Heartburn & Acid Reflux Institute at The Woodlands Hospital - The Woodlands, TX

Most frequently, acid reflux is felt as persistent heartburn. This burning feeling in the chest usually begins after eating and can last anywhere from a few minutes to a few hours. The involuntary return of incompletely digested food into the mouth, called regurgitation, is another common complaint. Other symptoms include:

• Asthma

• Bad breath

• Chronic cough

• Difficulty swallowing (dysphagia)

• Erosion of tooth enamel

• Gum pain and inflammation

• Hoarseness

• Sore throat

• Sour taste in the mouth

The process of digestion begins in the mouth with saliva. Food is broken down and then carried to the stomach through the esophagus. The stomach and esophagus are connected by the lower esophageal sphincter (LES), which opens and closes to allow food to pass into the stomach and keeps that food and stomach acid down. 

Acid reflux occurs when the LES is weakened and can no longer adequately control the separation of the stomach and esophagus. Stomach acid can then enter the esophagus and cause discomfort.

The following risk factors increase the likelihood of acid reflux:

• Being overweight or obese: Extra weight can put pressure on the stomach.
• Drinking alcohol or caffeine: Both alcohol and caffeine can relax the LES..
• Eating certain foods: Spicy, fatty or acidic foods can irritate the lining of the esophagus.
• Eating large meals or lying down after eating: Both of these behaviors can increase the amount of pressure on the stomach, making it easier for acid to flow back into the esophagus.
• Medical conditions: Some physical conditions affect the LES. For example, with a hiatal hernia, the upper part of the stomach protrudes through the diaphragm.
• Medications: Some medications, such as aspirin, ibuprofen and certain muscle relaxers impact the LES.
• Pregnancy: Pregnancy can increase pressure on the stomach and hormones can also play a role.
• Smoking: Smoking can also relax the LES, making it easier for acid to flow back into the esophagus.

• Medical history: Your provider will ask you about your symptoms, such as heartburn, regurgitation and difficulty swallowing, as well as your medical history.
• Physical examination: The physician may perform a physical examination to check for any signs of GERD, such as inflammation or irritation of the esophagus.
• Barium swallow: A barium swallow involves drinking a liquid containing barium, which shows up on X-rays. This study can help to identify any abnormalities in the esophagus or stomach.
• Endoscopy: An endoscopy is a procedure that involves the use of a thin, flexible tube with a camera on the end to look inside the esophagus and stomach. This exam can help to identify any signs of inflammation, ulcers or other abnormalities.
• Esophageal manometry: This test measures the strength and coordination of the muscles in the esophagus, which can help to identify any problems with the movement of food and acid.
• pH monitoring: A pH monitoring test can measure the amount of acid in the esophagus over a 24-hour period. This test can help to diagnose GERD and determine the severity of the condition.

Depending on the severity of your symptoms, your provider may suggest any of the following approaches:

Lifestyle changes

Making certain lifestyle changes can help reduce the symptoms of acid reflux. These may include:

• Eating smaller, more frequent meals

• Avoiding trigger foods, such as spicy or fatty foods, caffeine and alcohol

• Losing weight if you are overweight or obese

• Elevating the head of your bed

• Quitting smoking

Medications

There are several medications that can be used to treat acid reflux, including:

• Antacids: These can help to neutralize stomach acid and provide relief from symptoms.

• H2 blockers: These medications reduce the production of stomach acid.

• Proton pump inhibitors (PPIs): These medications block acid production in the stomach and are often used for more severe cases of acid reflux.

Surgery

Surgery may be an option if medication and lifestyle changes are not effective or if there are complications, such as Barrett's esophagus.

Different surgical procedures may be necessary to treat acid reflux. All of them focus on preventing stomach acid from traveling up the esophagus, but do it in different ways. Surgery options include:

• Nissen fundoplication: Surgeons can perform this as either a minimally invasive or an open procedure. It involves taking the top part of the stomach (the fundus), pulling it upward, wrapping it around the lower esophageal sphincter (LES), and stitching it together. Essentially, the top part of the stomach now hugs the LES, strengthening it and creating more pressure, so it’s more difficult for acid to escape from the stomach. 
• Transoral incisionless fundoplication (TIF): This procedure is similar to Nissen fundoplication, except it does not require any incisions. Instead, a surgeon inserts a long tube (endoscope) down the esophagus. This endoscope has a camera and tools on it that allow the surgeon to gently pull the bottom of the esophagus down and wrap the fundus around it, which they secure with fasteners that will stay in the body. 
• LINX Reflux Management System: LINX is an implant made up of several titanium beads that form a ring. During a minimally invasive procedure, a surgeon will make a few small incisions in the abdomen and use tools to secure the ring around the LES. The implant places enough pressure on the LES to prevent stomach acid from pushing its way up the esophagus.
• Bariatric surgery: While weight-loss surgery isn’t a direct treatment for GERD, it can help reduce the symptoms. That’s because excess weight in the abdomen can place pressure on the stomach and cause acid to travel up the esophagus. There are a variety of bariatric procedures that are available depending on a person’s unique needs.
  

Most insurance plans cover diagnostic and preventive procedures like colonoscopies. We can help you verify coverage with your insurance provider before scheduling.