GERD or Reflux or Heartburn
      Whatever you call it, it is not fun - but curable! The symptoms are heartburn that occurs too frequently, stomach upset and excess gas. Basically the problem is reflux of stomach fluids. As the esophagus becomes upset, it can cause sinus drainage, which leads to coughing, even gagging. The symptoms start out mild and may not be clearly defined. You will soon be very certain that something is wrong, and you had better get medical attention. Many people take over-the-counter medications like Tums and then may go on to prescription medications. There is danger in this because almost all of these medications either neutralize or inhibit stomach acid. But the stomach also contains bile and enzymes. The bile may not be as irritating as the acid, but it can do a lot of damage. If let go, the esophagus can be eroded, which can lead to Barret's Disease which is difficult to cure, and from there to cancer. This form of cancer is becoming a major item in the USA in recent years. For a good tutorial on the subject, go to www.surgery.usc.edu/foregut/gerd.html.
      I'm writing this in hopes that anyone else going through this will be guided to the proper medical care sooner than I was. No fault of the medical establishment; it is just hard to diagnose. This information comes from my personal experience, consultation with a couple specialists, and a very thorough treatment in "Disease Prevention & Treatment" published by Life Extension Foundation. The latter may be available on their website at www.lef.org. The comments below are somewhat truncated.
      I'm talking about gastroesophageal reflux disease (GERD). The symptoms start with reflux of stomach acid, bile and other digestive chemicals into the esophagus, which is not meant to tolerate these chemicals. The symptoms usually progress to the common heartburn. Anyone can have heartburn after eating too much spicy food, and this is of no particular concern. But if you have heartburn frequently and take any kind of medication for it, get medical attention. The critical part of the disease is that the esophagus cannot tolerate stomach acid and bile. If you take some medication to quiet the stomach acid, that still leaves the bile, and there is no easy way to eliminate that. The bile can do serious damage to the esophagus. So by taking something to neutralize or eliminate the acid, you are setting yourself up for esophagal erosion by the bile, and that is a serious matter. Having to take antacids more than a couple weeks is the clue that you need to see a doctor about it.

My History
      Several years ago I was having trouble with excess sinus drainage (runny nose and coughing). I was tested for allergies and had a cranial tumor (CAT scan), etc. Then I realized I was having a sore throat that seemed related to the sinus drainage. Then I noted much later, heartburn. If you have never had mild heartburn, it can seem like a sore throat, but as it gets worse, there is no doubt what it is!
      My then doctor tried several prescription medicalions for the heartburn and finally found one that worked reasonably well - Acephex. This is an acid inhibitor but it doesn't cure anything. He suggested a couple simple means to relieve the symptoms but they did not work. Meanwhile I went to an advertised seminar by a surgeon from USC (University of Southern California) and the symptoms he described fit me perfectly!
      I finally got approval for a specialist in gastroenterology. He was fairly certain I had GERD, based upon my descrption of the symptoms. I volunteered for a research program evaluating two well-known medications - Nexium & Prevacid - one against the other; double blind testing. The first thing was an edoscopy (running a scope down my throat) to have a look. The picture he took looked terrible! Like raw meat. But after a month on the researsh program, it had totally cleared up, and I was starting to feel better. After completing the research program (for which I was paid a small amount) the doctor suggested I change medical plans so I could have access to the surgeon from USC.
      I did that and the surgeon had me take a series of tests to pin down exactly what could be done surgically. The testing was not fun! First a series of X-rays (and videos) with barium drinks while eating some hamburger. Then I had to stop the medication for two weeks (Prevacid; Nexium did not work for me), and that was misery! I had forgotten just how bad the symptoms were. Like a full-blown dose of the flu, except no fever. Then they ran a catheter down my throat to measure the strength of the esophageal muscles. Finally they ran a smaller catheter down my throat for a day while I was working normally, with a portable recorder to measure pH, eating a controlled diet, including a fast food hamburger with fries! The 24 hour pH reading showed over three hundred reflux episodes!

