GERD & Heartburn Care
Our team at the VHC Heartburn Center is dedicated to evaluating, educating, and treating patients with illnesses related to gastroesophageal reflux and esophageal motility disorders. We are a regional center providing consultations to clinicians treating patients throughout the DMV and beyond. The director, Dr. Gillian, has more than 25 years of experience in the field of evaluating and providing medical and surgical management of patients with these issues.
He is a recognized national authority in the evaluation and surgical treatment of patients with these issues and continues to train surgeons around the country in these procedures.
Our comprehensive, streamlined approach capitalizes on the expertise of our colleagues in Gastroenterology, Surgery, Pulmonary Medicine, and ENT physicians who are dedicated to improving the quality of life of patients and reducing the risk of long-term complications caused by these disorders and reducing the complications from the prolonged use of medication used to treat these issues. Once an accurate diagnosis is made more effective conservative and (if appropriate) surgical treatment options can be suggested.
We offer state-of-the-art diagnostic studies for patients provided by an experienced and compassionate staff.These includes 24-hour outpatient pH studies and esophageal motility evaluations. We utilize esophageal impedance testing, which provides a more accurate diagnosis of esophageal motility disorders than other techniques.
Symptoms of GERD and Esophageal motility problems may include:
- Heartburn not controlled with standard medical management.
- Difficulty swallowing or a chronic lump in the throat (dysphagia/globus)
- Chronic hoarseness or loss of voice
- Adult-onset asthma with reflux issues
- Non-cardiac chest pains and spasms
- Difficulty sleeping due to regurgitation or choking.
- Medications only “taking the edge off” heartburn symptoms.
- Regurgitation and vomiting
The discomfort and pain of heartburn is caused when the lining of the esophagus comes into contact with digestive enzymes and stomach acid for an extended period of time.
The muscles at both ends of the esophagus, called esophageal sphincters, relax to let food pass, then tighten to keep stomach acid down. When the lower esophageal sphincter (LES) malfunctions and does not tighten enough, acid can wash up or "reflux" from the stomach into the esophagus, causing heartburn.
Some people also suffer from heartburn or chest pain due to a hiatal hernia. This is an opening in the diaphragm that allows a portion of the stomach to protrude upwards into the chest. This defect can be acquired over time and is typically due to a combination of genetics, straining, pregnancy, chronic coughing, gaining weight, and other factors that extend beyond a person's control.
When the stomach is in its normal position, the diaphragm, and the lower esophageal sphincter work together to keep stomach contents and acid from rising into the esophagus. When a hiatal hernia is present, acidic and non-acidic reflux can occur more easily. However a hiatal hernia is not “required” for reflux issues to occur.
Persistent reflux or heartburn that occurs more than twice a week is considered gastroesophageal reflux disease (GERD), and it can eventually lead to more serious health problems.
Other factors that may contribute to heartburn include:
- Obesity
- Pregnancy
- Smoking
- Large Meals
- Medications and dietary supplements
Your Diet’s Impact
Your diet does not cause GERD, but reflux symptoms may worsen when you consume:
- Chocolate
- Citrus fruits
- Drinks with caffeine or alcohol
- Fatty and fried foods
- Garlic and onions
- Mint-flavored foods
- Spicy foods
- Tomatoes, including spaghetti sauce, salsa, chili and pizza
Esophageal Motility Problems
Some patient’s symptoms are not from reflux of gastric fluid/acid but from motility problems in the esophagus. The esophagus is a muscular tube that propels the food/fluid from the mouth to the stomach via a series of complex muscular contractions. There are numerous structural, mechanical, neuromuscular, and metabolic disorders that can affect how the esophagus and LES contract and relax. If the coordination is impaired symptoms result.
Case in Point:
In some cases, the contractions are too strong and pain or difficulty swallowing result. The diagnosis of Esophageal Spasm, Nutcracker esophagus, Jackhammer esophagus and a Hypertensive LES are frequently made in our lab, and these can be managed successfully if correctly diagnosed.
In some cases, the contractions are so weak that patients struggle to get food to the stomach. Scleroderma can create a gradual atrophy of the smooth muscles in the esophagus resulting in weaker and weaker contractions over time. Achalasia is a well understood motility problem of the esophagus that is caused by the destruction of nerves responsible for the contraction of the esophagus and the relaxation of the LES. The consequence is severe chronic difficulty swallowing food/liquids with significant regurgitation and vomiting. It is often confused with reflux disease until proper evaluations are done.
