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Anti-Reflux Procedure Offers Long-term Relief

By Monica Saumoy, MD

Have antacids and other medications to help control gastroesophageal reflux disease (GERD) failed to bring relief?

Have you changed your diet but still suffer frequent heartburn or other uncomfortable symptoms?

If so, you might be a candidate for anti-reflux surgery.

Gastroenterologists with the Esophageal Program at the Center for Digestive Health at Penn Medicine Princeton Medical Center offer specialized care for diseases of the esophagus, using advanced diagnostic and treatment techniques, including noninvasive surgery that provides long-term relief from GERD.

A Range of Symptoms

GERD is one of the most common gastrointestinal diseases in the United States, affecting approximately 20% of people nationwide, according to the American College of Gastroenterology.

The condition is characterized by the frequent and chronic backflow of stomach acid into the esophagus.

Normally, when you eat, the ring of muscles in the lower esophagus — called the lower esophageal sphincter — prevents food from coming back up.

If this ring is weak or does not close all the way, stomach contents can leak back into the esophagus and cause a range of symptoms, such as:

  • Heartburn.
  • Regurgitation or the feeling of stomach contents rising in the throat or mouth.
  • Difficulty swallowing.
  • Chronic cough, especially at night.
  • Hoarseness or voice changes.
  • Sore or irritated throat.
  • Laryngitis.

Over time, if left untreated, GERD can lead to other health complications, such as:

  • Inflammation of the esophagus, which may cause ulcers in the lining of the esophagus.
  • Narrowing of the esophagus, which can lead to problems swallowing.
  • Respiratory problems, including asthma and chronic cough.
  • Barrett’s esophagus, a condition in which the lining of the intestine replaces the lining in the esophagus, increasing the risk for esophageal cancer.

Risk Factors

While almost everyone will experience heartburn every now and then, especially after a spicy dinner or a big meal too close to bedtime, there are certain factors that may increase your risk for GERD. These include:

  • Being overweight or having obesity.
  • Pregnancy.
  • Smoking.
  • Certain medications.
  • Hiatal hernia.
  • Scleroderma.
  • Lying down within three hours after eating.

In addition, GERD can be caused or made worse by hormonal changes during pregnancy.

Diagnosis and Treatment

If you have symptoms of GERD, it’s important to see your doctor for a proper diagnosis and treatment plan. Often, GERD can be diagnosed through a clinical exam and medical history.

In severe cases or in instances where symptoms have returned after treatment, your doctor may recommend an upper endoscopy to examine the lining of the esophagus, stomach and first part of the small intestine.

A gastroenterologist may also perform tests to measure the pressure inside the lower part of the esophagus and to determine how much stomach acid enters the esophagus.

Lifestyle changes are normally the first line of treatment for GERD. These include:

  • Maintaining a healthy weight.
  • Not overeating.
  • Avoiding caffeine, chocolate and spicy food.
  • Limiting alcohol consumption.
  • Quitting smoking.
  • Avoiding tight clothing.
  • Limit laying down for at least two hours after eating. Not eating for at least two hours before bedtime.

If lifestyle changes are not enough to control GERD, medication may be recommended.

Over-the-counter antacids may provide quick — though temporary — relief from symptoms. Other medicines such as proton pump inhibitors and H2 blockers H2 inhibitors (PPIs) can help alleviate symptoms and work to reduce acid production over time.

What’s important is that you work with your doctor to find an approach that is right for you.

A Noninvasive Surgical Solution  

For individuals who do not respond to conventional treatments or wish to avoid long-term medication use, surgical options, including a noninvasive procedure called transoral incisionless fundoplication (TIF), may be considered.

The procedure is performed through the mouth with an endoscope, which enables the gastroenterologist to see inside the stomach and the esophagus.

During the procedure, the gastroenterologist uses other specialized tools to wrap the top part of the stomach around the bottom part of the esophagus, helping to lengthen and strengthen the esophageal sphincter.

As a result, the sphincter works better to keep acid and stomach contents from coming back up into the esophagus.

The TIF procedure is a safe and effective alternative to other more complex surgeries for GERD. Patients often have an easier recovery and are typically able to return to a normal diet after six weeks. Moreover, the procedure does not preclude additional interventions if needed to treat the condition in the future.

Most people who are suffering from GERD that is unable to be managed through lifestyle changes and medication are candidates for the TIF procedure unless they have a large hiatal hernia. In those cases, traditional open or laparoscopic surgery can be performed.

At the Center for Digestive Health at Penn Medicine Princeton Medical Center, the TIF procedure is performed by clinicians with expertise in the management of GERD.

More than just an occasional bout of heartburn, GERD is a serious health condition that requires medical attention. If your symptoms persist even with lifestyle changes and medications, talk with your doctor about a surgical solution that can provide long-term relief.

To find a gastroenterologist with Penn Medicine Princeton Health or for more information, call 1 (888) 742.7496 or visit www.princetonhcs.org.

Monica Saumoy, MD, is board certified in gastroenterology, obesity medicine, and internal medicine. She is a member of the medical staff at Penn Medicine Princeton Health.

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