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The Center for Heartburn and Swallowing Disorders

The Center for heartburn and swallowing disorders marks a careful coordination of these often-related medical conditions – and treats the disorders in one convenient location at St. Vincent Charity's downtown Cleveland Campus.

More than 60 million people in the United States are suffering with gastroesophageal reflux disease (GERD). For many people, over-the-counter or prescription drugs have only eased GERD symptoms partially or temporarily. Others find medication and lifestyle changes haven’t helped because an underlying medical condition is causing their symptoms. The multidisciplinary team at St. Vincent Charity offers personalized management of GERD, including a longer-lasting treatment — an alternative to a lifetime of medication.

The Center treats:

  • Acid reflux, heartburn
  • Dysphagia, difficulty swallowing
  • Hiatal hernia
  • Barrett's Esophagus

Make an Appointment

If heartburn and acid reflux are causing you daily discomfort, our experts can direct you toward an option that will provide relief. To schedule an appointment with one of the Heartburn Center physicians or to refer a patient for a consultation, call:

216.241.8102

Signs & Symptoms of Acid Reflux

Heartburn is a painful, burning feeling in the chest caused by stomach acid that escapes the stomach and flows back into the esophagus.

It can sometimes be mistaken for a heart attack. Some people experience acid reflux as a sensation of food sticking as they try to swallow. Other symptoms are chronic cough, hoarseness of voice and regurgitation, which is when partially digested food or liquid from the stomach spontaneously flows back up into your mouth.

The stomach makes acid in order to digest food. Where the esophagus meets the stomach there is a muscular ring called the lower esophageal sphincter or LES. The job of the LES is to protect the esophagus from the normal stomach acid. Some reflux may occur normally but the lining of the esophagus is not built to tolerate long or repeated exposure to this acid. Reflux becomes a problem – a disease – when it begins to cause symptoms or damage to the esophagus.

If heartburn or other symptoms of acid reflux are happening frequently (at least 2 times a week for a few weeks), or when it begins to interfere with your daily life or damage your esophagus the issue may be gastroesophageal reflux disease (GERD).

Heartburn that isn’t treated or controlled well by lifestyle changes or medicine may cause serious issues, including, breathing problems like asthma, nighttime choking, and repeated pneumonia.

Inflammation and erosions to the lining of the esophagus that occur over time can cause changes to the esophagus. The esophagus may scar and narrow (stricture, stenosis) making swallowing more difficult. This can also lead to a condition called Barrett’s esophagus where the cells lining the esophagus become abnormal and can lead to cancer of the esophagus. A person with Barrett’s syndrome is 50 to 100 times more likely to develop esophageal cancer.

 

 

 

 

 

 

 

 

 

 

 

Symptoms of gastroesophageal reflux disease (GERD) include:

  • Bad breath or a sour taste in your mouth, or in the back of your throat
  • Breathing problems
  • Cough
  • Feeling like there is a lump in the back of your throat
  • Hoarse or raspy voice
  • Nausea
  • Difficult or painful swallowing
  • Sore throat
  • Tooth decay
  • Vomiting
  • Regurgitation

Diagnostic Testing

Endoscopy

If you have had long standing reflux symptoms, or have been taking medications to control these symptoms for a long time, you should consider having an endoscopy to ensure damage is not being done to your esophagus. Even if your medications are controlling your symptoms, reflux may still be causing damage because the medications are only lowering the acidity of the stomach contents, not stopping the reflux.

A long, thin tube with a camera and light on the end is put down your esophagus so your doctor can look inside your esophagus and stomach. Endoscopy can look for problems such as an ulcer or narrowing inside your esophagus.

pH Testing

This measures the acidity in your esophagus and is used to determine the severity of the reflux. Your doctor will put a small sensor in your esophagus. pH testing is done when there is diagnostic uncertainty to confirm that acid reflux is taking place and that it is what’s causing the patient’s symptoms.

Barium X-Ray

A Barium swallow study may also be done to evaluate esophageal function and may identify a hiatal hernia which is common in patients with reflux. The patient drinks a liquid that coats the inside of the digestive tract. Then X-rays are taken, which will show the outline of your digestive system.

Manometry

Esophageal manometry is an outpatient test used to identify problems with movement and pressure in the esophagus that may lead to problems like heartburn. Manometry measures the strength and muscle coordination of the esophagus when you swallow. During the test, a thin, tube is passed through the nose, along the back of the throat, down the esophagus, and into the stomach.

 

The need for diagnostic testing will be determined on an individual basis by the physician. Not all patients require testing.

 

Treatment Options

Lifestyle Options 

The first treatment for heartburn should be lifestyle changes. Lifestyle changes are low-risk and may improve or resolve heartburn symptoms:

  • Avoiding certain foods (spicy, citrus, tomato based, etc.)
  • Weight loss
  • Stopping smoking
  • Inclining the head of the bed
  • No eating before bedtime

If those changes are not successful, medications are an option.

