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If someone’s symptoms are mostly due to too much acid, acid-blocking medications often solve the problem. If the problem isn’t acid, but simply the reflux of non-acidic fluid into the esophagus, the only permanent solution may be surgery.

Surgeons can wrap part of the upper section of stomach around the base of the esophagus to reinforce the sphincter muscle. The procedure is done laparoscopically with the patient under general anesthesia. It typically requires only a night’s stay in the hospital.

Physicians have seen a big increase in cancer of the esophagus in recent years. Michael Rowland, M.D., a general surgeon with Pinehurst Surgical, calls it an epidemic and says it is largely due to the prevalence of reflux disease.

“By doing the anti-reflux surgery, we not only relieve symptoms, we reduce the risk of people going on and developing cancer,” he says.

Reflux in the throat
When reflux comes all the way up the esophagus to the throat, it’s called laryngopharyngeal reflux (LPR). The most common symptoms are hoarseness and the feeling that something is stuck in the throat.

“The tissues of the larynx (voice box) are a lot thinner than those of esophagus and don’t withstand as much acid exposure without showing signs of inflammation,” says Wyman McGuirt, M.D., an ear, nose and throat specialist with Pinehurst Surgical. “Probably nine out of 10 people with LPR do very well on acid-blocking medications alone.” The 10 percent who don’t may be candidates for a surgical procedure to tighten the lower sphincter.

Andy Kiser, M.D.

It isn’t uncommon for people to have symptoms of LPR without having heartburn, so convincing them that their problem really is reflux is sometimes the hardest part of the physician’s job.

“We use a scope with a video camera on it to diagnose LPR, and there’s a monitor that the patient and I can look at together,” Dr. McGuirt says. “What we look for is redness and swelling at the back of the vocal cords. Patients like being able to see it for themselves.”

A big meal of hot Mexican food was the last straw for Richard Waterman of Southern Pines. “I spent the rest of the night with the most unbelievable heartburn known to mankind,” he says. Waterman had suffered from gastroesophageal reflux disease (GERD) for years and had taken every kind of anti-acid medication ever made, from over-the-counter medications to the most powerful proton pump inhibitors. Michael Rowland, M.D. A few years ago, he had an endoscopy, a procedure that showed he had Barrett’s mucosa, a pre-cancerous change in the lining of the esophagus caused by too much acid over too many years. Still, like many people with chronic heartburn, he figured it was “just one of those things you live with.” Then he ate that Mexican dinner,and the heartburn that followed convinced him to have anti-reflux surgery at FirstHealth Moore Regional Hospital. Michael Rowland, M.D., was his surgeon. “It was immediately successful,” he says. “There are times now when I take an antacid, but I am enjoying essential freedom from the heartburn I had. I would definitely do it again. I pretty much eat what I want to, but I don’t press the issue. I don’t eat a plate of jalapeno peppers just to prove I can.”