Heartburn with reflux esophagitis, or GERD (gastroesophageal reflux disease) as it is most commonly called these days, is a condition in which the inner lining of the esophagus is abnormally exposed to stomach acid or to bile. As a result, the esophagus becomes inflamed and swollen. The affected person often experiences heartburn characterized by pain starting from the pit of the stomach, going up into the chest, sometimes going all the way to the throat. Some patients describe an acid taste in their mouth. Sometimes, the acid irritates the back of the throat and the patient's complain of hoarseness and a sore throat. Acid can spill over into the lungs causing severe coughing spells and occasionally asthmatic attacks. In its very severe form, the reflux can cause the esophagus to bleed, even form dense scar tissue and obstruction of the esophagus. Finally, severe inflammation of the esophagus can cause changes in the esophagus that are precancerous (Barrett’s esophagus).

GERD occurs because of a defect in the valve (lower esophageal sphincter—LES) that normally exists between the esophagus and the stomach. The defective valve allows stomach acid and bile to flow into the esophagus from the stomach.

Treatment of GERD:

1. Several lifestyle changes can lessen the symptoms from GERD.
   • Smoking cessation.
   • Abstinence from alcohol.
   • For overweight patients, losing weight.
   • Eating small meals and avoiding large meals.
   • Wearing loose-fitting clothes.
   • Avoiding lying down three hours after a meal.
   • Raising the head of the bed about six to eight inches using blocks under the bed.
     
     
2. Medical Therapy: Medications to neutralize stomach acid are helpful in decreasing the symptoms of GERD. These include antacids like Maalox or Mylanta, H2 blockers like Tagamet and Axid, and proton pump inhibiters (PPI’s) like Nexium, Aciphex, and Prevacid. These medications counteract the stomach acid so that whatever refluxes into the esophagus will not irritate the esophagus. These agents, however, do not correct the defective valve, they only neutralize the acid.
   
   
3. Surgical Therapy: Surgery on the other hand corrects the primary problem of GERD. The operation recreates the valve between the esophagus and the stomach. This is accomplished by fixing the hiatal hernia which is often associated with GERD, lengthening the amount of the esophagus that is inside the abdomen and by wrapping the stomach around the esophagus. Surgery is indicated in patients whose symptoms have become resistant to medications for GERD, or who have developed severe symptoms like obstruction and bleeding not controlled by medications, or in some patients who have developed Barrett’s esophagus (the premalignant change in the lining of the esophagus due to continuous acid exposure). The procedure can be performed laparoscopically avoiding a big incision, lessening the operative time and hastening the recovery of the patient.