Over 60 million Americans experience heartburn at least once a month. 15 million may experience heartburn symptoms each day. These symptoms may be more common among the elderly and women during pregnancy.
What is heartburn or GERD?
Gastroesophageal reflux is a physical condition in which acid from the stomach flows backward up into the esophagus (tube leading from the mouth to the stomach). People will experience heartburn symptoms when excessive amounts of acid reflux into the esophagus. Some patients may have chest pain or discomfort with it. Some even experience the bitter or sour taste of acid in the back of the throat. Symptoms may last for hours and may worsen after meals, with exercise, or when the person lays down to sleep at night. All of us may have occasional heartburn. But frequent heartburn, food sticking in one's throat, food regurgitation, choking, or weight loss may require a more extensive evaluation and treatment by your physician.
What causes heartburn or GERD?
Where the esophagus joins the stomach, there is a muscular rign called teh lower esophageal sphincter (LES). NOrmally, this muscular ring acs like a door that opens to let food into the stomah and then closes to keep stomach acids (which help digest one's food) from flowing backward into the stomach. When the LES muscles are weakened, acid from the stomach may flow back into the esophagus. This can cause the esophagus to become inflamed and irritated (a condition called "esophagitis") and produce the burning pain and discomfort of GERD. If left untreated, GERD can even cause ulcers to form in the esophagus, which can cause swallowing problems and even strictures which can make it difficult to swallow food.
How can one prevent infrequent heartburn?
Often lifestyle modifications can prevent the weakening of the LES that causes GERD. Such modifications include:
- Avoiding foods and beverages which contribute to heartburn such as alcoholic drinks, coffee, tea, sodas (especially caffeinated sodas), chocolate, and peppermints. Spicy and greasy foods can also be irritating.
- Stop smoking. Tobacco stimulates stomach acid production and relaxes the LES, contributing to GERD.
- Eat smaller meals.
- Reduce weight if overweight. Even small amounts of weight loss may help.
- Avoid eating within 3 hours of laying down to sleep and avoid drinking fluids within 1 & 1/2 hours of laying down.
- Avoid tight fitting clothing and bending over at the waist. Bend at the knees instead.
- Prop up the head of the bed on 4-6 inch blocks, especially if nocturnal symptoms are a frequent problem. Using extra pillows instead is not a good substitute, but a foam wedge beneath the upper half of the body is an alternative.
Over-the-counter medications may also be useful:
- Antacids such as Mylanta, Maalox, or Tums may provide quick relief.
- Gaviscon is a useful antacid with a foaming agent such that if reflux occurs the first fluid refluxing into the esophagus is the protective foam.
- Tagamet, Zantac, and Pepcid are known as H2 Blockers. They are available in over-the-counter strengths. However if one requires use of these products more than a couple of times a week, then a visit to one's physician and prescription of a stronger medication may be in order.
What prescription medications are used in GERD?
- H2 Blockers - Tagamet, Zantac, Pepcid, and Axid have long been mainstays in therapy in controlling the degree of stomach acid production and reducing the degree of esophagitis. Twice a day therapy with these agents may eliminate symptoms in about half of all patients and promote healing. Over-the-counter strength doses of these medications are also available.
- Proton Pump Inhibitors - Prilosec and Prevacid are stronger than H2 blockers and are indicated in moderate to severe esophagitis. Some patients may take it for 3 months to promote healing while others may require prolonged therapy to maintain control of the disease.
- Promotility agent - Reglan works in mild to moderate GERD by increasing the lower esophageal sphincter pressure which helps to prevent acid reflus and improve the movement of food out of the stomach. This is sometimes used in conjunction with one of the above medications.
What are the surgical options?
A Nissan Fundoplication is a surgical procedure which can be considered when other measures fail in a younger patient with severe disease who does not wish to be on medications for the rest of his life. This surgical technique tightens the lower esophageal sphincter, increasing the body's barrier against acid reflux.
What are the severe complications and atypical manifestations of GERD?
- Chest pain - Patients may experience chest pains that may be confused with heart disease pains. A cardiac work up may be indicated in some patients in conjunction with a GI work up.
- Asthma - Some patients with asthma have problems with reflux that then aggravates the asthma symptoms because the patients aspirate small amounts of reflux fluids into their lungs.
- Esophageal stricture - This complication is caused by the trauma of chronic acid reflux causing scarring and stricture in the distal esophagus. Patients then develop problems with swallowing food and may require a dilation and chronic medications.
- Barrett's Esophagus - Reflux sometimes stimulates the growth of tissue lining the esophagus such that it resembles the lining of the stomach or intestines. These patients then have a 30-fold increased risk of cancer of the esophagus, and must be followed on a regular basis by a gastroenterologist.