Diagnostic Studies to Evaluate Symptoms
Get evaluation of your symptoms at the VHC Health Heartburn Center. Our trained nurses and care team focus on making the testing process as simple, seamless and comfortable as possible. Your doctor may use one or more of the following tests to diagnose GERD.
Upper GI X-ray (UGI)
*done by Radiology
- This test may demonstrate reflux of the swallowed barium and will help spot abnormalities such as a hiatal hernia and other structural or anatomical problems of the esophagus.
- It will not detect mild irritation, although strictures/narrowing of the esophagus and ulcers can be observed.
Upper Endoscopy (EGD)
*done by Gastroenterology
- While you are sedated a doctor inserts an endoscope though the mouth and into the esophagus, stomach and first section of the small intestine. It has a camera so that the surface of these structures can be evaluated, and abnormalities detected.
- The doctor also may perform a biopsy. Small instruments are passed through the endoscope allowing the doctor to remove small pieces of tissue from your esophagus. The tissue is evaluated under a microscope to make diagnoses and to guide therapy.
BRAVO Study
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See EGD description above.
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The test involves attaching a capsule to you lower esophagus to measure acid exposure in the lower esophagus over several days. The data is recorded on a wireless monitor. Only sensitive to acid reflux.
Esophageal Function Testing (EFT) or High-resolution Impedance Manometry (HRIM)
*done at the Heartburn Center
• This test monitors the strength and coordination of the contractions in the esophagus and lower esophageal sphincter.
• It is used to identify problems with swallowing and to guide surgical and medical management.
24 Hour pH Impedance Study
*done at the Heartburn Center
- This test involves inserting a small recording wire into the esophagus that will stay there for 24 hours to measure when and how much acidic and non-acidic fluid is refluxing into your esophagus. It provides data from the entire length of the esophagus.
- When combined with a symptom diary, this allows the doctor to see correlations between symptoms and reflux episodes. The procedure can be beneficial in detecting whether respiratory symptoms, including wheezing and coughing, are triggered by reflux. It also helps determine the effectiveness of standard medical regiments.
Surgical Options for Symptom Control
In short, acid belongs in the stomach. The only way to keep the acid in the stomach and not suffer from GERD is to fix the valve between the stomach and esophagus.
There are several procedures available today that can accomplish this. The most durable results require significant surgical expertise and experience and are achieved with the following procedures. They are generally done as an outpatient procedure or with a short over-night stay.
Fundoplication
This is the classic “gold standard” procedure that has been utilized for 5 decades to control reflux. It is now done with laparoscopic and Robotic approaches depending on surgeon preference. If a hiatal hernia is present, it is repaired, and the upper portion of the stomach is wrapped around the lower esophagus to apply pressure and to prevent reflux. This essentially creates a new one-way valve to control reflux, but this does make it harder to belch and vomit after surgery.
LINX procedure
This is a newer laparoscopic/Robotic procedure where a hiatal hernia is fixed if present, and a small ring of magnets is placed around the valve between the stomach and esophagus.
This helps your valve stay closed when it is supposed to be closed. When you swallow, the esophagus
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pushes the magnets apart and allows the food/liquid to go through and then closes again. Unlike the Fundoplication this acts more like your normal valve, so it is easier to belch and vomit. Consequently, bloating is excess flatus that is reduced too. This lowered side effect profile has made this an increasingly popular option for patients.
Heller Myotomy
This is a classic surgical procedure that can now be done with minimally invasive techniques (laparoscopic/robotic). It allows the surgeon to divide the non- functional muscles of the esophagus and LES that create the obstructive issues for patients with Achalasia and some other spastic esophageal disorders. With the obstructing non-functional muscles divided a patient finds a significant decrease in symptoms and an improved quality of life.
If you would like more information on any of these topics, please contact us. Keep in mind that all studies require an order from your Physicians and/or Healthcare providers. We are happy to provide advice and consultation about the appropriate study for you condition if needed.
Looking to Refer Your Patient to the VHC Heartburn Team?
Please click here to get access to the VHC Heartburn Center referral pad.
Contact
Director: George K Gillian, MD, FACS
Nurse Coordinator: Leigh Ann Prickett, RN
Phone/Voice Mail: 703.717.4373
Fax: 703.717.4374
Email: HeartburnCenter@vhchealth.org
