Food for Thought: A Remedy for Reflux

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Robotic Assisted Surgery

Dr. Atif Iqbal, M.D.,FACCS, FASMBSAtif Iqbal, MD, FACS, FASMBS, medical director of the MemorialCare Digestive Care Center at Orange Coast Memorial, explains how to guard against this digestive disorder.

Listen to his recent podcast on Emerging Technology in the Treatment of Extreme GERD.

Gastroesophageal reflux disease, or GERD, is a digestive disorder. It’s a very common and under-diagnosed condition, affecting about 30 million people in the U.S. Patients with GERD frequently complain of heartburn, or acid indigestion.

“Gastroesophageal” refers to the stomach and the esophagus, or food pipe. “Reflux” means to flow backwards, or return. Thus, the term gastroesophageal reflux signifies the return of the stomach's contents back up into the esophagus. Oftentimes, the cause of this reflux is a malfunctioning of the lower esophageal sphincter.

Who is likely to develop GERD?

While anyone, including children, can develop GERD, it is most common in the 40-to-60 age group. Risk factors range from diabetes, obesity, smoking and defects of the sphincter to hereditary links. Persons who have hiatal hernias, asthma or who are pregnant also are at risk for GERD.

Are there different levels of GERD?

Yes – mild, moderate and severe. Mild and early moderate GERD can usually be managed with lifestyle modifications. Someone with moderate or severe GERD requiring ongoing medication, even over-the-counter drugs, should see their doctor since GERD can lead to serious complications. The primary doctor may refer to a gastroenterologist who can thoroughly diagnose the problem, and who may recommend seeing a surgeon specializing in reflux disease resolution.

What sort of complications can GERD cause?

People who have prolonged acid damage over a period of years are at risk for serious complications. The damage is first seen in the form of redness, also called gastritis or esophagitis, and can progress to bleeding, ulcer formation, scarring and a narrowing of the digestive system anatomy. The most devastating development is Barrett’s esophagus, a pre-cancerous condition that can lead to esophageal cancer. In the last 10 years, there has been a 600 percent increase in the incidence of esophageal cancer. It’s one of the most aggressive cancers.

Why has this cancer increased so dramatically?

The availability of over-the-counter medications that suppress acid secretion has kept many people from seeing their doctors. Too often, patients diagnosed with GERD are put on antacid pills that mask the symptoms and they are not reevaluated again for many years. The increase in GERD also coincides with the rise in obesity in America.

What are the best ways to diagnose and rule out GERD?

There are two reliable studies I routinely perform. The first, an upper endoscopy, allows us to visualize the anatomy and damage done to the esophagus as a result of acid reflux. It involves a thin, flexible tube equipped with a light and camera (endoscope) placed down the patient’s throat. The other is the Bravo capsule study. With this study, I implant a small, wireless transmitter about the size of a gel capsule into the sleeping patient’s esophagus, which is eventually excreted. Over a 24- to 48-hour period, we can measure how often stomach contents reflux into the lower esophagus and how much acid the reflux contains.

When is it time for surgical intervention?

If a patient has moderate to severe disease and has unsatisfactory results after making lifestyle changes and taking high doses of medication, or if they are diagnosed with Barrett’s esophagus or a hiatal hernia, they are likely to be candidates for a surgical repair.

What can surgery do?

Tremendous advances have been made in treating GERD, with about 98 percent of surgical patients cured. In a significant number of my cases, patients who have not been able to sleep in a straight bed for several years can finally lie down and sleep normally.

How has surgery for GERD evolved?

It’s become more minimally invasive. Surgery for GERD (fundoplication) was originally done as an open procedure, with the surgeon using his or her hands inside the body. At Orange Coast Memorial, our minimally invasive approach allows us to perform the surgery robotically. With robot-assisted surgery, we can visualize the field ten times better than with the human eye. As a result, surgery is more precise and safer than ever. Our patients typically stay in the hospital overnight and return home the next day completely free of GERD symptoms.

Another recent advancement is a highly effective laparoscopic procedure known as LINX. We implant a flexible titanium bracelet with a core of magnetic beads that encircles the malfunctioning lower esophageal sphincter (LES). The magnetic attraction between the beads helps keep the weak LES closed to reinforce the body's natural barrier to reflux. Food goes down and doesn’t come back up. The patients’ reflux is gone immediately. Other procedures require a liquid diet for a few days, but with LINX, patients can have regular food the day after surgery. Orange Coast Memorial is among the first in Southern California to undergo the in-depth training needed to offer LINX. It’s an amazing invention with great potential to help thousands of GERD sufferers.

What can I do to prevent GERD and its complications?

If you have acid reflux, eat slowly and keep portion sizes to a minimum. Eat a light breakfast with little to no orange or citrus juice. Avoid fried foods, eat healthy and limit alcohol intake. For dinner, it’s important to have at least a three-hour gap before going to bed. Anyone who is obese will find many benefits to losing weight, including relief from GERD symptoms. And, don’t smoke.

Valentine’s Day is just around the corner, so do people with GERD have to miss out on chocolates?

I, too, love chocolate, but it’s one of the worst things for people with GERD because it enhances acid production. If you don’t want to abstain, I’d recommend moderation, and white over dark chocolate.