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Heartburn May Be a Symptom of Serious Conditions

April 22, 2014

 Seminar Explains Complications of Untreated GERD or Acid Reflux

Most people experience the sensation of heartburn on occasion, especially if they've eaten a heavy, spicy meal just before bedtime. Occasional heartburn can often be treated with a simple antacid medication such as Tums or Maalox. Frequent heartburn, however, may be a symptom of a more serious condition called gastroesophageal reflux disease, also known as GERD or acid reflux.

Untreated GERD can lead to serious complications such as ulcers, scarring and strictures (narrowing) of the esophagus - the Ôfood pipe' that leads from the throat to the stomach - a pre-cancerous condition called "Barrett's esophagus," and esophageal cancer.

To promote greater awareness of GERD and its potential complications, Washington Hospital will conduct a free seminar on Tuesday, April 29 from 6:30 to 8:30 p.m. The seminar will feature presentations by Dr. Arun Srivatsa, a gastroenterologist on the medical staff at Washington Hospital, and Dr. Mary Maish, a thoracic surgeon on the medical staff at Washington Hospital. Both physicians have substantial experience and expertise in treating GERD, Barrett's esophagus and esophageal cancer. The seminar will be held in the Conrad E. Anderson, M.D Auditorium in the Washington West building at 2500 Mowry Avenue in Fremont.

Acid reflux happens when the contents of the stomach back up into the esophagus. The acid flows back up into the esophagus because the valve (also called a "sphincter") between the stomach and esophagus hasn't worked properly. In addition to heartburn and the flow of stomach contents up into the throat (regurgitation), symptoms of GERD may include nausea, sore throat and a hoarse voice.

"Some acid reflux is normal, and almost all people have it occasionally," says Dr. Srivatsa. "Reflux becomes a concern, however, when it is chronic and damages the esophagus. Anyone with consistent heartburn - even if it is controlled with medications - for over a year should see a gastroenterologist for an evaluation to see if testing for GERD or complications of GERD is indicated."

Nonsurgical Treatment Options for GERD

In many cases, uncomplicated GERD can be treated by making a few simple lifestyle changes.

"The single most important lifestyle change for people with GERD is to stop smoking if they are smokers," Dr. Srivatsa asserts. "Nicotine causes the valve between the esophagus and stomach to relax resulting in acid reflux. Alcohol consumption also can be a big contributing factor to GERD."

Changing your eating habits may be useful in treating GERD symptoms, according to Dr. Srivatsa.

"GERD can be worse after eating large meals, so smaller portions may reduce reflux," he explains. "Also, certain foods and beverages - such as fatty or spicy foods, chocolate, coffee, other caffeinated drinks and carbonated sodas - often promote reflux, so you should avoid them if you have GERD. Acid-containing foods including citrus fruits and juices also should be avoided."

Some other lifestyle changes that may reduce GERD symptoms include:
* Staying upright after eating, because gravity helps move food and acids down the digestive tract.

* Losing excess weight since it puts pressure on the abdomen and causes stomach acid to back up.

* Waiting at least two hours after a meal before exercising, since exertion may trigger heartburn.

In addition to lifestyle changes, various medications may help control GERD, including antacids, histamine blockers such as Zantac or Pepcid, and proton pump inhibitors such as Nexium or Prilosec.

"You should consult your physician as to which medications might work best for you," Dr. Srivatsa cautions. "It's also important to note that certain medications also may contribute to GERD, including nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen, and osteoporosis medications like Fosamax."


Surgical Treatments for GERD

Lifestyle changes and medications can treat the symptoms of GERD, but they don't change the function of a loose valve (sphincter) between the esophagus and the stomach. When a loose valve is diagnosed, usually with an endoscopy exam, surgery may be the best treatment option.

"In some cases, we can do an endoscopic procedure called trans-oral incisionless fundoplication - or TIF - to strengthen the valve between the esophagus and the stomach," says Dr. Maish. "We insert a small camera, called an endoscope, and a surgical device through the patient's mouth and guide it to the junction of the stomach and esophagus. Then we insert sutures in the stomach and esophagus to restructure and strengthen the valve. The procedure doesn't require any incisions in the abdomen.


"Fundoplication to restructure and strengthen the valve also can be done as a minimally invasive laparoscopic procedure that involves very small incisions," she adds.

A newer minimally invasive surgical procedure to correct faulty antireflux valve function involves inserting a "magnetic bracelet" over the end of the esophagus at the location of the valve.

"The magnetic bracelet, known as the LINX device, wraps around the base of the esophagus to prevent food, acid or bile from going from the stomach back up into the esophagus," Dr. Maish explains. "The bracelet is a one-way valve that is flexible enough to let food go down, but not back up."

Dr. Maish is currently the only physician in the Bay Area currently performing the LINX magnetic bracelet procedure.

"It's important to note that GERD is sometimes hard to distinguish from another condition called hiatal hernia," Dr. Maish cautions. "With a hiatal hernia, part of the stomach slips up into the chest, causing intermittent heartburn symptoms. A hiatal hernia is usually diagnosed by doing an X-ray after having the patient swallow a barium solution that shows up on X-rays, or by performing an endoscopy. Minimally invasive surgery can be performed laparascopically to correct a hiatal hernia by anchoring the stomach back down in the abdomen."


Serious Complications of GERD

Dr. Srivatsa notes that the three "danger sign" symptoms of serious GERD complications include:
* difficulty swallowing
* unexplained weight loss
* blood in vomit or stools

"Anyone with these symptoms absolutely needs to see a gastroenterology specialist right away," he emphasizes.

Among the serious complications of GERD are scarring and strictures (narrowing) of the esophagus.

"Strictures and scarring make it difficult to eat and swallow," says Dr. Maish. "Treating those complications may require surgery, sometimes as drastic as removing the esophagus and replacing it with other body tissues."

Dr. Maish notes that another serious GERD complication, Barrett's esophagus, affects approximately 3.3 million Americans, with a 2 percent risk per year of developing esophageal cancer.

"In Barrett's esophagus, the lining of the esophagus changes from normal cells to cells that resemble colon cells in an attempt to compensate for the acid," she explains. "These cells continue to differentiate and change, becoming precancerous, and perhaps becoming cancerous. An effective treatment for Barrett's - radiofrequency ablation - has been routinely available only for about the past five years."

With radiofrequency ablation for Barrett's esophagus, endoscopy is used to identify areas in the esophagus that need to be treated. Then a catheter is inserted into the area and inflated to allow transmission of radiofrequency waves that destroy the abnormal cells.

For patients with Barrett's esophagus that may have progressed to cancer, another advanced tool called endoscopic ultrasound (EUS) may be used to evaluate any suspected tumors.

"EUS combines endoscopy and ultrasound to obtain very detailed images and provide information about the spread of cancer," says Dr. Srivatsa. "With EUS we can biopsy and remove the suspicious area without having to make any incisions. It's a less invasive method of performing such procedures."

Esophageal cancer is not very common, with approximately only 16,000 cases diagnosed each year, according to Dr. Maish. Treatment for esophageal cancer involves "tri-modality therapy" that includes surgery - which may include removing the esophagus in advanced cases - as well as chemotherapy and radiation.

"Unfortunately, esophageal cancer is being diagnosed with rapidly increasing frequency," she says. "That's one reason why it's important to diagnose and treat GERD early, to reduce the risk of developing esophageal cancer later on."


To register for the seminar on April 29 or to learn more about seminars offered by Washington Hospital, visit whhs.com/event/class-registration. To find a physician close to you, visit www.whhs.com or the Washington Township Medical Foundation Web site at www.mywtmf.com.