Quenching the fire of heartburn
|Changing one's diet can prevent heartburn.|
Millions of Americans experience heartburn, or acid reflux, at least once a month. According to Yahya Mohammadian, an internal medicine physician at UC Davis Medical Group in Rocklin, the term “heartburn” was coined to describe the sensation of acid burning the esophagus, which lies just behind the heart.
Gastroesophageal reflux disease (GERD), also call acid reflux, is the most common adult chronic disease in the United States.
“The esophagus, or food pipe, is the tube stretching from your throat to your stomach,” Mohammadian says. “Food you swallow travels down the esophagus into the stomach, which produces hydrochloric acid to aid in the digestion of food. The inner lining of the stomach resists corrosion by this acid because cells that line the stomach secrete a protective mucus. The lining of your esophagus does not share these resistant features, leaving it vulnerable to stomach-acid damage.”
Normally, a muscle at the bottom of your esophagus, called the lower esophageal sphincter, prevents reflux (or backing up) of acid, the UC Davis primary care physician explains. This sphincter relaxes during swallowing to allow food to pass; it then tightens to prevent flow in the opposite direction.
With GERD, however, the sphincter relaxes between swallows, allowing stomach contents and corrosive acid to well up and damage the lining of the esophagus. It occurs to some degree in all healthy persons without causing significant esophageal damage. About 10 percent of the adult population develops daily symptoms of heartburn and nearly half go on to develop tissue injury, which causes painful swallowing and bleeding, Mohammadian says.
When to see your doctor
“If you are taking antacids more than four times a week to control symptoms, it's time to see a physician,” Mohammadian recommends. “While antacids partly alleviate symptoms, they may also mask more serious problems.”
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Some people have pain from the esophagus that mirrors chest pain and looks to the entire world like heart trouble. Other people may have stomach acid that spills over and causes inflammation of the vocal cords, leading to chronic cough, changes in voice, esophageal spasm or asthma.
If you have any of the following symptoms, he says, you should share it with your doctor immediately:
- Severe chest pain or pressure, especially if it radiates to your arm, neck or back
- Vomiting followed by severe chest pain
- Vomiting blood
- Dark, tarry stools
- Difficulty swallowing solids or liquids
“Early treatment of GERD not only improves symptoms like heartburn but also may prevent serious complications.” Mohammadian says. Your primary care physician will first look for indications of a serious infection, such as blood in the stool or weight loss.
Contributing factors to acid reflux
No one knows the exact cause of gastroesophageal reflux disease. Several contributing factors weaken or relax the lower esophageal sphincter, causing reflux, including:
Lifestyle — Use of alcohol or cigarettes, obesity or poor posture, such as slouching.
Medications — Calcium channel blockers, theophylline (Tedral, Hydrophed, Marax, Bronchial, Quibron), nitrates and antihistamines.
Diet — Fatty and fried foods; chocolate; garlic and onions; drinks with caffeine; acidic foods, such as citrus fruits and tomatoes; spicy foods; and mint flavorings.
Eating habits — Eating large meals or eating soon before bedtime.
Other medical conditions — Hiatal hernia, pregnancy, diabetes and rapid weight gain.
If no infection is detected, your doctor may suggest lifestyle changes and medication. Since weight gain, smoking and alcohol have all been implicated in the development of gastrosophageal reflux disease, the physician may recommend losing weight, quitting smoking and avoiding alcohol. The physician may also suggest elevating the bed slightly because exposure to esophageal acid can be reduced through gravity, and the physician may suggest eating smaller meals and avoiding spicy and fatty foods.
Pharmacological treatment involves the use of H2 antagonists, such as Tagamet, Zantac, Pepcid or Axid, which suppress acid secretion, and some familiar brand-name antacids, such as Gaviscon, Maalox, Mylanta, Tums or Propulsid, which promote stomach emptying, acid clearing in the esophagus and muscle tightening. In stubborn cases, physicians may prescribe stronger acting proton-pump inhibitors like Prilosec or Pravacid, which virtually shut off acid, or medications like Sucralfate (Carafate), which coats mucous membranes and sores to provide an additional protective barrier against stomach acid.
“If I suspect a more serious problem, I refer my patient to a gastroenterologist,” he says. The specialist might perform a barium swallow test to detect a stricture in the esophagus or an endoscopy to detect signs of inflammation or Barrett's esophagus, which is a predisposing condition of cancer of the esophagus. Another diagnostic tool, a probe, may be used to test of the stomach's acid pH.
Only in rare cases is surgery necessary. Today, gastrointestinal surgeons are able to perform a fundoplication laparoscopically. During the operation, surgeons wrap part of the stomach around the esophagus, re-establishing a muscular barrier to prevent reflux. The entire operation is performed through tiny incisions made in the abdominal wall.