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Medical Edge Newspaper Column from Mayo Clinic

NONSURGICAL OPTIONS FOR CONTROLLING ACID REFLUX

DEAR MAYO CLINIC: To alleviate my severe acid-reflux problems, a “wrap” was performed on my esophagus. But now it’s coming loose and my symptoms are returning. So I was wondering if there are any alternative treatments or procedures. — Anonymous

ANSWER: Acid reflux refers to the abnormal upward movement of stomach acids into the esophagus. Normally, the lower esophageal sphincter opens only when you swallow, but in your case and many others, a weakened or relaxed sphincter is causing the leakage of acid. This creates unpleasant symptoms (as you well know), such as the sour taste of stomach contents in your mouth; and a burning, congested, painful feeling centered behind the breastbone (hence the term “heartburn,” though the heart is not involved).

An estimated 10 percent of adults experience some degree of heartburn. Most people in this group find sufficient relief with over-the-counter medications such as antacids. But some 5 percent require the help of physicians. Wrapping the upper stomach around the lower end of the esophagus — called a fundoplication or, simply, a wrap — is the most common surgical procedure for preventing acid reflux into the esophagus. This procedure is generally durable over the long term, but breakdown of the wrap occurs in about one out of 100 patients.

Should an exam prove that your wrap is breaking down, you have several options:

— Go back on medications. They can block the production of the stomach acid that irritates the esophageal lining.

— Have the wrap procedure redone. It can now be performed laparoscopically, using special instruments and smaller incisions, which reduces the hospital stay and recovery time. If this option appeals to you, please note that a rewrap is more difficult than the first one, and it has a larger failure rate — about 15 percent.

— Have one of the new, nonsurgical and minimally invasive endoscopic procedures. These options, which work by restricting the size of the junction between the stomach and the lower esophagus, include cauterization (or surgical scarring) with radiofrequency energy; injection of a polymer; or the targeted placement of a stitch. Such procedures generally do not require an overnight stay in the hospital, and patients can resume their normal activities within three to five days.

Before pursuing any of these alternatives, however, you should undergo a complete evaluation by a skilled and experienced gastroenterologist. This will clearly establish whether there is indeed a breakdown of the initial wrap procedure and, if so, help to determine its cause.

— Ronald Hinder, M.D., General Surgery, Mayo Clinic, Jacksonville, Fla.

Additional Resources:
Treatment of Acid Reflux
Appointment Information
More Information onf Acid Reflux

READERS: If you’re giving chocolate to your sweetie, consider dark chocolate. It’s better for heart health.

Chocolate contains flavonoids. These natural antioxidants — also found in tea, red wine and some fruits and vegetables — help limit the negative effects of lipoproteins, which are components of the “bad” cholesterol, low density lipoprotein (LDL) cholesterol. Flavonoids may protect arteries and prevent heart disease, stroke and arteriosclerosis, a disease characterized by clogged arteries.

The darker the chocolate, the higher it’s likely to be in flavonoids, according to the Mayo Clinic Health Letter. For example, a bar of dark chocolate contains an average of 53.5 milligrams of flavonoids. A milk chocolate bar contains less than 14 milligrams. White chocolate doesn’t have any.

While dark chocolate may have some health benefits, it’s best to keep it as an occasional treat. Flavonoids don’t cancel out fat and calories.

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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.