BODY : FITNESS & EXERCISE SURGERY DOUSES THE FIRE OF CHRONIC HEARTBURN.

Byline: Noel Holton

Mark Robinson, a 39-year-old construction worker, began suffering from heartburn at an age when most people consider pizza, soda and ice cream a balanced diet.

``I have had chronic heartburn since the age of 18,'' Robinson said. ``They started giving me upper and lower GI's when I was 19 because the pain that I felt was so intense.''

So began a 20-year relationship with heartburn, one marked by frustration each time he tried a new medication and it failed to help.

His doctor eventually determined that he had severe ulcerations on his esophagus, caused by the constant irritation of stomach acid.

``My heartburn was so bad that I had to sleep sitting up,'' Robinson said. ``If I didn't position myself at a 45-degree angle before I went to sleep, whatever I had eaten that day would come right back up into my chest and wake me up.''

Finally, in March, Robinson got the relief he was looking for, not with a pill, but with a new type of surgery called laparoscopic fundiplication.

The idea behind the surgery is to get the sphincter of Oddi (the muscle located between the stomach and the esophagus) to do its job: namely, to contract so that swallowed food stays where it belongs - in the stomach.

Working through several half-inch abdominal incisions and using a tiny video camera to lead the way, a surgeon took the top part of Robinson's stomach, called the fundus, and wrapped it around the lower end of the esophagus. The wrap was intended to create enough pressure in the stomach so that the sphincter muscle would open only when it was supposed to and not allow stomach acid to push its way up into the esophagus.

Such an operation used to require a big incision and would keep patients in the hospital for weeks.

``I'll admit I was more than a little nervous about undergoing surgery,'' Robinson said. ``But I am so glad I did it. Now, I can eat anything I want; grapefruit juice, pizza, whatever. And I was out of the hospital in one day.''

Laparoscopic surgery for chronic heartburn was introduced about four years ago.

George Costantino of St. Mary's Hospital in Langhorne, Pa., has done nearly 50 of the heartburn surgeries, including Robinson's. He believes the new laparoscopic technique, covered under most major health plans, is a good option for some patients with chronic heartburn.

``I see people at the end of their rope,'' Costantino said. ``They have already tried medication for years and they still get symptoms. These are the best candidates for laparoscopic surgery, and they all report high satisfaction with the results.''

But Michael Wolfe, a gastroenterologist and author of a book about heartburn, ``The Fire Inside,'' said there isn't enough information on the success of heartburn surgery to warrant enthusiasm about the new laparoscopic procedure.

``If you have surgery, you are obviously doing it for the long-term effects,'' Wolfe said. ``There should, therefore, be long-term studies done on the outcomes of these operations, and there just aren't any.''

Some small studies with short-term follow-up, published in Journal of the American College of Surgeons, have found that the procedure is safe and effective.

A recent study by New York College-Cornell Medical Center estimated that approximately 60 million Americans suffer from heartburn, at least occasionally. Symptoms can range from mild abdominal pain and a burning sensation in the chest to difficulty swallowing and sour, acidic regurgitation.

For most people, heartburn is brought on by consuming fried, greasy or spicy foods, chocolate, citrus fruits or coffee.