Steven Immerman, MD
General & Thoracic Surgery
Heartburn is the term used for the burning discomfort that people experience behind the breastbone. This often occurs at night or after eating. It is frequently caused by gastro-esophageal reflux which is acid backing up from the stomach into the esophagus. There can also be other signs of heartburn: some patients may notice food or fluid backing up into their throat causing a bitter taste, and some patients may even develop a cough or asthma-like symptoms from this. Although everyone experiences heartburn at one time or another, if it is occurring more than twice per week, and lasts more than just a few minutes, it is something that should be addressed.
The first strategy that should be used is to try to determine if there is some dietary trigger to this. The most commonly implicated foods are coffee, chocolate and alcohol; as well as tomato based, acidic, fried, spicy foods and smoking cigarettes. Some patients find that probiotics or digestive enzymes are beneficial, and some patients have specific food sensitivities that play a role, so those foods are to be avoided. Several lifestyle management strategies to try are (1) avoid overeating (small frequent meals are better); (2) stop smoking if you smoke; and (3) lose some weight if you are overweight.
These three changes alone may lessen your symptoms greatly. At night it helps to avoid eating within three hours of bedtime, and sleeping with the head of the bed elevated.
If modification of your diet, lifestyle and eating habits do not improve your symptoms, the next step should be to question if any medications you might be taking for other reasons are causing your symptoms; in particular, aspirin, ibuprofen or other NSAIDS (non-steroidal anti-inflammatory drugs) can cause problems. If you are on any prescription medications, you should check with your physician to see if they may be contributing to the problem.
It is also appropriate to try over-the-counter (OTC) medications, such as liquid antacids, Tums, Pepcid or Zantac. If these make you feel better, that helps confirm the diagnosis of Gastro-Esophageal Reflux Disease (often abbreviated as “GERD”, or just called “reflux”).
If you are still uncomfortable in spite of lifestyle changes and occasional OTC medications, or if you are needing more and more medications with little relief it is time to schedule a visit with your physician. Chronic reflux can cause problems such as narrowing of the lower esophagus, ulcers, and even precancerous and cancerous changes. Specific testing may be needed to rule these out, and define your problem.
There are prescription medications that are more effective at reducing stomach acid than the over-the-counter varieties, and these are often used to minimize symptoms. However, if these are not effective there is a successful surgical procedure that can be done to prevent reflux symptoms.
The surgical procedure is called a Laparoscopic Nissen Fundoplication. This procedure creates a one-way valve at the point where the stomach and esophagus come together. This valve prevents acid from backing up into the chest. It is very effective and often has a very long lasting result. The procedure is usually done laparoscopically (through five 1/2 inch incisions), includes one overnight hospital stay, and often provides immediate relief of heartburn symptoms. Not everyone with heartburn symptoms is a candidate for this, and some testing is needed to determine who will benefit the most, but it is a very successful option.
Dr. Immerman and the surgeons at Evergreen Surgical have been performing this procedure at the OakLeaf Surgical Hospital since 1997 with excellent results. For more information, call Evergreen Surgical at 715.832.1044 or visit www.evergreensurgical.com.
Dr. Immerman – Evergreen Surgical
For information or to schedule an appointment:
715-832-1044 | www.evergreensurgical.com
Dr. Immerman sees patients in Eau Claire.