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A New and Innovative Way to Treat Heartburn

Dr. Michael Ujiki April 27, 2010 11:00 AM This chat has ended. Thank you for participating.
Moderator (Moderator) - 10:58 AM:
Welcome! Today’s chat: A New and Innovative Way to Treat Heartburn. Please start submitting your questions and Dr. Michael Ujiki will begin answering them as soon as we get started. While you are waiting for the chat to begin, feel free to visit our Gastroenterology Pages to obtain more information.

Dr. Michael Ujiki (NorthShore) - 11:05 AM:
Good morning and welcome to this live, online chat. I am Dr. Michael Ujiki, one of the gastrointenstinal endoscopic surgeons at NorthShore University HealthSystem. Today, I'd like to hear your questions regarding reflux or any other questions regarding scarless surgery. NorthShore is one of the most advanced scarless surgery programs in the country. Currently we offer procedures for reflux, obesity and other digestive tract diseases such as cholecystitis or inflammation of the gallbladder. With that, I welcome your questions.

Rick (Skokie, Illinois) - 11:06 AM:
Could you please explain what "scarless surgery" is and how it works? Both words appear to cancel each other out.

Dr. Michael Ujiki (NorthShore):
Great question, Rick. Surgical technology has evolved so that surgeries that used to require a 20 centimeter incision can now be done through natural orifices such as the mouth. This results in no incision, no scar and no pain associated with that incision. Other advantages include avoiding incisional hernias.

Dave (Northfield, Ill) - 11:08 AM:
I'm 40 years old and have experienced acid reflux for the past 15 years. The medicine I take works relatively well at relieving my symptoms. Is this TIF surgery something I should consider or discuss with my doctor?

Dr. Michael Ujiki (NorthShore):
Excellent question. For a young person such as yourself, you should hear what options are available which include the TIF procedure. Otherwise, you will be committing yourself to antacid medications for the next 40 to 60 years. We have recently learned that though these medications were previously considered very safe, they can result in problems such as osteoporosis, infections in the GI tract (like C diff colitis) and interference with other medications you may need for your heart such as Plavix. So in general, the medications are well tolerated, someone at your age should hear about options from an experienced GERD or reflux physician.

Monica (Chicago) - 11:11 AM:
I have GERD despite exercising regularly and eating healthy (lots of fruits and vegetables) My ppi meds are not consistenly effective. What would make me a candidate for this procedure?

Dr. Michael Ujiki (NorthShore):
Thank you, Monica. I applaud you for a healthy lifestyle and that's a first step toward attacking reflux. Unfortunately, we know that even with maximizing lifestyle changes, reflux can persist. If your medications are not consistently effective, you should speak to an experienced reflux physician regarding options such as the TIF procedure. Candidates for this procedure include those that have proven reflux and are not responsive to medications or do not want to be on medications long term. In addition, no mechanical contra-indications to the procedure such as a large hiatal hernia (greater than 3 centimeters) can be present. For those of you who do not know what a hiatal hernia is, it is when the junction between the esophagus and stomach lie in the chest rather than in the abdomen where it should normally lie.

Jamie (Glenview, IL) - 11:16 AM:
What foods can cause heartburn?

Dr. Michael Ujiki (NorthShore):
Different foods can cause heartburn for different people. But in general, acidic foods such as tomatoes, oranges and spicy foods. Other foods such as caffeine, alcohol, even peppermint or chocolate can relax the valve at the bottom of the esophagus and result in reflux and heartburn. We, thus, recommend to patients with reflux that they avoid these foods. Tobacco can also relax the valve and should be avoided.

Lisa (Chicago, Illinois) - 11:19 AM:
Does the TIF surgery completely eliminate GERD symptoms?

Dr. Michael Ujiki (NorthShore):
The TIF procedure at two years has shown to resolve heartburn in over 90 percent of patients. It also results in complete cure of reflux in 70 to 80 percent of patients being off of antacids. The nice thing about this procedure is that it is incisionless so very little pain is experienced. In addition, people can get back to their normal everyday activities and work, almost right away - within a day or two. Most importantly, it is a very safe procedure.

