Acid Reflux

There are several types of over-the-counter (OTC) medications for acid reflux, including:

• Proton Pump Inhibitors (PPIs) - PPIs work to stop the gastric proton pumps from secreting acid into the stomach, reducing the total amount of acid in the stomach. These require some time to take effect, so they are not the best option for treating occasional heartburn or acid reflux.
• H2 Blockers - Much like PPIs, H2 blockers prevent certain receptors in the stomach from secreting acid, reducing the overall amount in the stomach.
• Antacids - These are best for occasional bouts of acid reflux, not frequent or severe symptoms. These medications neutralize the acid in the stomach, which reduces the amount of acid that can reach the esophagus.

The occasional bout of acid reflux is normal and ok, but you should schedule an appointment if you notice any of the following:

• Acid reflux two or more times a week
• Chronic cough
• Difficulty swallowing
• Acid reflux symptoms that frequently wake you up at night
• Symptoms that persist after a 2-week regimen of OTC medications

Call 911 or seek emergency medical attention immediately if you notice:

• Bloody vomit
• Black or bloody bowel movements
• Sudden or intense chest pain, as this may be a heart attack and not heartburn

While the long-term usage of a PPI has not been heavily studied, some observational studies suggest that it can increase a person's risk of developing a number of conditions, including:

• Chronic kidney disease (CKD)
• End-stage renal disease (ESRD)
• Infections, including Clostridium difficile and pneumonia
• Micronutrient deficiencies, including magnesium, calcium, and vitamin B12
• Dementia
• More research is required to prove these results conclusively.

There are other treatments for GERD, including:

• Lifestyle Changes - Excess weight and smoking can cause acid reflux, so losing weight, changing your diet, and quitting smoking can reduce symptoms. These changes can also help you lead an overall healthier life.
• Nissen Fundoplication - In this procedure, a surgeon uses a surgical robot to wrap the upper curve of the stomach (fundus) around the esophagus and stitch it into place. This strengthens the valve between the stomach and esophagus, which stops the acid from rising as much. Most patients will no longer require medications to help control their GERD after this procedure.
• LINX Procedure - LINX is a small, flexible band of magnets that is surgically placed around the esophagus just above the stomach to help prevent reflux. This procedure augments the weak lower esophageal sphincter (LES), reinforcing the body’s natural barrier to reflux. According to the manufacturer, 85% of patients who have the LINX Reflux Management System reported that they no longer required medication, and most patients experience an improved quality of life.
• Bariatric Surgery - If obesity is one of the main causes of your GERD, your surgeon may recommend bariatric surgery to help you lose weight. This can help control other chronic conditions as well, including diabetes and hypertension.

Some patients with gastroesophageal cancer will have trouble swallowing or may not be able to tolerate food without throwing up. Make sure to report this to your doctors.

It is important that you get in enough calories per day while you are undergoing treatment and preparing for surgery. Some techniques you can do to try to maintain your calories are:

• Eat 6-8 small meals daily. This means you should try to eat a ½ to 1 cup portion (serving) of food every 2-3 hours.
• Include supplements like Ensure© or Boost©
• Blend or puree your food and/or eat soft food.
• Chew your food well.
• Avoid carbonated beverages (drinks with bubbles like soda or beer)
• Eat slowly and carefully.
• Sit upright during meals.
• Have your last meal of the day at least 2 hours before bedtime.
• Don’t have more than 4 ounces (½ cup) of liquid with your meals.
  • Remember that soup and protein shakes count as liquids.
  • It’s okay to take extra sips of liquids if your mouth feels dry or you’re coughing.
• Include protein with each meal. Good protein sources include eggs, meat, poultry, fish, nuts, milk, yogurt, cottage cheese, cheese, peanut butter, and tofu.
• Avoid spicy and peppery foods.
• Avoid bulky foods like breads or meats.

If you feel like your food will regurgitate into your windpipe, do not force it. Let you doctor know of this problem. In cases like this, some people will require placement of a temporary feeding tube to increase the number of calories they are getting in.

Many supplements can be purchased at your neighborhood pharmacy, but discounted supplements can often be found at

Cancer Services of Baton Rouge:

550 Lobdell Avenue
Baton Rouge, LA 70806
(225) 927-2273
staff@cancerservices.org

It is common for patients to require a temporary feeding tube at some point during their treatment. In most cases (but not all), the feeding tube is placed at surgery into the small intestines through a small incision in the left abdominal wall.

