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VCU Division of Cardiothoracic Surgery, Department of Surgery, Virginia Commonwealth University VCU Division of Cardiothoracic Surgery VCU Medical Center VCU

VCU Division of Cardiothoracic Surgery

Gastroesophageal Reflux Disease (GERD/Heartburn)

What is Heartburn (GERD)


Heartburn is an irritation of the esophagus that is caused by stomach acid. This can create a burning discomfort in the upper abdomen or below the breast bone.  It is also commonly called reflux.  Some patients also feel the food or fluid travel back upwards into the chest, referred to as regurgitation.  Combined or by itself, this problem in medical terms is called gastroesophageal reflux disease (GERD). 
The LES is located where the esophagus meets the stomach.  The LES is positioned below the rib cage and below the diaphragm.  Normally it opens to allow food into the stomach or to permit belching; then it closes again. But if the LES opens too often or does not close tight enough, stomach acid can reflux, or seep, into the esophagus and cause the burning sensation.


Symptoms of GERD
  • Heartburn
  • Regurgitation
  • Feeling of food not going down properly (with inflammation & hiatal hernia)
  • Cough when lying down or at night time
  • Changes to your voice
Other situations that affect GERD
  • Obesity and pregnancy (increased pressure in the abdomen pushes fluid into esophagus)
  • Too much food in the stomach (overeating- increased pressure in the stomach)
  • Certain food like tomatoes, citrus fruits, garlic, onions, chocolate, coffee, caffeinated products (they relax the LES)
  • Lack of sleep
  • Stress
  • Smoking
  • Alcohol
  • PRESENCE OF A HIATAL HERNIA- This pushes the LES into the chest up from its normal location and it does not work effectively anymore.
Consequences of GERD


Occasional heartburn isn't dangerous, but chronic heartburn or gastroesophageal reflux disease (GERD) can sometimes lead to serious problems. Heartburn is a weekly occurrence for about 20% of Americans and very common in pregnant women.  With long term irritation of the esophagus, the inflmmation can progress to permanent change in the lining of the esophagus called Barrett’s esophagus.  Patients with Barrett’s esophagus can progress to have invasive cancer.

 
Treatment of GERD


First and foremost is lifestyle changes with avoiding certain foods mentioned above, losing some excess weight if possible, restraining from smoking & alcohol and medications like nexium or prilosec.


Surgery for GERD


Surgery is offered to patients who have significant GERD symptoms in spite of trying the measure listed above and for patients with hiatal hernia and other complications of GERD.  The surgery is performed with minimally invasive techniques (laparoscopy, small band-aid incisions) and most patients are able to go home in 1-2 days and able to go back to work in 2-3 weeks.

 

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