Michael (Buffalo Grove) - 11:22 AM:
I'm curious as to how this TIF surgery works? I know you have to work through the mouth but what happens from there?

Dr. Michael Ujiki (NorthShore):
With the use of a standard endoscope which is a long, flexible tube with a camera on its end, we enter through the mouth and down the esophagus where we then rebuild the valve at the end of the esophagus and restore its natural anatomy. This results in a barrier to stomach acid. If you come to one of us who performs the TIF procedure, we can show you an animation of how the procedure works. The technology is very impressive.

Dale (Park Ridge, IL) - 11:28 AM:
I'm 38 and have reflux and chronic cough. The latter has always been linked to mild asthma. I'm on a PPI and inhalers. I've read about TIF on the Internet and would like to know if TIF can be effective post operatively for people who use inhalers.

Dr. Michael Ujiki (NorthShore):
That's a great question. This concern is a very common occurrence. Asthma and reflux have been linked for a long time and, unfortunately, they cycle off each other: Reflux makes asthma worse and asthma, in turn, can make reflux worse. PPIs make the refluxate (or stomach juice) less acidic but does not stop it from entering into the lungs by way of the esophagus. We, therefore, feel strongly that the mechanical barrier (the valve) at the end of the esophagus be restored to its natural anatomy. Whether it be TIF or a laparoscopic procedure, this may be more effective than just medications alone in the treatment of asthma associated with reflux. You should see an experienced reflux doctor regarding this concern.

Jamie (Glenview, IL) - 11:33 AM:
Does alcohol cause heartburn?

Dr. Michael Ujiki (NorthShore):
Alcohol has been found to relax the valve at the end of the esophagus, resulting in reflux that can cause heartburn. We, therefore, recommend that people who suffer bad reflux avoid alcohol.

Jamie (Glenview, IL) - 11:34 AM:
Which medicines are the best to treat heartburn?

Dr. Michael Ujiki (NorthShore):
Currently, there are several effective medications available. Some are over the counter such as H2 antagonists (i.e., Pepcid), proton-pump inhibitors (i.e., Prilosec), and others require prescription.

Robert (Glenview) - 11:37 AM:
I previously had severe heartburn related to diet and smoking. Now that I've cleaned up my diet and quit smoking, it still flares back up every once in a while at random. Is infrequent, random heartburn normal or something I should worry about?

Dr. Michael Ujiki (NorthShore):
Very good question because we know that symptoms do not correlate well with the amount of injury to the esophagus. You should definitely let your physician know if you have difficulty swallowing food, for example. Otherwise, I applaud you for the lifestyle changes you made, and often times, that's all that is required to help reflux disease. Intermittent use of antacids is probably the best indication for those medications. Again, seek the advice of your physician if this is more than just heartburn or if it just concerns you.

Moderator (Moderator) - 11:47 AM:
Thank you everyone for your great participation, the chat will be ending in approximately 10 minutes. Please submit any final questions you have.

Angelica (Chicago) - 11:50 AM:
I eat spicy food all the time, but never get heartburn. Do you think I will develop heartburn in the future if I keep eating spicy food?

Dr. Michael Ujiki (NorthShore):
Congratulations on having a great gastroesophageal valve. If you are not having problems, then you don't have to avoid those foods.

Dr. Michael Ujiki (NorthShore) - 11:58 AM:
Thank you all for participating. I'm very impressed with the questions and hopefully this will help people who view the transcript in the future. I would like to reiterate that technology is advancing and what used to be a difficult procedure to recover from can now sometimes be done with minimal invasiveness; and thus, a quicker return to your normal life. If you have questions about the scarless surgery program at NorthShore University HealthSystem, please call 847-570-1700 and ask for Dr. Ujiki's office. Again, thank you for your time today.

Moderator (Moderator) - 11:58 AM:
Thank you again for participating in our chat today. For more information please visit our Gastroenterology Pages.

Also, a transcript of this chat will be available shortly.
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