Originally published in HealthScene Ohio in 2018
To the layperson, gastroesophageal reflux disease (GERD) and heartburn may seem like the same thing.
Even someone suffering from GERD might not notice the difference in symptoms. But while heartburn can easily be treated at home, people suffering from GERD will more than likely require surgery.
Dr. Jessica Reynolds of Surgical Associates of Northwest Ohio, part of Blanchard Valley Health System, recently completed the first LINX Reflux Device implant in Northwest Ohio, which helps treat patients who have severe heartburn or GERD. The LINX device augments the lower esophageal sphincter, preventing stomach acid from escaping.
HealthScene Ohio: What are common misconceptions of heartburn and GERD?
Dr. Jessica Reynolds: Most people think that GERD means heartburn, but GERD can present many other symptoms, including regurgitation, a feeling of food getting stuck in the esophagus, chronic sore throat, chronic cough, voice changes and respiratory symptoms. GERD is not just an acid problem; it’s a problem with the valve between the stomach and the esophagus. So, although medication can help with some symptoms by reducing the acidity of the stomach contents that come up into the esophagus, they don’t prevent reflux. Only surgery can fix the valve and prevent reflux.
HSO: Are there any more severe health complications that can arise if a patient chooses to self-treat a severe case of GERD?
JR: When reflux continues, it can lead to permanent scarring of the esophagus that makes it difficult to swallow. The chronic inflammation of the esophagus can also cause changes that lead to cancer of the esophagus. The stomach contents can also reflux into the lungs, causing permanent scarring and fibrosis.
HSO: Who is more susceptible to experiencing GERD?
JR: Anyone can experience GERD, from the very young to the very old. Though being morbidly obese does seem to increase the risk of GERD, it also occurs in individuals who are within normal weight.
HSO: What are some options for preventing GERD?
JR: GERD is the reflux of gastric contents into the esophagus because of a weak lower esophageal sphincter (LES). Certain foods, such as caffeine and alcohol, can cause a weak LES to become even weaker. Large meals and carbonated beverages can overwhelm a weak sphincter. Staying upright for two hours after a meal and sleeping with the head of the bed elevated can help keep stomach contents where they belong. Medication can make stomach contents less acidic so they don’t burn when they reflux into the esophagus. The only way to fix the LES and prevent reflux is with surgery.
HSO: How does a doctor determine whether a patient has GERD or just heartburn?
JR: Diagnosis of GERD is straightforward and involves measuring the amount of acid in the esophagus over a period of 24 to 48 hours. This is called a pH study.
HSO: How has perception and treatment changed in recent years?
JR: In recent years, there has been more concern about the long-term effects of proton pump inhibitor use. This has led to an increase in the need for safe, durable surgical treatments for GERD with few side effects.
HSO: What level of severity necessitates surgical options?
JR: Anybody who is diagnosed with GERD by a positive pH study is a possible candidate for surgery. Medications and surgery all carry their own risks and benefits, so it’s important to have an in-depth discussion with a surgeon to decide if surgery is right for you. Generally, patients who have symptoms that are not well controlled despite medication or who have precancerous changes in their esophagus should strongly consider surgery.
HSO: What is the LINX Reflux Device and why is it effective?
JR: The LINX device is a flexible band of magnetic titanium beads that is placed around the LES to help make it stronger and prevent reflux. The magnets make the device dynamic so that it can open and close just like the native sphincter. This allows it to resist opening inappropriately and prevents reflux of acidic gastric contents into the esophagus. However, it’s able to open under the appropriate conditions, such as when swallowing food or when there is a need to belch.
HSO: How does this method of LINX treating GERD differ from other iterations?
JR: The main surgical option for GERD prior to the development of the LINX was a fundoplication, which involves wrapping the floppy part of the stomach around the esophagus to recreate the lower esophageal sphincter. The main difference is that fundoplication is static, whereas the LINX is dynamic. The wrap cannot open and close like the LINX. Fundoplication is very effective in controlling reflux symptoms, but can also have side effects that arise from gas not being able to get out of the stomach. This includes bloating, crampy abdominal pain, diarrhea and increased flatulence. Because the LINX is dynamic, it can open to allow gas to escape the stomach just like the native LES.
HSO: How does this way of treating severe GERD impact future developments in dealing with this disease?
JR: By providing an effective surgical treatment for GERD that has fewer side effects than the traditional surgical option, more people may seek surgical intervention, which could help decrease the consequences of uncontrolled GERD, including esophageal cancer.
Rocco Falleti is an assistant editor. Feedback welcome at feedback@cityscenemediagroup.com.
About the Expert
Dr. Jessica Reynolds completed medical school at the University of Toledo College of Medicine in Toledo, Ohio. She completed her general surgery residency at Los Angeles County+USC Medical Center in Los Angeles, California and is fellowship trained in minimally invasive surgery at the University of California, San Diego.