Treatment
      At first the doctor may suggest using an antacid like Tums. That helps, at first. I also found cough drops helped control the coughing. Another treatment might be to raise the head of your bed about 6", and there are a couple other simple lifestyle changes that might help, like not lying down for 3 hours after eating.
      Initially, the doctor may prescribe any of several drugs like Tagamet, Pepcid or Zantac. These cover up the heartburn symptoms, but the esophageal damage may be continuing unchecked. Obviously this is not a great idea.
      Beyond that, the generally prescribed medications are either Nexium, Prevacid or Prilosec; Prilosec is now available over the counter. These are proton-pump inhibitors that completely suppress hydrochloric acid production in the stomach. Tums and other such antacids neutralize the acid. But they have now learned that if there is no acid in the stomach, digestion is not complete, particularly of protein. This can then get into the bloodstream and cause several serious side effects, and can lead to cancer. So these prescription drugs are not recommended to be used longer than 6-12 months. If your doctor does nothing but prescribe medications, I strongly urge you to request a specialist.
      If the lifestyle changes do not work and if you can't take the medications for an extended period of time, what next? Surgery. The procedure is relatively simple, using small incisions (five of them) and the hospital stay is overnight, followed by a week or so of taking it easy while the incisions heal. What they do is wrap the stomach around the top (sphincter) valve to reinforce it. Along with a weak sphincter valve, you may also have a hiatal hernia, a stretched abdominal wall (diaphragm) opening through which the esophagus passes. This can be corrected at the same time.
      The previous method of surgical correction involved a large incision, which required several weeks of recuperation. This newer surgical method was pioneered at USC; I asked my surgeon if it was available elsewhere and he said just about any major university hospital could perform it today.

Follow Up Report
      I had the operation on 4/8/05; the surgeon said it could not have gone better. He repaired a hiatal hernia that was larger than he expected and did the sphincter valve repair. Overnight in the hospital and then a week of rest at home, with pain killers for a couple days. The surgeon said the conditions for leaving the hospital the next day were that I could walk, that I could drink water, and that I could pee! Walking was encouraged but driving was discouraged for a few days; that could stretch the incisions too much at first, and if on the painkiller, you could be dangerous on the road.
      I expected the incisions to hurt, but only one did, and then only when I leaned over to put on socks and shoes. Otherwise the majority of the pain was in my shoulders and upper chest; I hadn't expected that. It was caused by the surgeon having to horse me around on the operating table. That was the only reason I wanted pain killers. The incisions were put back together very neatly; the stitches were done under the surface with self-dissolving sutures; the skin was covered with a plastic to hold it together. I could shower the next day without concern. Today (3/12/06) the incisions are barely visible. My throat hurt for a few days from the tube they had down it; once that felt better, I started eating some more solid foods. The tube was a sizing tube to assure that they did not make the esophagus too small.
      I had to watch what I ate for a couple weeks. Any tough fiber had to be chewed well, and meat, like steak, was the last thing added back to my menu. They let me decide what I could and could not do. I started driving again on the 15th and went back to work - carefully - on the 19th. On my follow-up visit on the 18th, the surgeon said I was ahead of schedule on recovery.
      Results were fantastic relief from the heartburn and most other symptoms. I discontinued the Prilosec I was taking immediately. I did have some nausea when I started eating more solid foods, but that only lasted a couple days. For a while I had to eat slowly and I am eating less; too much at one time is bloating. They encourage more smaller meals. I had some difficulty getting the elimination back to normal, but as I added solid foods, that normalized.
      At my next followup visit, on 5/9/05, I told the surgeon that I was pretty well back to normal eating, except smaller amounts, and I was back to work in my contracting business. I still have excess gas to eliminate; he said I should expect that to normalize in a few months as my stomach learns anew how to work. He suggested I might try Beano or Gas-X to reduce that, but they didn't work.
      On a later followup visit I complained about some pain on my right side. The surgeon was concerned that it might be gall stones so he had a sonogram run. It came back with the report that all internal organs looked very normal. The excess gas is continuing and he said it will eventually go away.