GERD/Reflux

Resources

What Is GERD?

If you feel a painful burning sensation in your chest after you eat, you may have gastroesophageal reflux disease (GERD). Heartburn is a classic symptom of GERD, but you may have other symptoms as well.

Note: Chest pain may also be caused by heart problems. Be sure to have all chest pain evaluated by a doctor.

When You Have a Reflux Problem

After you eat, food travels from your mouth down the esophagus to your stomach. Along the way, food passes through a one-way valve called the lower esophagealsphincter (LES), the opening to your stomach. Normally the LES opens when you swallow. It allows food to enter the stomach, then closes quickly. With GERD, the LES doesn’t work normally. It allows food and stomach acid to travel back (reflux) into the esophagus.

Some Common Symptoms

  • Frequent heartburn or burping
  • Sour-tasting fluid backing up into your mouth
  • Symptoms that get worse after you eat, bend over, or lie down
  • Difficulty or pain when swallowing

Tips to Control GERD

When you have GERD, stomach acid feels as if it’s backing up toward your mouth. Lifestyle changes can often control GERD. Talk to your doctor about the following suggestions, which may help you get relief. Watch Your Eating Habits

Certain foods may increase the acid in your stomach or relax the lower esophageal sphincter, making GERD more likely. It’s best to avoid the following:

  • Frequent heartburn or burping
  • Sour-tasting fluid backing up into your mouth
  • Symptoms that get worse after you eat, bend over, or lie down
  • Difficulty or pain when swallowing

Relieve the Pressure

Raise Your Head

Reflux is more likely to strike when you’re lying down flat, because stomach fluid can flow backward more easily. Try raising the head of your bed 4 to 6 inches. To do this:

  • Slide blocks or books under the legs at the head of your bed.
  • Place a wedge under the mattress.
  • Tilt the whole bed or mattress.
  • Don’t just prop your head on several pillows. This increases pressure on your stomach. It can make GERD worse.

Tobacco and Alcohol

Avoid smoking tobacco and drinking alcohol. They can make GERD symptoms worse.

Medications for GERD

GERD is sometimes treated with over-the-counter antacids that you can buy without a prescription. If antacids don’t provide enough relief, your doctor may prescribe other medication to help with digestion. Your doctor will tell you which is best for your symptoms.

Neutralizing Stomach Acid

Many over-the-counter antacids are available to neutralize or weaken stomach acid. You don’t need a doctor’s prescription to buy them. You should take these antacids only when you need to, or according to your doctor’s advice.

NOTE: Side effects may include constipation and diarrhea. If you have high blood pressure, check with your doctor. Antacids can be high in sodium.

Reducing Stomach Acid

If antacids alone don’t work, your doctor may recommend stronger medications called H-2 blockers. These medications suppress most of the stomach’s acid production. Many of these medications are now available at a lower dosage without a doctor’s prescription.

NOTE: H-2 blockers may cause confusion in elderly patients. Some can also increase the effects of alcohol.

Eliminating Stomach Acid

Your doctor may prescribe a medication to stop production of stomach acid and to help control the symptoms of GERD.

NOTE: These medications are mainly prescribed for short-term use. Side effects can include stomach or abdominal pain, diarrhea, and nausea.

Stimulating Stomach Muscles

Some medications strengthen the squeezing action of the esophagus. These medications are usually used with H-2 blockers and are sold only with a prescription. Some make the stomach empty faster.

NOTE: The most common side effects of these medicationss are abdominal cramps, constipation, diarrhea, and the “jitters.”

Avoid Certain Medications

Aspirin and anti-inflammatory medications like ibuprofen reduce the protective lining of your stomach, which can lead to more irritation. Be sure to check with your doctor or pharmacist before taking any new medications.

Surgery for GERD

During this surgery, called a fundoplication, your lower esophageal sphincter (LES) is re-created by wrapping the top of your stomach around the esophagus. It can sometimes be done with a laparoscope through several small incisions instead of a single long one, as in the traditional open procedure. As a result, there is less pain, a quicker recovery time, a shorter hospital stay, and lower risk of infection.

Lifting the Esophagus

If the opening of the hiatus is too large (hiatal hernia), the doctor may tighten it with a few stitches (sutures). This repairs the hiatal hernia. Then the esophagus is lifted out of the way for a short time.

Stomach being wrapped around the esophagus. This added support helps prevent reflux.

The wrap is permanently stitched in place. Two commonly used wraps are full and partial.

Laparoscopic Surgery

Open Surgery

After Your Laparoscopic Fundiplication

Activity

You will be out of bed the day of your surgery. After your discharge, you may be up and around as you desire, but should avoid overly strenuous activity for several days. You may walk and climb stairs in moderation. You may resume normal activity, including driving a car, after three to four days. However, you should avoid heavy lifting for 2 weeks.

Care for the Incision

You may remove the bandages and shower 24 – 48 hours after your surgery. Leave the white steri-strips in place. The steri-strips may get wet. NO TUB BATHS or swimming until after you are seen in the office for your post-operative visit. Gently pat the incision dry after showering. You may re-apply simple band aids if you wish. You may notice a slight drainage (usually pink or reddish in color) or bruising at or around the incision. This is normal and not a cause for concern.

Diet

For the first 24 hours after surgery, you may not have much of an appetite or feel able to tolerate heavy foods. We encourage you to keep up with your liquids. Gradually progress your diet to thicker liquids, and then soft foods such as pudding, mashed potatoes, or bananas. Chew your food well. Avoid eating bread, meat, or food which must be swallowed in large pieces for two to three weeks. Also, avoid carbonated beverages during this period. Within two to four weeks, you should find your ability to swallow returning to normal.

Medication

You will be given a prescription for pain medication. Take this as directed for post-operative pain. If you are experiencing only mild discomfort, you may find that over-the-counter medication, such as Tylenol (acetaminophen) or Advil/Nuprin (ibuprofen), may be all you need for comfort. If constipation becomes a problem, a stool softener (Metamucil) or a mild laxative (Milk of Magnesia) may be taken. You may stop your anti-reflux medication immediately.

Follow up

You will be seen in our office 7 to 10 days after your surgery and again in several weeks. Prior to surgery, you should have made an appointment for your first post-operative visit. If for some reason that appointment was not scheduled, please call our office at (703) 359-8640 as soon as your return home to schedule your appointment.

If Difficulties Arise

You may have trouble belching or vomiting for several weeks after surgery. This will subside as your body adjusts to the operation. Please call our office immediately if you develop any of the following; chest pain, excessive drainage, fever over 100F, persistent nausea or vomiting, or difficulty with urination. Please call us if other problems or questions arise. We can be reached any time, including evenings and weekends, by calling our office number (703) 359-8640.

Risks and Complications