Heartburn and reflux are symptoms of GastroEsophageal Reflux Disease, or GERD.
GERD occurs when excess stomach juice comes up into the esophagus. The most noxious component of stomach juicie is acid. Medications can reduce the acid content in stomach juice; but in many patients non-acid reflux will occur even on medication. Exposing the esophagus to stomach juice can cause heartburn, chest pains, indigestion, excess throat clearing, hoarseness, chronic cough, asthma, and other problems with the throat and lungs.
Many people have heartburn and reflux and indigestion on an occasional basis. When GERD symptoms occur regularly then medical advice should be sought. GERD can cause permanent injury to the esophagus, and rarely precancerous changes to the esophagus. And GERD - once you have it - generally doesn't go away.

GERD is due to a defect in the valve mechanism that prevents stomach contents from going back up into the esophagus. It is not to excess acid production by the stomach. This valve mechanism is called the Lower Esophageal Sphincter. Hiatal hernias weaken the valve mechanism and so contribute to the severity of GERD. Procedures that work to cure GERD repair this defective valve mechanism and if needed the hiatal hernia - something that medication cannot do.

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All procedural treatments of GERD work to repair the lower esophageal sphincter valve mechanism. Until recently this has involved a surgery done laparoscopically (occasionally openly) often referred to as a Laparoscopic Nissen Fundoplication. A new technique of Transoral Incisionless Fundoplication is a promising technique to repair the lower esophageal sphincter in some patients with GERD.

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Medicines that treat GERDmost effectively reduce the amount of acid in the stomach, but do not correct the defective valve. Acid reflux causes much of the burning and injury to the esophageal lining when it is refluxed back up. Medications have been the mainstay of the treatment of GERD because they have been very effective at alleviating symptoms, healing erosions in the lining of the esophagus, and they have been thought to be very safe. However both the effectiveness and the long-term safety of medication have been questioned (See our section on Problems with Medical Therapy?)

GERD is a spectrum - from patients with occasional heartburn to patients with daily heartburn. Patients may never experience heartburn but may have asthma, chronic cough, or hoarseness due to reflux. Patients may have a severe heartburn but minimal damage to their esophagus. Other patients will have severe damage to their esophagus and few symptoms. Some patients will have a huge hiatal hernia, others very little hiatal hernia. We try to tailor our treatment recommendations according to where patients are within this spectrum of GERD.

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