Heartburn

Relief For Your Heartburn Has Arrived!

Heartburn / Acid Reflux / GERD

Heartburn, also known as acid reflux, is a common problem with about 10 million Americans experiencing symptoms once a day. Acid reflux is typically caused when the muscle that connects your esophagus to your stomach, the lower esophageal sphincter (LES), weakens, allowing stomach acid to flow backward up into the esophagus. People can experience heartburn when excessive amounts of acid reflux into the esophagus. Symptoms may last minutes to hours and may include a bitter or sour taste in the mouth, burning sensation, or pressure in the chest and regurgitation. Acid reflux becomes a disease, known as gastroesophageal reflux disease (GERD), when symptoms become more frequent (two or more times a week) and severe, causing difficulty swallowing, weight loss, or damage to the esophagus, pharynx or respiratory tract.

There is a difference between heartburn and GERD. Our gastroenterologist specialist, Dr. Levy, can determine if you have GERD.

Gastroesophageal Reflux Disease (GERD)

In gastroesophageal reflux disease (GERD), the LES, a muscle that acts as a valve between the stomach and the esophagus, relaxes too frequently. When the LES functions correctly it is supposed to tighten after food passes into the stomach to keep food and stomach acid from leaking backward into the esophagus. A weak LES will not close correctly, allowing stomach acid to wash back into the esophagus and often causing injury to the lining of the esophagus. There are many factors that may contribute to heartburn including eating a large meal (which increases pressure in the stomach), fried or fatty foods, spicy foods, and caffeine (coffee, tea, colas, chocolate).  Other factors include nicotine (any tobacco products), citrus fruits and juices, peppermint and spearmint, pregnancy, lying flat, hiatal hernia and certain prescription medicines.

Why Choose Us

As a Heartburn and Acid Reflux expert, Dr. Levy offers state-of-the-art technology to evaluate and treat patients suffering from chronic heartburn, including upper endoscopy, ambulatory pH monitoring, esophageal manometry and evaluation for LINX Reflux Management System.

Dr. Levy is the only private gastroenterologist in Macon to formally complete Covidian (Medtronic) certification in Barrx RFA, and regularly perform RFA, making him a great choice for patients diagnosed with Barrett’s Esophagus, a precancerous condition in which the lining of the esophagus has been damaged by chronic acid reflux.

Dr. Levy also offers Wide Area Transepithelial Sampling with 3D Analysis (WATS), an innovative biopsy technique. WATS is a non-surgical technique performed during an upper endoscopy that uses a brush biopsy to obtain wide-area, full thickness samples of esophageal tissue.  This new diagnostic tool has proven to be more effective in the detection of Barrett’s Esophagus then standard biopsy techniques alone. Learn more about WATS biopsy at wats3d.com.

Acid Reflux (GERD) Symptoms

Acid Reflux (GERD) Symptoms

  • Burning in the chest (localized behind the breastbone that moves up toward the chest and neck)
  • Chest pressure
  • Regurgitation
  • Stomach pain (upper abdomen)
  • Sour or bitter taste in the mouth
  • Throat pain
  • Sleep disruption
  • Difficulty or painful swallowing

Extra-Esophageal Manifestations (EEM): GERD can mimic other conditions

Chronic acid reflux can lead to irritation and damage to the esophagus and may cause an array of symptoms other than simple heartburn. Acid reflux can be the culprit in patients suffering from hoarseness, chronic cough, asthma-like symptoms and recurrent lung infections (pneumonia). In some cases, patients have never reported heartburn.

Tests to evaluate for GERD

Tests to evaluate for GERD

A diagnosis of GERD starts with a thorough physical examination during which you describe your symptoms and medical history. If the typical symptoms of reflux disease are present, including heartburn and regurgitation, specific diagnostic tests are usually not needed to begin treatment. In some cases, the following tests may be needed:

Upper Endoscopy (EGD)

For patients with chronic heartburn symptoms, an upper endoscopy (EGD) is necessary to determine the cause of symptoms and to ensure that Barrett’s esophagus has not developed. This test involves passing a thin flexible tube, equipped with a light and camera, through the mouth into the esophagus, stomach and the beginning of the small bowel to examine for abnormalities. The test is performed using sedation. It is the best test to identify Barrett’s Esophagus (precancerous tissue in the esophagus caused by chronic heartburn) and injury (erosions and ulcers) in the upper GI tract.

Upper GI series

X-rays are taken after you drink barium to monitor the functioning of the esophagus and stomach. The patient is asked to move into various positions on the X-ray table while the radiologist watches the GI tract and takes X-rays.

Esophageal Manometry

Esophageal manometry involves passing a small flexible tube through the nose into the esophagus and stomach in order to measure pressures and function of the esophagus, especially the LES.

Esophageal PH

This test measures the acid level in the esophagus over a 48-hour period by attaching a capsule to the lining of the esophagus.

Acid Reflux (GERD) Complications

Acid Reflux (GERD) Complications

Peptic Stricture

Patients complain of food sticking in their lower esophagus.

Barrett’s Esophagus

Barrett’s Esophagus is a precancerous condition in which the lining of the esophagus has been damaged by stomach acid. Chronic acid reflux (GERD) causes the lining at the lower end of the esophagus to resemble the stomach lining (intestinal-like cells). As a result of this defense mechanism against acid reflux, patients with Barrett’s Esophagus may have heartburn symptoms improve. Unfortunately, patients with Barrett’s Esophagus have approximately a 30-fold increased risk of developing esophageal cancer.

