Living With Heartburn

© Steven C. Immerman, MD, FACS, 2000.

Heartburn, also called Gastro Esophageal Reflux Disease (GERD), is a common condition. It usually feels like a burning pain beginning behind the breastbone and moving upward to the neck and throat. Many people notice food coming back into the mouth leaving an acid or bitter taste. The burning, pressure, or pain of heartburn, can last as long as two hours and is often worse after eating. For some patients, reflux symptoms occur every day and are a major part of their lives.

Heartburn is caused by acid and stomach fluid backing up into the esophagus. The esophagus is the tube that carries food from the mouth down to the stomach. Many people suffer from occasional heartburn; it is estimated that 40% of people experience heartburn at least once a month. Most of the time non-surgical measures can help improve the symptoms. These measures include avoiding coffee, chocolate, alcohol peppermint, garlic, onion, cinnamon, citrus fruits and juice tomato products and aspirin. Many patients notice that symptoms are worse at night, and elevating the head of the bed is helpful, as well as avoiding snacks after dinner. Taking antacids and acid suppressing medications, such as Tagamet, Zantac, Pepcid or Prilosec will reduce the acid content of stomach and make any reflux less irritating and painful.

Surgery can be done to prevent reflux and its associated symptoms. The procedure done most frequently is the Nissen Fundoplication. This is an operation that has been done since the 1950's, but technological advances now allow this procedure to be done laparoscopically. Laparoscopic surgery means less pain and quicker recovery.

Surgery is recommended to four general categories of with reflux disease:

• Patients with symptoms not relieved by medications.
• Patients who do not want to take medications for reflux rest of their lives.
• Patients who have occasional "breakthrough" symptoms of medication
• Patients who have precancerous changes in the esophagus caused by the chronic irritation.

Laparoscopic surgery for heartburn is usually an outpatient or one-day-stay procedure. Most patients take about a week off of work. The success rate for controlling the reflux symptoms is well over 85%. 

Published in Health Viewpoints, August 2000