Heartburn, or Something Else?

True or false: You have heartburn, so you have gastroesophageal reflux disease (GERD).

False. While heartburn is one symptom of GERD, it is not the only symptom, nor is it a necessary one to receive a diagnosis. Northwestern Medicine Thoracic Surgeon Mary Maish, MD, discusses some of the myths surrounding GERD and why it’s important to get to the bottom of this condition.

Myth 1: GERD is prolonged heartburn.

“Most people will think if they have heartburn, they have GERD. Most of the time they’re probably right, but it may represent other medical problems too,” says Dr. Maish. Similarly, if you don’t have heartburn, but experience other symptoms, you can also have GERD.

There is a constellation of symptoms of GERD, such as:

• Heartburn
• Regurgitation
• Chest pain
• Chronic or recurring cough
• Recurrent respiratory infections
• Pneumonia
• Asthma
• Nausea
• Hoarseness
• Dental decay

See a full list of symptoms you shouldn’t ignore.

Myth 2: You can take over-the-counter medications unmonitored.

Several medications are readily available over-the-counter for temporary heartburn relief:

• Proton pump inhibitors (PPI)
• H2 blockers
• Antacids

These medications all work to reduce acid exposure in the stomach. Antacids dilute the acid produced by the stomach, while PPIs and H2 blockers reduce the stomach’s production of acid. Although these can help manage symptoms, consult your physician if you find yourself needing these medications more frequently or more than two times a week.

“Your physician will use a series of tests to determine if your symptoms are related to the body’s release of acid,” says Dr. Maish. “It is important to undergo testing to identify what is really going on, and if you have GERD or some other condition. Only then can the treatment plan be identified. It is not a good idea to be on medication unmonitored.”

Additionally, your physician may be able to recommend a specific approach to alleviate symptoms. For example, taking an antacid and an H2 blocker may help an individual by first neutralizing the acid in the stomach and then limiting additional acid production.

Myth 3: Medications ‘fix’ GERD.

Non-surgical options can help manage symptoms by decreasing or eliminating acid production in your stomach. However, for those with GERD, the actual root issue lies in the mechanics of your body. “The actual acid reflux is still occurring,” says Dr. Maish. “Therein lies why we have to look at the testing to see what is really going on.”

If left untreated, GERD could put you at risk for other, more serious health issues. Persistent regurgitation can cause inflammation in the esophagus. This can lead to Barrett’s esophagus or a narrowing in the esophagus, both of which can lead to difficulty eating and esophageal cancer. “Medication helps, but a silent problem can continue,” says Dr. Maish.

Myth 4: There aren’t many surgical options.

For many years, there was one mainstay of surgical treatment: laparoscopic antireflux surgery, also known as fundoplication. This procedure reinforces the valve at the bottom of your esophagus using part of your stomach. Once a gold standard of care, Dr. Maish agrees it’s still the best treatment for some. “It’s very valuable in our toolbox, but we need to look at all the options,” says Dr. Maish.

In March 2012, the FDA approved the LINX procedure. This minimally invasive procedure uses a string of magnetic beads to encircle the lower esophagus. The magnets reinforce the valve, preventing acid from going up into the esophagus.

While LINX has a shorter recovery time than fundoplication, Dr. Maish stresses that not every patient is eligible for the procedure. Treatment decisions are made based on each individual’s needs. She stresses the importance of seeing a specialist who is well versed on all of the options available, which will allow you to understand all of your options and determine what is best for your unique needs.

Myth 5: If you have surgery, you’ll never eat normally again.

When determining which procedure is right for you, discuss what to expect with your physician.

“Many have concerns they’ll never be able to eat normally again,” explains Dr. Maish. “But it’s hard to define normal. In the majority, their diet may improve.” For example, individuals who have to plan around social functions or avoid certain food because of GERD may be able to resume eating what they want in moderation.

Myth 6: I won’t be able to burp or vomit.

“For the most part, this is a myth. It depends on what your symptoms are and how surgery needs to be performed to help those symptoms,” Dr. Maish explains. Most people are able to burp and vomit after having the LINX procedure.

Bottom Line

GERD can look different from person to person. If you experience persistent symptoms, consult a specialist to determine the underlying cause in order to assess the best treatment options. For some, surgical treatment may offer relief and ultimately address the root issue.