Amanda Wilde (Host): Heartburn is a condition that affects millions and can signal more serious health issues. So, what is heartburn? Who gets heartburn? Is it chronic? Is it treatable? Minimally invasive surgeon, Dr. Beata Belfield, is here to answer those questions and share her expertise. If you've ever dealt with that burning sensation in your chest, you won't want to miss this expert breakdown of everything you need to know about heartburn.

Welcome to St. Joseph's Health MedCast, a podcast from St. Joseph's Health. I'm your host, Amanda Wilde. Dr. Belfield, thank you so much for being here.

Dr. Beata Belfield: Well, thank you so much for having me.

Host: Well, the statistics are more than 60 million Americans experience heartburn at least once a month and 15 million suffer from it daily. Dr. Belfield, can you begin by explaining what heartburn is?

Dr. Beata Belfield: Absolutely. So, heartburn is a symptom that most people would describe as burning in the center of their chest. And it is associated most times with the diagnosis gastroesophageal reflux disease or GERD, but it's not always associated with GERD. So, a lot of people deal with that symptom, but it's not always acid that's underlying that symptom.

Host: What else can it be?

Dr. Beata Belfield: So, there's a lot of other things that it can be, including chest issues, difficulty with swallowing, sign of a hiatal hernia. And so, even though it's a symptom many people deal with often, it's something that deserves some attention.

Host: The primary symptom is that burning sensation. Is that fair to say?

Dr. Beata Belfield: Yes.

Host: And how do we distinguish it from other similar conditions?

Dr. Beata Belfield: So, other symptoms can go along with heartburn, like difficulty with swallowing. Sometimes that's so subtle that people don't even notice they're having that difficulty because there's many different ways to compensate for it. Regurgitation where liquid comes up into your mouth and being unable to bend over or work out or lay all the way down flat without those symptoms is a very common thing.

And how we differentiate what's causing it is through testing. So, we can do testing with endoscopy, where we use a small camera to actually look inside the stomach and the food pipe, the esophagus. We can do testing with contrast imaging, where the patient swallows contrast and we take x-rays of it going down and see how the muscles are working. And then, we also have pressure studies that study the muscles of the food pipe. 

Host: Now, Dr. Belfield, why is heartburn such a common issue for so many people?

Dr. Beata Belfield: Honestly, it has a lot to do with our dietary choices and with obesity in America, but it's not always related to those things. Sometimes it's related to how the body is arranged on the inside.

Host: So, sometimes it's something we can't do anything about. Sometimes there are lifestyle factors. What are some of those more significant factors that we can control that contribute to heartburn?

Dr. Beata Belfield: So, I basically see people who deal with heartburn in three different ways. One is lifestyle modifications, like you mentioned. And that's things like avoiding trigger foods, losing weight, sleeping with your head elevated, eating less late in the day, or eating smaller meals. And that can work for some people. If those things don't work, then we move on to the treatment option of medications. And there's over-the-counter medications and prescribed medications.

A lot of people have really good reflux control on prescribed medications, but then decide that because of side effects, they don't want to be on those for their whole entire life. So then, they start looking at the third option, which is surgical repair of the actual underlying mechanisms that cause reflux. The heartburn medications take the stomach acid and make it less acidic so that when it goes into the food pipe, it doesn't cause as much damage, but it can't change what's causing it to go up there in the first place. And that's what surgery does. It takes the bottom of the food pipe and reinforces the sphincter that should keep acid down, and it also takes the diaphragm and reinforces that and that actually has a role in heartburn as well.

Host: And what does it mean to say that you are a minimally invasive surgeon when it comes to this kind of procedure?

Dr. Beata Belfield: So, surgical options are always open with a larger incision up and down in the middle of the belly or minimally invasive through laparoscopic or robotic surgery. And I did my fellowship training in minimally invasive surgery, specifically for reflux and hiatal hernia. And my training was laparoscopy, and my current practice is to use the robotic technology for all of these surgeries. It improves visibility, it helps with pain afterwards, people recover much faster, and it is a very superior platform to use when doing an anti-reflux procedure.

Host: So, that robotic technology really improves outcomes. And is that still being developed? Do you expect more improvements in the future?

Dr. Beata Belfield: I expect all kinds of changes to my field in the future. Just the difference between now and five to ten years ago is huge, and we haven't seen this yet, but I'm sure AI will start to be incorporated into surgery. But ultimately, even though we talk about robotic surgery, there's no artificial intelligence there yet. And every move the robot makes is controlled by the surgeon. So, it's still a very, very human operation.

It always will be, because it's dependent on your expertise.

Right. I think a lot of people would be uncomfortable with an AI performing surgery, but that may be in the very distant future. Who knows?

Host: St. Joe's has a dedicated Heartburn Center. What makes the Heartburn Center where you work at St. Joe's unique?

Dr. Beata Belfield: So, I love working at the Heartburn Center at St. Joe's. I'm the Surgical Director of the Heartburn Center. And what we bring to the area that is completely unique is a very close collaboration between gastroenterologists and surgeons. And a lot of people see their gastroenterologist first for heartburn and heartburn workup, and then get referred to a surgeon later. When you come here, everything's available in one place. So, we provide all the testing. We provide prescriptions and medication trials. And we also provide the ability to see a surgeon and talk about surgical options without needing to go to a different office.

The surgical options that are available at a Heartburn Center are also a little more diverse than the other hospitals in Syracuse. We have three different antireflux options, including a magnetic sphincter implant called the LINX, and the gold standard for antireflux, which is called fundoplication. The hiatal hernia repair or parasophageal hernia repair also goes hand in hand with reflux control and that is performed as a part of every surgery if you do have a hiatal hernia.

Host: So, you have, at the center, accessibility to all levels and all types of treatment.

Dr. Beata Belfield: Yes, exactly. You can start here, having never seen anyone else for this. You can start having tried many different options and failing any of them. We just take you as you are. We don't want to step on any other doctor's toes. So, we'll get all your testing from before.

And the exciting thing about the Heartburn Center is that we're also able to deal with other issues that cause the same symptoms. Like, if you're found to have Barrett's esophagus, which is a cell change, that can also be associated with heartburn and reflux, but can need a different treatment, and that we can provide as well. And essentially, whatever we find while we're looking at your symptoms, we'll be able to suggest an intervention or provide a treatment for not just reflux.

Host: Well, doctor, thank you so much for bringing clarity today on this condition that affects so many people. It's good to know there's so many options for treatment. And in your case, they're all in one place. I really appreciate your time and insight.

Dr. Beata Belfield: Well, thank you so much for having me, Amanda. It's a pleasure to talk to you about something that I deal with almost every day. And I really enjoy helping detangle this complex subject for people so that they can understand it on their own level. I also really enjoy taking people through their different options and helping people pick interventions that make sense for them and their symptoms and their test results. This is not a one-size-fits-all type of situation, and we definitely take each patient as an individual.

Host: Dr. Beata Belfield is Surgical Director of the Heartburn Center at St. Joseph's Health. Call the Heartburn Center if you have concerns about your health, 1-866-478-2876 or visit sjhsyr.org/heartburncenter. If you found this podcast helpful, please share it on your social channels and check out the entire podcast library for topics of interest to you. I'm Amanda Wilde, and this is St. Joseph's Health MedCast. Thanks for listening.