Over-the-counter Medications

Many over-the-counter medications can help relieve heartburn, but they may interact with other medications and can have risks if used long-term. Options include:

  • Antacids help neutralize stomach acid. Antacids may provide quick relief, but they do not heal an esophagus damaged by stomach acid.
  • H-2-receptor antagonists (H2RAs) can reduce stomach acid. H2RAs don't act as quickly as antacids, but provide longer relief.
  • Proton pump inhibitors such as lansoprazole (Prevacid 24HR) and omeprazole (Nexium 24HR, Prilosec OTC) can reduce stomach acid. 

    Many people take PPIs for years and find their symptoms come back if they miss a dose or try to stop taking it. This is because reflux continues even while PPIs are being taken, just with less acidic stomach contents which results in symptom improvement.

    This means reflux can continue to cause damage to the esophagus. PPI treatment also does not stop regurgitation. Regurgitation is where acidic, or bitter tasting, stomach contents can spontaneously reflux all the way up to the back of the throat or mouth.

If over-the-counter treatments don't work or you rely on them often, see a doctor. You may need prescription medication and further testing.

 

 

 

 

 

 

Surgical Options

When to consider anti-reflux surgery:

  • If you do not want to be dependent on medication for symptom control.
  • If symptoms reoccur when medication is stopped.
  • If symptoms continue despite taking medications as directed and if the diagnosis of acid reflux is confirmed.

A physician can help determine if you would be a good candidate for one of several surgical treatment options.

THE CENTER FOR HEARTBURN AND SWALLOWING DISORDERS OFFERS TWO SURGICAL OPTIONS TO TREAT ESOPHAGEAL REFLUX:

  • Fundoplication, Nissen/partial 
  • ROUX-EN-Y Gastric Bypass

These procedures are performed laparoscopically, with small incisions, under general anesthesia. Each patient is assessed individually to determine which treatment is best to treat their reflux, taking into consideration other medical conditions and the diagnostic testing results.

Clinical Leaders

  • Leslie L. Pristas, D.O.

    Dr. Leslie Pristas, board-certified in general surgery and a Fellow of the American College of Surgeons (FACS), is the medical director and surgeon for the Center for Bariatric Surgery. An experienced bariatric surgeon, Dr. Pristas began practicing at St. Vincent Charity Medical Center in July 2018 bringing with her advanced capabilities in surgical treatments for heartburn. In addition to her role within the Center for Bariatric Surgery, Dr. Pristas performs minimally invasive general surgery and welcomes those consults in addition to her weight loss surgery practice. Her special interests also include hernia repair, colorectal surgery and robotic surgery.

    Dr. Pristas earned her medical degree from Ohio University College of Osteopathic Medicine and completed her residency at Keesler Air Force Base Medical Center in Mississippi. She grew up in Delaware, Ohio and went to Denison University for her undergraduate degree. After completing her medical degree at Ohio University, she joined the Air Force. Dr. Pristas then moved to Mississippi for her active duty residency at Keesler Air Force Base. Upon finishing her residency, she stayed in Mississippi for four years of active duty.

    She returned to Ohio in June 2018 and lives in Medina with her husband and three children.

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    Specialties:

    Bariatric Surgery
    General Surgery
  • Roshni Venugopal, M.D.

    Board-certified in both General Surgery and Surgical Critical Care since 2013, Dr. Venugopal performs a number of specialized General Surgery procedures:

    • Weight loss surgery, including laparoscopic and endoscopic bariatric procedures
    • Diaphragmatic, Hiatal and Paraesophageal hernia repair
    • Laparoscopic anti-reflux surgery for GERD
    • Laparoscopic myotomy for achalasia
    • Laparoscopic gastric pacemaker for gastroparesis
    • Tracheostomy
    • Thyroidectomy, Parathyroidectomy
    • Splenectomy
    • Adrenalectomy
    • Laparoscopic inguinal hernia repair

    Dr. Venugopal earned her medical degree at Rutgers University New Jersey Medical School and completed her internship at NYU Langone Health. She finished general surgery residency at the University of Tennessee, and completed surgical critical care fellowship at Rush University & Cook County Hospital. Dr. Venugopal practiced as an acute care surgeon prior to completing minimally invasive surgery fellowship at Dartmouth Hitchcock Medical Center.

    With the addition of Dr. Venugopal, the Center for Bariatric Surgery is expanding its capabilities in minimally invasive surgery, and will be evaluating patients for repair of diaphragmatic and hiatal hernia, for surgical treatment of gastroesophageal reflux disease (GERD), and for surgical management of esophageal and gastric dysmotility disorders, in addition to weight-loss surgery patients.

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    Specialties:

    Bariatric Surgery
    General Surgery