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Doctor, what exactly is heartburn and how can I prevent it?
You just ate a rich meal at your favorite steakhouse and now find yourself with a feeling like someone has dumped hot coals in the pit of your stomach. Or you may have recently fallen asleep and suddenly you wake up with a mouthful of sour, bitter liquid. If you have these or similar experiences, you are most likely one of the growing number of Americans, numbering in the millions, who suffer from Gastro Esophageal Reflux Disease or GERD.
Aggravated by the growing epidemic of obesity in our country, GERD affects everyone from young people to senior citizens. If you have problems with GERD, caused by acid reflux from the stomach going into the swallowing tube (esophagus), here are some tips for you:
- Avoid late-night meals and eat smaller meals.
- Foods such as citrus, tomato sauce, peppermint and chocolate can aggravate symptoms, as can alcohol, smoking and medicines like aspirin, Advil and Motrin (or any of the other NSAID-like drugs).
- Sleep with the head of the bed elevated, either by placing a 6-inch block underneath it or by using a wedge-shaped pillow purchased from a medical supply store.
- Weight loss in those significantly overweight and avoidance of tight-fitting garments may help reduce reflux.
- For occasional or rare instances of the problem, liquid antacids, TUMS, or over-the-counter medications like Pepcid, Zantac or Prilosec can offer relief.
- For those who experience symptoms often (weekly or more) or for those whose symptoms are not promptly relieved with the over-the-counter medicines, consultation with their doctor is necessary.
Unfortunately, there are a number of other diseases whose symptoms may mimic those of GERD, including serious heart disease, ulcer disease and gallbladder disease. Your doctor may want to order certain tests to exclude some of these problems, or you may be referred to a gastroenterologist (a stomach, intestinal and liver specialist) for further evaluation. He may also prescribe a class of medicines call PPIs, such as Prevacid, Prilosec, Nexium, Protonix or Aciphex, all of which are best if taken a half hour before breakfast in the morning. Most people will become symptom-free as long as they take their capsules. Their biggest drawback is cost, as they are expensive medications. Rarely, persistent laryngitis, recurrent pneumonia, chronic cough and new onset asthma can also be the result of GERD.
Those who have heartburn symptoms frequently (two to three times a week or more) and have had symptoms for a long time (more than a year) are at risk of developing a condition called Barrett’s esophagus. Barrett’s is a change that takes place in the lining of your swallowing tube, occurring in about 10 percent of those with chronic, frequent heartburn, where the normal cells get replaced by specialized intestinal lining cells called Barrett’s epithelium. The significance of this change (diagnosed by a procedure called an upper endoscopy or EGD) is that those who have Barrett’s have a 40-fold increase in the development of esophageal cancer as opposed to those who do not. To put this in perspective, the relative risk of developing esophageal cancer with Barrett’s is only about 0.5 percent per year, so most people with Barrett’s never get cancer. However, because they are in a higher risk group, they are monitored more frequently with regular endoscopies.
If you have problems with swallowing or having the food “stick” as it is going down, you may have developed a structure or even cancer secondary to GERD, and should seek urgent medical attention. Fortunately, the majority of GERD sufferers do not have complications of their disease, and can manage well with diet modification, weight loss and medicines, with surgery reserved for the rare refractory patient.
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| Contact Information |
Dr. George Ferenczi is board-certified in internal medicine and gastroenterology and practices at 210 S. Grand Ave., Suite 415 in Glendora.
For more information about Dr. Ferenczi or other fine physicians who have medical staff privileges at Foothill Presbyterian Hospital, call The Doctor Connection at 888/456-CVHP or visit The Doctor Connection on the web.
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