Heartburn Program

No matter how serious your reflux or related condition may be, effective treatments are available. These can start with lifestyle changes, such as quitting smoking or changing your diet. Avoiding certain foods and beverages – citrus, tomato products, chocolate, alcohol, coffee, and spicy meals, to name a few—can make a big difference for mild to moderate sufferers. If symptoms persist despite lifestyle changes, over-the-counter and prescription medications are often the next resort. Severe symptoms may require a surgical procedure. 

If you have acid reflux or related symptoms, Memorial Medical Center offers diagnosis and treatment options for serious conditions such as heartburn and gastroesophageal reflux disease (GERD). Contact our Physician Referral Line at 1.800.424.DOCS (3627) to make an appointment with a physician.

Together, we can improve the management of GERD and help you take the next step toward treatment.

GERD Diagnostic Options: 

There are a number of important diagnostic tests we use to help determine how to treat your heartburn and GERD symptoms.

Upper Gastrointestinal Series

The upper gastrointestinal series (GI) is a radiographic (X-ray) examination of the upper digestive tract using a liquid suspension that may be a barium or a water-soluble contrast. The esophagus, stomach and duodenum (first part of the small intestine) are made visible on X-ray film by the liquid suspension.

BRAVO

Esophageal pH monitoring is a minimally invasive test that evaluates whether acid from the stomach is refluxing into the esophagus and causing various symptoms. This test requires the attachment of a small monitoring device onto the esophageal wall during an EGD. The test monitors the acid from the stomach for 48 to 96 hours, which assesses whether the patient’s symptoms are correlated with the reflux.

24-hour pH/Impedance reflux monitoring

This measures the amount of reflux (both acidic and non-acidic) in the esophagus during a 24-hour period and assesses whether the patient’s symptoms are correlated with the reflux. A catheter will be passed through your nose and throat into your stomach and then withdrawn slightly so that the tip is positioned just above the stomach. The catheter will then be secured to your nose, cheek and neck with tape. You will be able to feel it in the back of your throat, but it should not be too uncomfortable. You will be able to breathe, eat and drink normally. 

Bagel/Marshmallow Swallow Test

An alternative method for monitoring esophageal muscle movement, this test is exactly as it sounds. The patient swallows a barium-soaked marshmallow followed by a barium-soaked bagel portion. When swallowed, the movement of the food is tracked through the gastroesophageal junction during fluoroscopic video esophagography. The ability to swallow the portions indicates to the surgeon that the patient can tolerate the anti-reflux surgery.

Manometry

The patient is asked to perform swallowing maneuvers, providing information on the status of the esophageal muscle function, coordination and contract ability of a patient’s swallowing mechanism. The insertion of a pressure-sensitive catheter through the nose into the esophagus. The procedure takes approximately 30 to 45 minutes to complete. You may resume regular activity, diet, and medications once the procedure is over.

GERD Treatment Options:

Based on the results of the diagnostic testing, GERD can be treated a number of ways.

TIF (Transoral Incisionless Fundoplication)

TIF is a minimally invasive treatment for GERD. The TIF procedure is performed from inside the patient’s stomach without incisions. The TIF procedure repairs the anti-reflux barrier by reducing a paraesophageal hernia (≤2cm) and creating a valve 2-4 cm in length and greater than 270-degree circumferential wrap.

Advantages:

  • Minimally invasive
  • Endoscopic procedure
  • No scars
  • Fast recovery
  • Does not limit future treatment options

Disadvantages:

  • Paraesophageal hernias cannot be greater than 2 cm

STRETTA

STRETTA therapy is a minimally invasive procedure performed with an EGD. The STRETTA procedure treats the lower esophageal sphincter muscle with radiofrequency energy bursts that stimulate the regenerative growth of the muscle tissue. This allows for the muscle to become thicker to reduce reflux.

Advantages:

  • Minimally invasive
  • Endoscopic procedure
  • No scars
  • Fast recovery
  • Does not alter anatomy
  • Does not limit future treatment options

Disadvantages:

  • Difficulty belching
  • Bleeding
  • Infection
  • Difficulty swallowing

LINX

The LINX system uses a small flexible band of interlocking titanium beads with magnetic cores that fits around the Lower Esophageal Sphincter (LES) to provide resistance to opening by the gastric pressures, thus preventing reflux. The LINX device will release the magnetic beads when swallowing fluids and solids, allowing them to pass normally into the stomach. After swallowing, the magnetic beads will come together to close the LES, preventing any reflux after eating or drinking.

Advantages:

  • Minimally invasive
  • Reduction in reflux
  • Improvement in heartburn and regurgitation
  • Reduction or elimination of GERD medications
  • Implant can be removed
  • Additional treatments can be performed

Difficulties:

  • Implantable device
  • Allergies to nickel, titanium, stainless steel or ferrous metals
  • May not be able to belch or regurgitate
  • Weight restriction for 30 days

NISSEN FUNDIPLICATION

Laparoscopic procedure in which the upper portion of the stomach is wrapped around the LES to strengthen to sphincter to prevent acid reflux and to repair a paraesophageal hernia. The Nissen procedure will strengthen the area of the weakened lower esophagus, which allows for the stomach acids to flow up into the esophagus instead of containing these acids in through the down-stream digestive system.

Advantages:

  • Minimally invasive
  • Reduction of reflux
  • Improvement in heartburn and regurgitation
  • Reduction/elimination of GERD medication

Disadvantages:

  • 1-2 night stay in hospital
  • Weight restriction for 30 days
  • Modified diet immediately post-op
  • Few additional treatment options left
  • Persistent dysphagia

The device that is implanted during this procedure is placed around the lower portion of the esophagus. It is about the size of a quarter and is made of a flexible ring of magnetic titanium beads.

Size comparison of magnetic sphincter augmentation device.