Nearly everyone knows how heartburn feels. The searing sensation in the chest, the sore throat and bitter mouth taste are no fun, but they are no big worry as long as they go away within a short time and don’t return any time soon.
Heartburn happens because the sphincter muscle or valve at the bottom of the food tube (esophagus) fails to close properly, letting the acidic contents of the stomach wash back up briefly. This is sometimes called acid indigestion or acid reflux. The burning sensation indicates that the lining of the food tube is being irritated.
When heartburn happens occasionally, most Americans simply take an antacid or other remedy and consider changes in their eating habits. When the symptoms continue to occur frequently despite these measures, it’s probably time to see a doctor. Symptoms recurring more than twice a week or interfering with daily activities qualify for the diagnosis, gastroesophageal reflux disease (GERD),
GERD can occur at any age. In fact, it’s estimated that 35 percent of babies have GERD at birth. Although healthy and happy, these infants spit up or vomit frequently–a problem that usually resolves by their first birthday.
In children and even in some adults, GERD is characterized not by heartburn but by a persistent dry cough, asthma symptoms or trouble swallowing. Young children may be irritable and arch their backs during or shortly after feeding.
Cause Is Often Unclear
Infants with GERD probably have a gastrointestinal system that is not yet fully developed. In adults, causes are still unclear. Weakening of the sphincter muscle can occur as a result of smoking. And the problem often develops because of crowding and pressure on the stomach during pregnancy or in people who are obese.
Some individuals develop GERD because of an anatomical abnormality known as a hiatal hernia. Normally, the diaphragm helps the sphincter function, but, with a hiatal hernia, the stomach and sphincter are pushed above the diaphragm.
Foods that are often linked to acid reflux or GERD include citrus fruits, chocolate, drinks containing caffeine or alcohol, onions and garlic, mint flavorings, spicy foods and tomato-based foods such as pasta sauce, salsa, chili and pizza.
Even if you feel you can live with the symptoms, it’s important to seek treatment for GERD. Constant irritation by stomach acid can cause the esophagus to develop ulcers or bleed. Scar tissue can form, making it increasingly difficult to swallow. And, in some cases, persons with GERD go on to develop Barrett’s esophagus or esophageal cancer.
Barrett’s esophagus involves dysplasia or changes in cells of the esophagus that are sometimes pre-cancerous. It’s reasonable to assume that persons with long-standing, severe symptoms of GERD are most at risk of developing both Barrett’s esophagus and esophageal cancer. And such patients are usually singled out for screening.
A recent study published in the Archives of Surgery [July, 2011] called this practice into question. Among 769 patients taking medication for treatment of GERD, those with severe symptoms had significantly lower rates of esophageal cancer than those with mild symptoms or none at all. This finding explained previous results showing that 95 percent of patients diagnosed with cancer were unaware of the presence of Barrett’s esophagus and thus had not been recommended for screening.
While most individuals can manage occasional heartburn through lifestyle changes and use of over-the-counter medications, many patients with gastroesophageal reflux disease need stronger prescription medications as well as lifestyle changes. In most cases, the disease is best managed by a gastroenterologist who has specialized diagnostic tools and experience.
Lifestyle measures that should be started even before occasional heartburn turns into GERD include:
• weight loss,
Generally, acidic and spicy foods are the culprits, but fatty, greasy foods such as french fries can also trigger heartburn.
• avoiding cigarette smoke,
• eating smaller meals,
• not eating a snack just before bedtime or lying down right after a meal;
• wearing clothing that fits loosely around the waist so as not to put pressure on the abdomen;
• sleeping on your left side;
• elevating the head of your bed six to nine inches with wood or cement blocks (raising your head with pillows will not help); and
• avoiding foods and drinks that trigger heartburn.
Generally, acidic and spicy foods such as oranges, vinegar, tomatoes and grapefruit are culprits, but fatty, greasy foods such as french fries also trigger heartburn in some persons. Carbonated and caffeinated drinks may also bring on acid reflux.
Initial over-the-counter heartburn treatments include antacids such as Maalox, Mylanta, Gelusil, Rolaids and Tums. These are designed to neutralize stomach acids, and overuse can cause diarrhea or constipation.
H-2 receptor blockers such as Tagamet HB, Pepcid AC, Axid AR and Zantac 25, 75 or 150 reduce stomach acid. These provide longer term relief but don’t act as quickly.
Proton pump inhibitors such as Prevacid and Prilosec block the production of acid, allowing damaged tissue in the esophagus time to heal.
Both H-2 receptor blockers and proton pump inhibitors are available in stronger prescription strength formulations. A doctor’s supervision is needed since proton pump inhibitors can lead to loss of bone density in some persons and may decrease the effectiveness of blood thinners such as Plavix.
Other medications, known as prokinetic agents, may be prescribed to tighten the sphincter muscle and help the stomach empty more rapidly.
When lifestyle changes and medications fail to stop symptoms, more invasive measures may be necessary. One surgical procedure, known as Nissen fundoplication, involves tightening the sphincter at the lower end of the esophagus by wrapping the very top of the stomach around it.
Another surgical procedure places stitches in the stomach near the weakened sphincter, creating a barrier to keep stomach acid from backing up. For a third option, scar tissue can be created through electrode energy to help strengthen the barrier. Both of these are used primarily for patients with severe, longstanding symptoms who are not considered good candidates for Nissen fundoplication.
If you suffer acid reflux on a regular basis, with symptoms that keep you awake or impair your productivity at work, it’s best to do something about it. Seeing a doctor is the first step toward relief.
04/18/2012
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