Once the tube is place, before you leave the hospital, you and your family will be educated about it, how to use it, and how to maintain it. After discharge, you will have a home health nurse and an infusion team come to your home on a regular basis to assist you with its maintenance.

It may be more comfortable for you to use a soft velcro belt to hold the feeding tube in place. You can purchase one on Amazon.com. Search under “gtube holder belt” to find one for purchase.

When the tube is no longer needed, your doctor can remove it in the office.

Yes. As tolerated with the precautions outlined in question 1. If you feel like your food will regurgitate into your windpipe, do not force it. Let you doctor know of this problem.

You should have several meetings scheduled with a registered dietician who will assess your food intake, make recommendations to your treatment team accordingly.

To contact one of our registered dieticians, call (225) 765-5785

Cancer is treated in 3 main ways: with surgery, with medicine (such as chemotherapy, targeted therapy, immunotherapy, and hormone therapy), and with radiation. Not every patient will need all three types of treatments, but effective cancer treatment often requires more than one of these treatment types.

Each type of treatment is provided by a different specialist. For instance, medical therapy (like chemotherapy) is given by a medical oncologist, surgery is performed by a surgeon (or a surgical oncologist), and radiation is given by a radiation oncologist. Your specific treatment will be determined by the stage of the cancer and by many other factors.

Prior to your operation, the surgeon and anesthesiologist meet with you and your family in the preoperative holding area to answer any last-minute questions.

The anesthesia team takes you to the operating room, where they put you to sleep with intravenous (IV) medications. The anesthesiologist also places a breathing tube so you can get oxygen during the operation. The surgical team inserts special IV lines, a bladder catheter, and a stomach tube (through your nose) after you are asleep.

Most patients wake up with a small tube in their nose to drain the stomach, an abdominal drain, a tube to drain from the bladder, and sometimes a chest drainage tube. These tubes are almost always removed before you leave the hospital.

Gastric and esophageal surgery is considered a major operation, but almost all patients survive the procedure. About one-third of patients may have a complication from the operation. These complications can be major or minor and can include bleeding, infection, clots, pneumonia and heart attacks. We can usually manage most of these problems without having to perform another surgery.

Yes. In the first few days following your operation, your surgical team may want to do an X-ray swallow test before starting you on a diet to ensure that food will pass through well. If this swallow test looks good, you will likely be started on a clear liquid diet of ice, jello, juice, and broth. Depending on how you tolerate this, you may stay on this liquid diet for a few more days or you may be allowed to eat fuller, richer food.

The goal will be for you to eventually eat regular food again within the first several weeks of surgery. However, the way you eat and digest (break down) food will be very different because of the surgery. Your stomach will be smaller, or it may have been completely removed. This means you will feel full much faster than you did before your surgery, and you will not be able to eat 3 big meals like before. In fact, if you eat too much at one sitting, you could experience symptoms like abdominal pain, nausea, dizziness, or rapid diarrhea. So adherence to this special diet is very important. More details about your post-surgical diet can be found in the nutrition guide.

If a large part of your stomach was removed during your surgery, you may need to take extra vitamin B12. Vitamin B12 can be given as an oral supplement (such as a pill), in the nose, or as a monthly shot.

An abdominal nerve block is typically done by the anesthesia team in the OR after you go to sleep. We take great care to work with your nurses and treatment team to ensure your pain is managed adequately.

Pain medications can be taken by mouth after eating is resumed or through the feeding tube as well. Patients go home from the hospital with a limited supply of the appropriate (by mouth) pain pills.

Our goal is for you to return to normal activity with time, and we want you to start by getting out of bed and to begin walking the day after your operation. Having said that, you should not lift anything heavier than a gallon of milk and avoid any strenuous physical activity for at least two months after your surgery. Please check with your surgeon before driving, working or participating in sexual activity.

Yes. Most patients return for a routine postoperative checkup within three weeks of surgery. Follow up after this will depend on how rapid your recovery is and whether you need any additional treatment.

Contact your healthcare provider if you have:

• A fever of 101 °F (38.3 °C) or higher
• Worsening abdominal pain
• Shortness of breath/chest pain
• Persistent nausea/vomiting