Here’s how to put the pain of heartburn behind you
By Stephanie Thurrott
Ayman Mahmoud, 29, was plagued by gastroesophageal reflux disease (GERD) for years. His symptoms were so severe that twice-daily doses of Nexium couldn’t hold back the heartburn and regurgitation. “Every time I ate, 45 minutes later the food was coming back up,” the Hoover resident says. “It was really uncomfortable.” And the only way he could sleep was by elevating the head of his bed, so he hadn’t slept flat on his back in years.
His doctor, Mary Hawn, M.D., chief of gastrointestinal surgery at UAB, recommended fundoplication, an operation that can get GERD under control. Mahmoud underwent the surgery in September 2006 and has not needed reflux medication since. “I went home and took those bricks out from under my bed,” he says. “I should have done this a long time ago. I can’t believe I spent years suffering like that.”
More Than Heartburn
Just about everybody confronts heartburn now and then, whether it’s after eating acidic foods, overeating or eating close to bedtime. In fact, the American Gastroenterological Association estimates that 10 percent of Americans have heartburn or reflux as least once a week.
“Reflux is very common, but there’s a difference between reflux and disease, where you experience symptoms daily to the point where they’re interfering with your quality of life,” Dr. Hawn explains.
In addition to the pain and lost sleep, untreated GERD can lead to complications: The esophagus can get inflamed and bleed, or scar tissue can build up in the esophagus, making swallowing difficult. There’s also a small but measurable increased risk in esophageal cancer.
If heartburn and regurgitation are more than occasional problems for you, talk to your doctor. In many cases, he or she might be able to diagnose GERD based on your symptoms. Sometimes your physician also might perform a test such as:
- upper GI endoscopy to look inside your esophagus
- upper GI contrast X-ray
- esophageal manometry, a test that measures muscle function
- pH monitoring, which tracks how often acid enters the esophagus in a set time frame
If GERD is diagnosed, your doctor might recommend lifestyle modifications such as:
- changes in medications you take, since some irritate the stomach or esophagus
- quitting smoking
- limiting fried and fatty foods, peppermint, chocolate, alcohol, coffee, citrus and tomato products
- eating smaller portions and avoiding overeating
- watching alcohol consumption
- waiting a couple of hours after eating before going to bed
- losing weight
- raising the head of your bed
Dr. Hawn emphasizes the importance of weight loss in getting GERD under control. “Obesity is one of the biggest contributors to reflux,” she says.
Along with lifestyle changes, your doctor also may suggest medication. “I often start with some type of acid suppression therapy,” Dr. Hawn says. That may mean an over-the-counter medication such as Pepcid® AC, but she usually moves on to a class of medications called proton pump inhibitors (PPIs). Introduced in 1989 with the advent of Prilosec®, PPIs are among the most frequently prescribed drugs (not to mention the most heavily advertised). They work by blocking the stomach’s production of acid and are generally well tolerated. Most are prescription-only, though you can purchase Prilosec OTC® over the counter, as the name suggests.
“Depending on the chronicity of symptoms, I’ll give people a two- to six-week course of medication. Combined with lifestyle modification, people then may be able to come off the medication,” Dr. Hawn says. But for some people, GERD will be a lifetime problem. Fortunately, it’s considered safe to take PPIs for a lifetime.
Surgery for Some
Medication controls GERD for more than 90 percent of people, but some, like Mahmoud, still have annoying and painful symptoms. A mechanical barrier, designed to keep acid inside the stomach, not in the esophagus, can sometimes help.
“The most effective mechanical barrier is a surgical procedure called fundoplication,” Dr. Hawn says. It’s a minimally invasive procedure performed laparoscopically, where surgeons use part of the stomach to re-create the valve around the esophagus, preventing reflux.
Dr. Hawn says the surgery can have some side effects—people may initially have problems swallowing due to swelling, and can have some bloating and distention since they can’t belch as well—but generally fundoplication is well tolerated.
Fundoplication proved to be just what Mahmoud needed. He spent one night in the hospital following the operation and had to stick to a liquid diet for the next month while the surgical site healed. After that, he was free to eat whatever he chose. “I can eat pizza, spaghetti—anything that used to cause heartburn,” he says.
The surgery brought another benefit for him, too—weight loss. “I cannot eat as much as I used to because part of my stomach is now wrapped around my esophagus,” he explains. “I’m full with half a meal. I’m eating smaller portions three to five times a day, and I’m losing weight,” he says.
A Common Cause
GERD often is caused by a hiatal hernia, where a small part of the stomach pushes through the diaphragm into the chest. Acid and stomach contents can be retained above this opening and can spill into the esophagus, causing reflux.
“This type of hernia can predispose you to reflux, but it usually doesn’t need surgery. We usually direct our therapy toward treating reflux,” Dr. Hawn explains.
In more complicated hernia cases, the stomach can migrate up into the chest alongside the esophagus. These hernias sometimes don’t cause symptoms but are picked up on chest X-rays for other conditions. If a hernia isn’t bothersome, your doctor may simply want to keep an eye on it.
But sometimes these hernias cause reflux as well as more obstructive symptoms. You might feel full after eating just a little bit or even have chest pain or shortness of breath, because the stomach is pressing on the lungs. In these cases, the hernia should be surgically repaired. “It’s similar to the surgery for reflux, but more complicated because you have to get the stomach out of the chest and repair that opening in the diaphragm,” Dr. Hawn says. People generally stay two nights in the hospital and may need to recover at home for two weeks.
But for most people with GERD, simpler solutions suffice. So if symptoms are bothering you, talk with your doctor. You don’t need to suffer.