Heartburn Treatment

Published in Healthy Viewpoints, Oak Leaf Medical Network Publication, Spring 2001.

© Seth Smith, M.D. 2001

Heartburn is a common problem affecting millions of Americans. Fortunately, it is usually mild and well controlled with nonoperative treatment. Many factors may contribute to one's developing heartburn. First, the ingestion of certain foods, such as fatty food, alcohol, peppermint, chocolate and coffee can cause it. Another factor is a common anatomic abnormality of the stomach, in which the upper stomach protrudes into the chest. Finally, overeating or eating just prior to lying down may worsen it.

A typical symptom of heartburn is discomfort in the mid-upper abdomen that sometimes is accompanied by an acid-like taste in the mouth. In some instances, one may develop regurgitation of food or respiratory symptoms such as choking and difficulty breathing. A few patients develop scarring in the lower esophagus (the tube connecting the mouth to the stomach), which causes swallowing problems. On rare occasions, patients may develop changes in their esophagus that increase their risk of cancer.

Most people with heartburn respond well to nonsurgical treatment. These include such things as:

1) Avoidance of the above mentioned food; 2) Not eating large meals, especially before bedtime; 3) Losing excess weight; and 4) Taking antacids or other acid reducing medicines.

Surgery is a good option for some patients with heartburn. The recent advent of laparoscopic surgery has increased patients' interest in surgical treatment of heartburn. Surgery may be considered for the following groups of patients: 1) Those who continue to have symptoms despite nonsurgical treatment; 2) People that develop complications of heartburn despite medical treatment; 3) Young, healthy patients who can't control their heartburn without continually taking medicine.

Surgery for heartburn, in the past, had been done in an "open" fashion, which involved an incision extending about half the length of the abdomen. Recently a "laparoscopic" approach has been developed that fixes the problem in the same fashion, but only requires several inch-long incisions that reduce pain and debility. Often, patients are able to go home within one or two days. This procedure involves wrapping the upper portion of the stomach around the lower part of the esophagus.

If you have heartburn and would like any additional information on the subject, please feel free to call me anytime. Dr. Seth Smith, Evergreen Surgical (715) 832-1044.