Over 60 million Americans experience heartburn at least once a month and studies have suggested that over 15 million have symptoms every day.
Heartburn is a common, but not necessarily trivial condition. If you suffer infrequent heartburn, antacids or the newer over-the-counter remedies now available without a prescription may provide the relief you need.
But, if you are experiencing heartburn more than twice a week, or still have symptoms on your current medication, it may be more serious, You may have “acid reflux disease” (also known as Gastroesophageal Reflux Disease or GERD) which is potentially serious if not treated appropriately.
If you are self-medicating for heartburn more than 2 times a week, or you’re still having symptoms on your over-the-counter or prescription medication, you should see your doctor. You may be referred to a gastroenterologist, a physician specializing in digestive diseases.
Your gastroenterologist may evaluate you for GERD. Using the range of prescription medications and other treatments available today, you may be able to become symptom-free, avoid potential complications, and restore the quality of life you deserve.
What is GERD ?
Gastroesophogeal reflux is a physical condition in which acid from the stomach flows backward up into the esophagus. People experience heartburn symptoms when excessive amounts of acid reflux into the esophagus. Many describe heartburn as a feeling of burning discomfort, localized behind the breastbone, that moves up toward the neck and throat. Some even experience the bitter or sour taste of the acid in the back of the throat. The burning and pressure symptoms of heartburn can last for several hours and often worsen after eating food. All of us may have occasional heartburn, however, frequent heartburn (two or more times a week), food sticking after swallowing, GI tract bleeding or weight loss may be associated with a more severe problem known as Gastroesophogeal Reflux Disease.
Most people will experience heartburn if the lining of the esophagus comes into contact with too much stomach “juice” for too long a period of time. This stomach “juice” consists of acid, digestive enzymes, and other materials, which can be potentially injurious. The prolonged contact of these stomach juices with the lining of the esophagus injures the tissue in the esophagus and produces a burning discomfort.
Normally, a muscular valve at the lower end of the esophagus called the lower esophageal sphincter or “LES” keeps the acid in the stomach. In gastroesophageal reflux disease, the LES relaxes too frequently and allows stomach acid to reflux, or flow upward into the esophagus.
GERD can masquerade as other diseases or aggravate them. Patients with GERD may have chest pain similar to angina or heart pain. If your doctor has ruled out cardiac trouble and you have chest pain, it may be GERD. GERD may also be a cause of ear, nose and throat problems such as chronic cough, sore throat, frequent throat clearing or growths on the vocal cords. If these problems do not improve with standard treatments, GERD may be investigated as a cause. Patients may experience bleeding, vomiting blood, or have black tarry bowel movements. They may also experience shortness of breath, choking, coughing or hoarseness.
Complications of Longstanding GERD
Peptic Stricture: This results from chronic acid injury and scarring of the lower esophagus. Patients complain of food sticking in the lower esophagus. Stretching of the esophagus and proton pump inhibitor medication are needed to control the condition.
Barrett’s Esophagus: A serious complication of chronic GERD is Barrett’s esophagus. Here the lining of the esophagus changes to resemble the intestine. Patients with the condition may not have heartburn, but have a 30 times greater risk of developing esophageal cancer.
Evaluating and Treating GERD at the Heartburn Center at Graduate Hospital
Our interdisciplinary team uses a variety of techniques to diagnose your condition, including:
Esophageal Manometry which involves passing a small flexible tube through the nose into the esophagus and stomach to measure pressures and functions of the esophagus.
Esophageal pH which involves passing a very small flexible tube through the nose into the esophagus and stomach so that the degree of acid refluxed can be measured over 24 hours.
Upper GI Series in which you will swallow a liquid barium mixture and a radiologist will use a flouroscope to watch the barium as it flows down the esophagus and into the stomach.
Endoscopy which involves passing a small lighted flexible tube through the mouth into the esophagus and stomach to examine abnormalities. The test is usually performed with the aid of sedatives. It is the principal method to identify esophagitis and Barrett’s esophagus.
Treatments for GERD
Some patients experience relief from lifestyle changes such as raising the heard of the bed and changes such as avoiding eating less than three hours before bedtime. Changing diet to foods which do not diminish the effectiveness of the LES may help. This includes avoiding especially fatty foods, chocolate and avoiding foods which irritate the lining of the esophagus (especially coffee, citrus juice and tomato juice).
Prescription Medication Treatments including:
H2 receptor antagonists – Used since the 1970’s, these are acid-suppression agents which improve heartburn and reduce the flow of stomach acid. They can help about 50% of patients with twice daily dosing, but healing of the esophagus may require higher dosing. These agents maintain complete remission of symptoms in about 25% of patients.
Proton pump inhibitors – These have been found to be effective in healing esophagitis more rapidly than H2 blockers. They provide not only relief of symptoms, but also promote healing. Studies have shown that these usually can promote healing of the muscosal tissues of the esophagus in 6 to 8 weeks in 75% or more of cases. They are significantly more expensive, however, than H2 receptors.
Promotility agents - These drugs increase lower esophageal sphincter pressure and prevent reflux. Symptoms are eliminated in about 50% of patients with twice daily dosing.
Other Treatment Options
When lifestyle and diet changes combined with medical treatment with drugs are not sufficient to return patients to the quality of life they expect, or patients cannot tolerate the medications, surgery may be an option. Surgery may be considered for any patient not achieving improved healing of damage to the esophagus with other methods, chronic bleeding, or recurrent stricture.
A variety of techniques are used to improve the natural barrier between the stomach and the esophagus. These include traditional surgical techniques and newer videoscopic techniques, which are less invasive and are appropriate for many patients.
Evaluation of the need for and appropriateness of surgery should be made after consulting with both a gastroenterologist and a surgeon experienced in the area of esophageal and LES repair.
If You Experience Chronic Heartburn, see your doctor or call the Heartburn Center at Graduate Hospital for an evaluation.
Call Toll Free at (877) 200-BURN