If you casually ask people about their digestive health, you’re bound to get some funny looks. But ask people whether they have a problem with heartburn, and many will answer affirmatively and emphatically.

Recognizing the difference is one of the keys to success at our Digestive Health Center. Our outreach efforts are centered around the word that seems to really get people’s attention. People may have GERD, reflux or regurgitation issues, but the word they relate to most is heartburn.

In fact, we now have a Heartburn Center, a specialized program that we’ve developed, and one that’s become increasingly profitable over the last few years. Here’s how we built it and some of what we’ve learned along the way.

We started slowly, in 2015, concentrating primarily on a couple of diagnostic procedures for people with chronic heartburn — mostly manometry and Bravo (a procedure in which a small capsule is attached to the wall of the esophagus to measure acid levels). Then, in 2016, we launched it on a larger scale, and our numbers quickly began to go through the roof.

The big launch followed an ad we put on the front page of our local newspaper. The key words in the ad: heartburn and PPI (proton pump inhibitors). Now, we hold the seminars twice a year. It’s great for us if the attendees decide to come in for consultations — and I’d estimate that between 10% and 20% do.

For patients who have chronic reflux and who don’t respond to lifestyle changes or medication, we’ve had tremendous success, primarily with the endoscopic TIF (transoral incisionless fundoplication) procedure. Similar to Nissen fundoplication, TIF alleviates GERD symptoms by wrapping a portion of the stomach around the esophagus to restore the esophageal valve. But unlike traditional fundoplication, the TIF procedure is performed through the mouth rather than through laparoscopy or open abdominal incisions. We did our first few TIFs in 2016, then almost 40 in 2017 and well over 50 in 2018.

Among the anti-reflux procedures we do, TIF offers immediate results. We usually do it as an outpatient procedure, and many of our patients are off their medications within 2 or 3 months. They can enjoy the foods they couldn’t eat previously, without any ill effects — even such trigger foods as chili, wine, chocolate and coffee.

To help document our success, I give patients a quality-of-life survey the day of the procedure and the same survey again after 2 months. The questions cover severity of symptoms, whether their reflux keeps them up at night, how often they have regurgitation and so forth. What we find is that on a 0 to 50 scale, with zero being the score that indicates no problems at all, the average before surgery is around 25; the average after surgery is about 3. Seeing those dramatic improvements is very rewarding, and our patients are very satisfied.

We’ve been doing TIFs for a relatively short time period, so it will be interesting to see what kind of long-term results we achieve. But the available data from our first cases are encouraging, and the patients we had in 2016 are still doing wonderfully. I recently talked to one woman who’d previously had to sleep upright for years. She’s thrilled. Instead of sleeping in a recliner, she can sleep lying down, with her husband, in a normal bed.

We’ve had a small number of recurrences, but they’ve been primarily compliance-related. We explain to patients what they can do and what they can eat in Week 1 after the procedure, in Week 2, in Week 3 and so on. We also tell them to keep taking their medications for the duration of their recovery, and we taper them off slowly. Most are weaned off completely by 3 months and can start enjoying life again.

One other caveat: Patients also have to maintain a healthy weight. Significant weight gain increases abdominal pressure, which puts pressure on the repaired valve. That can either cause the fasteners to pop off or cause a hiatal hernia to reoccur.