Heartburn describes the symptoms that people feel when they have reflux. We refer to the reflux as gastro-esophageal reflux disease, or GERD for short. GERD is basically the reflux (backflow) of acid from the stomach and bile from the intestine into the esophagus. Normally the acid and bile travel down the intestine, but with GERD there is a defect in the mechanism that connects the stomach and the esophagus. When there is a defect or dysfunction of the valve between the stomach and esophagus, it becomes easier for the acid and bile to go upwards instead of down. Over time the lining of the esophagus, which is not accustomed to acid, becomes irritated and inflamed, leading to a burning pain. Since the pain is behind the heart, it is referred to as heartburn.

Besides heartburn, patients can have a variety of other symptoms. They may have a bitter taste in their mouth after eating, have worsening pain and even vomiting when they lay down, worsening dentition, worsening asthma or even onset of asthma. If the esophagus is really inflamed, patients can have difficulty swallowing. Over time the inflammation of the esophagus can lead to scarring and the inability to swallow. More commonly long time GERD can lead to changes that are pre-cancerous, called Barrett’s esophagus.

When you have initial pain like heartburn you should see your physician, since there can be many problems that give this type of pain and it is important that you find out what the real cause is. Most physicians will be able to diagnose GERD by taking a complete history and physical. If the pain is significant, most physicians will recommend that you be scoped with a camera. This process is referred to as an EGD, or esophagogastroduodenoscopy, named for the organs that the camera passes through. A small camera is passed down your esophagus into your stomach. You will not need general anesthesia for this procedure, but you will be sedated, which is a sleep-like state that allows the doctor to talk to you during the procedure but you will not remember it. This procedure will give the physician a lot of answers and make sure there is nothing serious going on. There are many other procedures that could be recommended for diagnosis if certain conditions are found.

GERD is very common, and simple treatment controls it well in many cases. Most people who are diagnosed with GERD will be placed on medications that prevent the stomach from making acid. The two most common medications are histamine antagonists (prevent histamine release) and proton pump inhibitors (PPIs). Patients usually have to take their medication every day. If symptoms are not well controlled by these conservative measures, the treatment will then become surgery.

Those patients whose symptoms are not controlled on medication or who do not want to take medication should see a surgeon. Surgical control of GERD is based on preventing the acid and bile from refluxing into the esophagus. This is done basically by creating a new valve between the stomach and esophagus which prevents reflux from happening. This new valve is actually made by suturing the stomach over the esophagus. This procedure has a long history, allowing us to perfect it over the years.

Until recently this procedure was always done as an open procedure, requiring an abdominal incision and 5 - 6 days in the hospital. With the more recent advent of laparoscopic surgery, a minimally invasive surgery using small incisions, this is now a very well tolerated procedure. Usually the patient comes into the hospital the day of surgery and leaves the next day with resolution of their symptoms. Although this surgery has become more common and has been perfected, it should be done by a surgeon who is experienced in this particular procedure.

There may be reasons why the procedure cannot be done laparoscopically, and on occasion the surgeon will start to do the procedure laparoscopically and then find a condition that requires that the procedure be done as an open procedure with a larger incision. This is not a complication, and it is only done when, in the opinion of the surgeon, it is safer for you to have the surgery done open. If this should happen you will expect a longer recovery period and a longer incision, but recent advances in the treatment of postoperative discomfort and early mobilization has greatly reduced the discomfort and extended postoperative period that used to occur with these procedures.