Heartburn is a condition that has been increasing in frequency for the last 20 years. Heartburn is almost always caused by reflux of gastric acid or contents into the esophagus, leading to irritation pain and regurgitation. Recent research has shown that almost all people who have reflux disease and heartburn will have a hiatal hernia.
Treating for the symptoms is usually fairly well-controlled with antacid medication including calcium medications and medication such as Zantac Tagamet, Prevacid and Nexium.
Though these medications control the symptoms they do not control the root cause of heartburn which is usually a hiatal hernia and dysfunction of the lower esophageal sphincter. Reflux can cause damage to lower esophagus with conditions such as esophagitis, esophagile ulcers and ultimately Barrett’s esophagus. Barrett’s esophagus is an abnormal condition in which the esophagus begins to change to protect itself from the acid and refluxed contents. These changes can lead to pre-cancerous and ultimately cancerous changes and lead to esophageal cancer. This may continue despite taking medication and no longer having symptoms
The medications are used to control the symptoms have been around for sometime and are effective for controlling the symptoms; however, these medications were not meant to be used for long-term use.
They were initially indicated for only six weeks of use for fear of causing tumors in the Nuro endocrine system of the G.I. tract; however, it is not uncommon to see people who have been on these medications for over 20 years. They are effective in controlling the heartburn symptoms; however, they are not effective at all at controlling regurgitation symptoms. Ongoing reflux and regurgitation may lead to reflux of nonacidic contents into the lungs and lead to chronic bronchitis, asthma and recurrent pneumonias. In addition, these medications known as proton pump inhibitor‘s and H2 antagonists, have been increasingly linked to potential long-term problems such as osteoporosis, Alzheimer’s disease, and possibly even a link to celiac disease and changes in normal gut flora. The point is heartburn and reflux symptoms are not related to an overproduction of acid in general, but they are related to the acid not staying where it is supposed to remain, as in in the stomach. Medical treatments serve to treat the symptoms; however, they do not treat the problem. As with other anatomic problems such as hernias the treatment is to fix the hernia and the anatomic problem, not to just treat the symptoms.
Surgery to repair hiatal hernias in control reflux or the last 30 years has been fraught with complications and sub optimal results. Most people over the years have suffered from recurrence of the Hiatal hernia and difficulty with being able to burp or vomit if needed (gas/bloat syndrome)
Many changes have occurred in the last few years to improve our understanding of the mechanisms of failure for these operations and improve patient outcomes and results. This includes thorough repair of the hiatal hernia which almost all reflux patients have as well as control of the reflux through wrapping the stomach (which is the older treatment) and now the placement of a device to help control reflux from the lower esophageal sphincter.
The latter is an explanation of the LINX procedure. Surgery to control heartburn involves several steps, the most important of which is repairing and thoroughly closing the hiatal hernia defect.
The second part is increasing the ability of the lower esophageal sphincter to prevent reflux which is performed by either wrapping stomach around itself to create a new valve or placing a magnetic cincture augmentation device (LINX procedure).
With the added knowledge that we have accrued over the last few years and with the addition of the links procedure results have improved and patient outcomes have been far more acceptable compared to previous procedures. I have taken on special training to further my ability to provide unsurpassed service to our community to repair the Hiatal hernia in a more effective manner and now be able to provide the links procedure to minimize the surgical complications associated with anti-reflux surgery.
As one of the first surgeons in California to be trained to perform the links procedure I am confident that this procedure can provide permanent or long-lasting results for the growing number of patients who suffer from reflux disease
For more information please refer to our YouTube videos and please call the office for a consultation.