Troubled by Heartburn? Don’t Ignore It. Get the Help You Need.

Have you ever experienced heartburn? That burning sensation in your chest or throat? Many Americans endure heartburn on a regular basis. In fact, about 1 in 5 Americans — 60 million people — suffer from heartburn at least once a month. 

Although it’s unpleasant, the occasional episode of heartburn is nothing to worry about. The problem is that one quarter of those 60 million people experience heartburn every day, and at that level, heartburn is an issue that demands serious attention. In fact, if you have heartburn more than twice a week, you should talk with your doctor.

“Heartburn,” “acid reflux” and “GERD” are terms that people often use interchangeably, but they’re not the same. Heartburn is a symptom of acid reflux, the backward flow of stomach acid into the esophagus. Frequent acid reflux is a sign of gastroesophageal reflux disease or GERD. What causes GERD? That’s more complicated. 

GERD is usually caused by a weak lower esophageal sphincter (LES). The LES acts as a valve between the esophagus and stomach. If it doesn’t close properly, acid reflux occurs. GERD can also be caused by a hiatal hernia, a condition in which part of your stomach moves above your diaphragm. That also prevents your LES from functioning properly.

Heartburn can be serious because stomach acid doesn’t belong in your esophagus. When it ends up there, it causes irritation that can, over time, lead to problems. They include difficulty swallowing, asthma (from inhaling stomach acid), chronic hoarseness, pneumonia, and Barrett’s esophagus, a condition that puts you at risk for cancer of the esophagus.

There is a wide range of things people can do to address heartburn. Over-the-counter antacid tablets or liquids can help in many cases. When consulted, clinicians will typically suggest tactics like limiting certain foods, avoiding large meals before bedtime, quitting smoking, going easy on alcohol and losing weight. Some people will get help by taking these actions. Some will need medication to get the relief they’re looking for. And a few are candidates for surgery. 

A great place to begin the search for your solution is the LVHN Reflux Treatment Program.

The LVHN Reflux Treatment program, part of Jefferson Health, is a unique program designed to provide those suffering from heartburn with all the information they need to arrive at an appropriate solution. Surgeon Scott Beman, MD, with LVPG General, Bariatric and Trauma Surgery, and gastroenterologist Patrick Hickey, DO, with LVPG Gastroenterology, are two of the physicians who see patients in the multi-faceted program. 

“There are three parts to treating reflux,” Dr. Beman explains. “The first is conservative management, which is doing everything we know we’re supposed to do, like not eating right before bed, losing weight, quitting smoking, avoiding trigger foods and eating multiple small meals rather than large meals. If this doesn’t work, we turn to medication. When conservative management and medication both fail, then surgery is often a very good option for controlling symptoms and improving quality of life.”

Note that even if medication is effective, staying on it for long periods of time may not be the best option. Long-term use of medications for reflux should be done in consultation with your physician.

“Any long-term medication carries potential risks,” Dr. Hickey says. “For patients on medical therapy longer term — about six months to a year or more — we monitor carefully to ensure the benefits continue to outweigh those risks.”

Some of the potential risks of long-term medical therapy have been in the media lately. And for good reason. They can be serious.

“There’s the potential for certain infections in the gut, or issues with vitamins like B12 or magnesium,” says Dr. Hickey. “While these problems don’t occur in every patient, they certainly could happen, so medications need to be thoughtfully prescribed.”

Dr. Hickey also cautions about the indiscriminate use of over-the-counter medications:

“I’m not opposed to people trying things, but they need to be cautious of masking what might be significant symptoms — or never reviewing their symptoms with a physician. You don’t want something that should be investigated to be swept under the rug.”

If surgery sounds extreme, consider that it can eliminate the need for medication and could well provide long-term relief from your reflux.

“Often the people with whom I discuss surgery have been on medications for a long time and still have symptoms that are significantly affecting their quality of life,” Dr. Beman says. “Also, we often see people with larger hiatal hernias that don’t respond to medication. There are people who have ‘red flag symptoms,’ meaning they have swallowing difficulties or regurgitation or chest discomfort. Those folks really need to be seen by a surgeon.” 

A surgeon can oftentimes repair a hiatal hernia, improve a lax LES, and address nearly any other anatomical issue that is causing acid reflux. Most procedures are minimally invasive. Many are aided by robotics. One of the latest options employs a solution using magnets to correct the function of a lax LES. Some patients can go home the same day their procedure is done. Although, if you have a very large hernia or there are other health issues complicating your case, you may be in the hospital overnight.

In every case, long before there is talk of surgery, there is a complete evaluation of your situation.

“At LVHN, everyone’s journey starts with a conversation and a thorough exam,” Dr. Beman says. For most patients, an EGD or esophagogastroduodenoscopy will be recommended. It involves the use of a camera to view the esophagus, stomach and first part of the small intestine. The objective is to assess for a hiatal hernia and complications from acid reflux disease. The EGD also helps diagnose the reason for other symptoms such as swallowing difficulties, abdominal pain and reflux.

Additional testing such as the “96-hour Bravo Ph probe” might also be employed to monitor acid in the esophagus. High-resolution esophageal manometry (HRM), an advanced diagnostic test that uses a catheter with many pressure sensors to create a detailed color map of your esophagus's muscle function during swallowing, may also be used.  

“We want to make a very careful decision as to how we are intervening surgically so that we avoid post-surgical complications,” Dr. Hickey says. So, the more information, the better.

The unique team-oriented approach that distinguishes the LVHN Reflux Treatment Program helps to ensure that careful decision-making is always part of the process of providing care, and that care is always advancing.

“We’re always working to keep up with patients’ needs, tracking our data, tracking our outcomes and holding ourselves to the highest standard,” says Dr. Hickey. “We do everything we can to provide top-notch care. That may include medicines, it may include surgery, but it’s all available here.”