Why does this happen? Under normal conditions, the esophagus is a one-way system. This long tube in the chest connects the mouth to the stomach, where it ends with a ring-like muscle that blocks the contents of the stomach from moving back up the esophagus. Gastroesophageal reflux disease (GERD)-- or reflux esophagitis -- occurs when this muscle opens inappropriately and permits the backup of acidic stomach enzymes. In most people, this gateway may relax several times a day, but why it happens much more frequently in those with GERD remains unknown. The incidence of reflux also seems to increase quite dramatically after age 40.

Reflux affects people differently and sufferers often list a number of things that can bring on the symptoms. Drinking coffee or acidic beverages (orange, grapefruit or tomato juices, for example), cigarette smoking, and eating chocolate or peppermint may provoke an attack in some sufferers. Many people are convinced that spicy, fried or fatty foods trigger their episodes of heartburn, and may decide to avoid certain foods whether or not they are really the culprit. The reflux victims that adopt a very restricted diet and still experience the discomfort should stop self -medicating and seek medical advice.

In severe cases, victims report that physical activity or simply bending over will send the acid rushing up into the esophagus. People who are overweight and pregnant women also complain about reflux symptoms, which probably result from increased pressure on the abdomen. Lying down -- instead of helping to ease the discomfort -- usually only makes it worse.

Over prolonged periods of time, if left untreated, reflux esophagitis can cause more serious problems. The constant exposure to stomach acid can make it difficult to swallow, cause hoarseness or chronic laryngitis, and even damage to the vocal cords. Unfortunately, when the stomach acid gets into the airways, reflux can also cause respiratory problems such as pneumonia and asthma. Bleeding ulcers can develop in the esophagus, and scar tissue can build up, causing a narrowing of the esophagus. Reflux esophagitis is rarely life-threatening, but is can become so unpleasant that it forces the sufferer to curtail normal activities.

Endoscopy is the only way to diagnosis this condition. During this relatively painless diagnostic procedure, the patient swallows a thin, flexible fiber-optic tube to give the doctor a direct look at the lining of the upper gastrointestinal tract. If necessary, tiny tissue samples can be taken during the procedure for biopsy and further analysis. In many cases, endoscopy is used to evaluate patients who have chronic GERD in order to rule out a more serious condition and to help the surgeon determine if the patient is surgically viable.
 

What can be done to treat reflux disease? Actually, there are several alternatives, beginning with lifestyle modification. Obviously, the first thing to be done is to avoid doing whatever triggers an attack. Research has found, for example, that eating early in the evening instead of closer to bedtime, and eating high-protein, low-fat meals seems to help people avoid heartburn. An effective weight loss program may also reduce pressure on the abdomen and minimize the symptoms.

In many cases, moderate doses of antacids will regulate the problem. Many GERD victims who experience daily episodes try self-medicating with over-the-counter remedies. A significant portion of these people ultimately become dependent on these medications to get through the day or night. In extreme cases, the best and most effective long-term solution is surgery to repair the lazy muscle.

The traditional open surgery to correct this condition can often be avoided thanks to a minimally invasive laparoendoscopic procedure called the Nissen Fundoplication can produce the desired result of keeping stomach acid where it belongs.

Here’s how it works. We insert the laparoscope -- a slender, lighted tube with magnifying lenses connected to a tiny fiberoptic video camera -- through a tiny incision which allows us to view the abdominal area on a video monitor. Using special instruments that are also operated from outside the body, we wrap the top portion of the stomach around the esophagus to create a new, stronger muscle which repairs the faulty "plumbing."

Patients generally stay just a few days in the hospital, and progress from liquids to soft foods the day after surgery. During the recovery period, some people experience a little difficulty in swallowing, some mild nausea, or the sensation of being full after small meals, but these symptoms soon disappear. The tiny incisions through which the instruments were inserted into the abdomen quickly heal.

Not everyone who suffers from reflux esophagitis is a candidate for this surgical procedure. For chronic heartburn sufferers, however, it can markedly improve their quality of life and provide lasting relief. See your physician for an accurate diagnosis of heartburn symptoms, and to discuss treatment alternatives.