Barrett’s Esophagus Treatment

Barrett’s Esophagus treatment includes prescription medication called a proton pump inhibitor (PPI) to reduce stomach acid production which minimizes the acid irritation to the esophagus. Routine upper endoscopy with biopsies is recommended to monitor the progression of this condition – a critical step in treatment. If pre-cancerous cells or tissue are found during these routine procedures, advanced endoscopic techniques, such as Barrx Radiofrequency Ablation (RFA), can remove this tissue without surgery and reduce the risk of developing esophageal cancer. Studies have shown that patients who receive RFA have over a 90% likelihood of removing precancerous tissue from the esophagus.

Barrx Radiofrequency Ablation (RFA)

Barrx Radiofrequency Ablation, also known as RFA, is an FDA-approved procedure that uses a thin, flexible tube called an endoscope to deliver heat energy to destroy precancerous tissue in the esophagus caused by Barrett’s Esophagus. The goal is to destroy these cells before they become cancerous so that healthy cells can grow again. This process takes between 25-35 minutes and is performed under sedation.  After undergoing RFA, normal tissue is usually restored in the esophagus within six to eight weeks.

Most patients require one to three RFA treatment sessions to remove all of the precancerous Barrett’s tissue. A follow-up endoscopy is performed after two to three months to asses healing and evaluate if further treatment is required. Patients are monitored with surveillance endoscopy on a regular basis, with increased intervals if findings are normal.

Esophageal Cancer

If GERD is left untreated for several years, it could lead to the most serious complication – esophageal cancer. In patients with chronic heartburn, an endoscopy will often be recommended to visually monitor for any suspicious or precancerous changes, such as Barrett’s Esophagus. The preventative strategy is to treat GERD. Survival rate for esophageal cancer, at this time, is dismal.

Treatments

Treatments

In many cases, infrequent heartburn can be controlled by lifestyle modifications and proper use of over-the-counter medicines.

Lifestyle and Dietary Modifications

In order to decrease the amount of gastric contents that reach the lower esophagus, certain simple guidelines should be followed:

  • Watch your weight
  • Limit fatty foods, caffeine, alcohol, peppermint
  • Quit smoking
  • Don’t eat 2 to 3 hours before bedtime
  • Raise the head of your bed 4-6 inches
  • Eat small frequent meals rather than fewer large meals.

If the efficacy of the drugs decreases and dietary changes are not helping, it is best to request an appointment or contact us now, because GERD can eventually lead to serious health conditions – including precancerous Barrett’s esophagus.

Medical Treatment of GERD

Most patients can effectively use a combination of lifestyle changes and drug therapy to treat their GERD. If you are using over-the-counter medications two or more times a week, your doctor may recommend evaluation for GERD and prescribe medications that reduce acid production, increase LES tone, or improve gastric emptying.

Surgical Treatment of GERD

Surgical measures to prevent reflux can be considered if other measures fail, GERD-related complications occur, or patients prefer an alternative to medications.  Dr. Levy works with a network of surgical experts to ensure that his patients receive the highest caliber surgical care.

LINX Procedure for Reflux

The LINX® SYSTEM STRENGTHENS THE WEAK LOWER ESOPHAGEAL SPHINCTER (LES) TO HELP PREVENT REFLUX

When patients with chronic heartburn or GERD no longer have adequate symptom relief from medication, Dr. Levy evaluates and refers appropriate candidates for anti-reflux surgery. Effective minimally invasive surgeries include laparoscopic Nissen Fundoplication and the LINX® procedure.

The LINX® System is a small, flexible band of magnets enclosed in titanium beads. The beads are connected by titanium wires. The magnetic attraction between the beads helps keep the weak LES closed to prevent reflux (see Figure 1). Swallowing forces temporarily break the magnetic bond, allowing food and liquid to pass into the stomach (see Figure 2). Magnetic attraction closes the LES after swallowing to reinforce the body’s natural barrier to reflux. The ring of magnets is placed during minimally-invasive laparoscopic surgery.

LINX® procedure is well-tolerated. After surgery, patients can resume a normal diet as quickly as tolerated. Patients usually go home the next day and can return to non-strenuous activity within a couple days. The device should not affect airport security, however patients are given implant cards in the event that issues arise. It is compatible with MRI, however patients should discuss MRI scanning options prior to deciding on treatment with the LINX® system.

The LINX® Reflux Management System uses permanent magnets that are designed never to wear out. However, if needed, LINX® can be removed during a laparoscopic procedure similar to the implant procedure. Removal of the device generally leaves the esophagus the same as before the implant.

Please view the video below for more information.

This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Dr. Levy is a very knowledgeable and highly skilled physician.

Nikki R.

Dr. Levy improved my quality of life so much! He is friendly, down to earth and takes more time with me than other gastroenterologists that I have dealt with. The care I’ve gotten from him changed my life. Under his care, I went from not being able to eat solid foods for a year to being able to eat normal foods I enjoy. I can tell he cares and I'm not just another patient. I’m so grateful to Dr. Levy!

Susan A.

Dr. Levy is unbelievable! My cardiologist insisted that I see Dr. Levy for my colonoscopy and I’m glad I did. His knowledge gave me a lot of confidence in what I was facing since I have inflammatory bowel disease. His caring and compassionate ways make him different from other physicians I’ve seen. He is kind, gentle, caring, and not pushy. His staff is excellent, and the Endoscopy Center was more efficient and personal than having my procedure at the hospital. I would recommend Dr. Levy to any friend or doctor.

Jane W.

Dr. Levy goes above and beyond to provide excellent care. I was very sick and getting worse, and with his knowledge and persistence he diagnosed a rare vascular condition called median arcuate ligament syndrome (MALS). This allowed me to find a specialist and cure my condition. Dr. Levy actually listened to me, did a full work-up, and took the time to research my case. Since seeing Dr. Levy, I haven’t had any issues. I felt comfortable talking with him and I knew he would do whatever it took to help me. I highly recommend going to Dr. Levy!

Carissa G.