While there's no record of prehistoric man seeking a chalky substance to calm his stomach, heartburn goes as far back as Shakespeare, as Beatrice says of Don John in "Much Ado About Nothing, that man always looks so sour! Just looking at him gives me heartburn."
We now know that heartburn, while uncomfortable at best, is a symptom of the much more serious condition of GERD (gastroesophageal reflux disease). Also known as acid reflux, the disorder was first described in 1925 by two physicians looking the relation between heartburn and hiatal hernias. It occurs when the stomach contents rise into the esophagus. In addition to heartburn, symptoms include the taste of acid in the back of the mouth, bad breath, chest pain, vomiting, breathing problems and wearing away of the teeth. The major complication of GERD is the development of Barrett esophagus, a pre-cancerous lesion.
Dr. Matthew Tufts, general surgeon, who specializes in bariatrics, anti-reflux surgery and other minimally invasive general surgery techniques, understands GERD from a personal and professional perspective. "Gastric acid production in the stomach is normal, but refluxing the acid into the esophagus, which is the tube from your mouth to your stomach, can cause a lot of different problems, most commonly the sensation of heartburn," Tufts states. "As the disease progresses it can lead to more ominous results, damaging the esophagus' ability to squeeze and even cause irreversible damage to the lining of the esophagus."
Dr. Tufts said about one in four people have some spectrum of the disease. Healthcare statisticians agree, while noting that the number may be higher, since many people with GERD symptoms don't consult a healthcare provider. A 2014 systematic review estimated that some 30 percent of the U.S. population has GERD. "It's generally pretty mild," said Dr. Tufts, "but about one in four people take something for heartburn at least once a week, something like Tums. Because there's a spectrum with acid reflux disease, some people are totally happy doing that.
"On the flip side, there are people with acid reflux that's causing a cough, scratchy throat or even some breakthrough heartburn on medications which lead to sleep disturbances," he said. "Those are the people that may be interested in surgical options."
According to Dr. Tufts, laparoscopic Nissen fundoplication surgery may be an option for esophageal reflux not treated well by medications. Named for the Swiss surgeon who developed it, Nissen fundoplication is a procedure to reinforce the lower esophageal sphincter. In this procedure, the surgeon wraps the top of the stomach around the lower esophagus. This reinforces the lower esophageal sphincter, making it less likely that acid will back up in the esophagus. "Wrapping the stomach in this manner creates a pressure valve that will prevent reflux of acid and food contents back into the esophagus," Tufts stated. "The reflux surgery wasn't very popular at first because they had to do it through a large and painful incision," said Dr. Tufts, "but once the new technology of both robotic and laparoscopic techniques became widely available, it's actually become a pretty popular operation."
"I still think they're safe medications," he added. "That's why in my discussions with patients, I'll recommend surgery only if their medications are not controlling their symptoms or they are having actual hard signs that they're not tolerating their medications."