MANSFIELD — Keith Lilly considers himself fortunate to be alive.
For years, the 58-year-old Mansfield man dealt with heartburn, not thinking much of it. Sleep at night was often prefaced by coughing — which could last up to three hours and was often followed by vomiting.
“It got to the point where the acid reflux didn’t bother me anymore because my throat was so bad,” he said.
Finally, he mentioned his symptoms to his primary care physician, Dr. Bruce Grund, who referred him to Dr. Elwood Martin, medical director of the Heartburn Treatment Clinic at OhioHealth Mansfield Hospital.
“I think God put him here to help me,” Lilly said of Dr. Martin.
After undergoing a biopsy, Lilly learned his condition was much more serious than frequent bouts of heartburn. He was diagnosed with a paraesophageal hiatal hernia, gastroesophageal reflux disease (GERD), and long-segment Barrett’s esophagus – a condition that presents a significantly higher risk for esophageal cancer.
Fortunately, once the diagnosis was confirmed, Dr. Martin had a plan to bring Lilly relief. He underwent laparoscopic hiatal hernia repair with Nissen fundoplication. After the surgery, the coughing and vomiting has ceased and he lost nearly 30 pounds (he’s since gained back 10).
“I haven’t thrown up in two years,” Lilly said.
His evaluations since the procedure are even more cause for celebration.
“His story is very encouraging. We know that about one out of every four patients with Barrett’s esophagus who undergo anti-reflux surgery will see complete regression of the disease – meaning it’ll go completely away. That almost never happens in long-segment Barrett’s,” Dr. Martin said. “At his last scope, which was about a year ago, there was no visible evidence of residual Barrett’s. That’s way beyond me.”
Reflux disease affects an estimated 30 percent of the American population. It causes a problem with the lower esophageal sphincter, which functions as a rubber band around the bottom of the esophagus. If working correctly, it should keep the esophagus and the stomach completely separated, except when swallowing.
Dr. Martin said there are two main reasons why people experience symptoms: the acidic nature and the volume of what’s regurgitated.
“The acidic nature and volume of stuff that comes back up have to do with caustic injury of the esophagus,” said Dr. Martin. “Chronic caustic injury can lead to carcinogenesis or development of premalignant findings like Barrett’s esophagus.”
In order to treat reflux disease, the lower esophageal sphincter must be fixed. This can be done using different surgical approaches, including using a LINX device or Nissen fundoplication. Lilly received the latter.
People with reflux disease may experience any number of symptoms, which are broken down into two categories: esophageal symptoms and extra-esophageal symptoms. Esophageal symptoms include heartburn, regurgitation, difficulty swallowing; whereas, extra-esophageal symptoms include chest pain, shortness of breath, asthma, hoarseness, sore throat, cough, ear pain and postnasal drip.
Early detection is critical when it comes to reflux disease because of its link to cancer, but that often doesn’t happen for many esophageal cancer patients.
“This disease is poorly understood and pushed to the back burner because it’s a disease of inconvenience. Patients are told, ‘Just take this pill and you’ll be fine,’” Dr. Martin said.
Years pass and they may not even notice heartburn symptoms anymore.
“The reason for that is the myenteric plexus, which is the nerve center of the esophagus, gets completely destroyed so they no longer have the ability typically to sense heartburn and often not even regurgitation,” Dr. Martin said.
“That is why it’s so important that patients undergo testing if they think they have reflux disease. There will be patients like you (Lilly), who have long-segment Barrett’s and, if ignored for another decade, could lead to cancer of the esophagus.”
Dr. Martin said the procedure forces patients to eat the way the human body is meant to be nourished.
“In western society, there’s a tendency is to fix it fast, eat it faster and move onto the next thing. The human body aches from that eating behavior,” said Dr. Martin.
“This operation forces you to slow down. Your brain has to relearn how to eat and embrace a healthier diet. As a result, patients often see short, and sometimes long-term weight loss.”
As a final word of advice, Lilly urges anyone who experiences reflux disease symptoms to speak with a physician.
“If anyone has a problem, they need to just come see Dr. Martin,” he said. “Don’t wait like I did.”
