Return to Research+Publications Getting to the Heart of the Burn Everybody gets heartburn occasionally, but about 60 million Americans experience the searing pain behind the breastbone at least once a week, requiring stronger remedies than the drugstore shelf can offer. For them, help may come from a new, minimally invasive procedure that reaches the very cause of the burn. Gastroesophageal reflux disease, or GERD, occurs when the sphincter or muscular valve between the bottom of the esophagus and the top of the stomach no longer closes completely, allowing stomach acids to backflow into the esophagus. In addition to heartburn, GERD can cause insomnia, cough asthma and interfere with activity as simple as bending over. More ominously, prolonged GERD can cause abnormal changes in the esophagus' cells and lead to Barrett's esophagus, a precancerous condition. GERD is one of the many conditions that doctors are specially trained and equipped to diagnose and treat at the H.H. Chao Comprehensive Digestive Disease Center (CDDC) at UCI Medical Center in Orange. The CDDC, which opened earlier this year, offers medical and surgical treatment for disorders of the esophagus, stomach, colon, liver and pancreas. For GERD patients, the CDDC's leading-edge technology helps specialists assess the condition precisely and provide the appropriate therapy, ranging from medication to endoscopic procedures requiring no incisions, or laparoscopic surgery performed through keyhole incisions.		Dr. Kenneth Chang, director of UCI Medical Center's Comprehensive Digestive Disease Center, is a leader in treatment of reflux disease and other gastrointestinal disorders. In one minimally invasive treatment for reflux disease, a miniature suturing device is inserted down the patient's esophagus to the top of the stomach. After suction is applied to pull a small amount of tissue into the endoscopic suture device, a needle makes stitches in the tissue and ties the thread. This narrows the sphincter to help prevent stomach acid from traveling back up the esophagus.
"Different patients require different treatments," says Dr. Kenneth Chang, CDDC director. "The CDDC is a one-stop shop where patients can be diagnosed with the latest, most accurate techniques and then receive the best treatment." Diagnosis involves a 24-hour pH study to determine the extent of abnormal reflux, accomplished by nonsurgically attaching a tiny, painless probe at the bottom of the patient's esophagus. While the patient resumes normal activity, the probe measures acid reflux and transmits the information wirelessly. After a few days the probe detaches itself and is passed through the digestive system. UCI Medical Center is one of the few hospitals that offer endoscopic treatments for GERD, which involve placing a long tube equipped with a camera down the sedated patient's esophagus to the lower esophageal sphincter. In one version of the outpatient procedure, called endoscopic suture device (ESD) gastroplication, the doctor places stitches below the sphincter, then draws them together to tighten the valve. In another endoscopic treatment, called Stretta™, the doctor applies radio-frequency energy to the sphincter, producing lesions that gradually cause the tissue to contract and help prevent acid backflow. If the endoscopic treatments are not appropriate for a particular patient, surgery may be required, which now can be performed laparoscopically, resulting in smaller incisions, less pain, and quicker recovery. "Reflux disease can be miserable," says Chang. "Getting effective treatment helps restore a patient's enjoyment of life."

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