs a suturing and fastening system to create pleats in order the improve the lower valve function.
The team at Lenox Hill Hospital was the first center in the New York City metropolitan area to offer the EsophyX TIF (Transoral Incisionless Fundoplication). The EsophyX TIF procedure is also available at other hospital affiliations that include The Langone New York University Medical Center and Beth Israel Medical Center. Working in conjunction with the developers and manufacturers of the endoscopic reflux therapy devices, we have taken the lead in the diagnosis and management of gastroesophageal reflux disease.
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