Acid reflux or “heartburn” occurs when stomach contents leak back, or reflux, into the esophagus. Refluxed stomach acid creates a burning sensation in the chest or throat called heartburn or indigestion. Occasionally, people describe reflux as a burning sensation in the back of the mouth. Heartburn that occurs more than twice a week may be considered gastro-esophageal reflux disease (GERD). Some people have GERD without heartburn. In other words, it is a “silent’’ reflux. Others experience pain in the chest, hoarseness in the morning, or trouble swallowing.
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What Causes Acid Reflux?
The esophagus is the muscular tube that carries food from the mouth to the stomach. At the end of the esophagus there is a valve called the lower esophageal sphincter (LES). The function of the lower esophageal sphincter (LES) is to keep stomach contents from refluxing back into the esophagus. Reflux that happens from time to time is normal and usually does not cause any symptoms. Chronic reflux, however, can cause ulcers , an erosion of the lining of the esophagus, a stricture, or severe inflammation.
Reflux is a mechanical problem. It is caused by the sphincter (LES) being dysfunctional, sometimes, a hiatal hernia preventing the sphincter from working properly. Foods, chemicals and certain medications can weaken the function of the sphincter (LES) Examples include:
- Peppermint
- Chocolate
- Tobacco
- Alcohol
- Certain Medications
- Anticholinergic drugs ( urinary tract disorder medications)
- Antihistamines
- Asthma Medications
- Calcium Channel Blockers (High Blood Pressure)
- Diazepam (anxiety disorders and seizure medication)
- Nitrates (Angina)
- Opioid Analgesics ( Prescription pain medications)
- Some Antidepressants
Other conditions can lead to higher pressures in the abdominal cavity which can overwhelm the sphincter LES causing it to become ‘weakened’ and incompetent. Examples include the following:
- Pregnancy
- Obesity
- Chronic cough or straining
- Bending over
- Over eating or eating late in the evening
When the sphincter (LES) is displaced by a hiatal hernia, patients often experience reflux. A hiatal hernia allows the sphincter (LES) to slide up into the chest (diaphragm) which weakens the sphincter causing reflux.
Over time chronic acid reflux can lead to changes in the cells that line the esophagus. This is known as Barrett’s Esophagus. Patients can also develp pre-cancerous changes (dysplasia) as a result of chronic reflux. Once a patient develops these findings, careful and close follow-up is mandatory with an annual upper endoscopy to rule out the development of cancer.
Treatment
In most cases reflux can be managed with simple strategies. If you are experiencing reflux you should visit with your doctor for diagnosis and treatment. Pain in the chest can also signify serious conditions such as heart disease so a professional medical consultation is required to distinguish heartburn from something more significant.
Once diagnosed properly, reflux can be managed with several strategies including lifestyle changes and medical therapy
- Avoid causative agents (STOP SMOKING and ALCOHOL CONSUMPTION)
- Weight loss
- Avoid over eating and late night meals
- Elevate the head of the bed a few inches
- Medications
- Antacids (tums, pepto-bismol)
- H2 blockers (zantac, pepcid)
- Proton pump inhibitors (prilosec, prevacid, zegerid, nexium)
- Your physician may order additional testing including: x-ray (upper gi series), endoscopy, manometry. pH (BRAVO) testing
Surgical treatment of acid reflux
Most GERD symptoms will respond to lifestyle changes and medical management. People who do not respond to conservative management should consider surgery. Over time the cost of the medicines can be significant and some patients will elect to have surgery to correct the condition. Studies have shown that results are better if the surgery is done before the patients GERD becomes severe (maximum medical therapy). Any patient who has developed Barrett’s esophagus or pre-cancerous changes (dysplasia) in the lower esophagus should strongly consider anti-reflux surgery. There are recent studies that report the regression of these findings in some patients who undergo an operation. Patients with Barrett’s esophagus or dysplastic changes who undergo surgery should continue to have close follow-up including endoscopy on a regular scheduled basis until the condition resolves.
There are multiple surgical options for the treatment of GERD. After thoroughly reviewing your history and clinical symptoms, your surgeon may recommend one of the following:
Nissen Fundoplication is the traditional surgical treatment for GERD. In this operation, the upper part of the stomach is wrapped around the lower end of the esophagus and the hiatal hernia is repaired.
Implantation of a Linx Magnetic Sphincter Augmentation device is an alternate FDA approved device that is recommended for patients whose symptoms are not controlled with medication or lifestyle changes, or who may not be candidates for Nissen Fundoplication. These patients include post- sleeve gastrectomy patients and post- RNY gastric bypass patients who are at risk for developing GERD in the late post operative period.
Linx
At BMI of Texas, Drs. Englehardt and Patel are leading the field to address the increasing prevalence of GERD in San Antonio by offering the Linx surgery.
The Linx Magnetic Sphincter Augmentation (MSA) device is an FDA-approved device for the treatment of gastroesophageal reflux disease (GERD) and is approved for post-sleeve and RNY gastric bypass patients. Studies show that 85% of patients are able to stop anti-reflux medications and over 80% had resolution of bothersome heartburn at 5 years.
How does Linx work?
The Linx device is a flexible ring of magnetized titanium beads that is placed in a specific position on the esophagus. The device acts as a helper to the lower esophageal sphincter (LES) muscle allowing it to prevent reflux of stomach contents into the esophagus.
Is there any workup prior to a Linx procedure?
Specific testing to determine if you are a candidate for linx can include:
- upper endoscopy
- esophageal manometry
- bravo pH testing
Am I a candidate for Linx?
Ideal candidates are those with one or more of the following:
- Patients with symptoms of GERD despite maximal therapy
- Presence of a hiatal hernia
- Abnormal pH testing
- Normal esophageal function
- Reflux following sleeve gastrectomy or RNY gastric bypass
What is the recovery process?
The linx surgery is performed on an outpatient basis. Patients are ambulatory and able to perform light activities following surgery. Patients will be able to consume a regular diet modified to have small frequent meals.
In general, patients can return to work within 2 weeks of surgery. By working collaboratively with your surgeon, you will be able to wean off any medical therapies for GERD over time.