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HeartburnThomas Peller, MD Heartburn — the feeling of burning discomfort behind the breastbone,
Reflux occurs when the acidic contents of the stomach flow back up into the esophagus. The prolonged contact of the acid with the lining of the esophagus causes injury and produces a burning discomfort. Some degree of reflux is normal in everyone, especially after a large meal, but these episodes are short and occur infrequently (heartburn less than once per week). Acid reflux becomes GERD when a person has frequent symptoms (usually more than 2 episodes of heartburn per week) or the esophagus becomes damaged. Normally a sphincter, called the lower esophageal sphincter or LES, prevents these reflux events from occurring. However, in GERD, the LES relaxes too often, increasing the chance for reflux. Why the LES relaxes more often is not known. These relaxations can be particularly bad when they occur at night. When one is laying down, there is longer acid exposure because of the lack of gravity to drain the esophagus. Although heartburn is the most common symptom of GERD, not everyone with GERD will have heartburn. Some people experience what are called atypical symptoms of GERD including sore throat, hoarseness, worsening asthma, worsening dental disease, chronic cough and stomach pain. Other times the first symptom a person has is of a complication of GERD. Symptoms of complications include food sticking after swallowing, chest pain, bleeding, anemia and weight loss. If you experience any of these symptoms you should discuss them with your doctor. When symptoms are infrequent, lifestyle modifications and over-the-counter medications (OTC) to include Maalox, Mylanta, Zantac 75 and Pepcid AC, are usually sufficient to treat symptoms and prevent complications of the disease. Lifestyle changes include:• Eating smaller meals • Not eating 2 – 3 hours before lying down • Quitting tobacco • Losing weight • Avoiding foods that can cause heartburn such as spicy food, tomato products, chocolate, coffee and peppermint When symptoms are not controlled with lifestyle changes and OTC medications or OTC medications are needed more frequently, you should see your physician. This is so that an accurate diagnosis can be made and more aggressive treatment started, if needed. More aggressive therapy includes a group of drugs called proton pump inhibitors. These medications inhibit the release of acid into the stomach and provide the best long-term treatment for GERD. Aggressive treatment is needed in some patients, not only to eliminate symptoms, but also to heal damaged cells in the esophagus and prevent complications. Complications of GERD include narrowing of the esophagus (called a stricture) and a pre-malignant change in the lining of the esophagus called Barrett’s esophagus. The worse complication of GERD is cancer of the esophagus. Additional testing is sometimes ordered by the doctor if there is a poor response to aggressive treatment or the diagnosis of GERD is still uncertain. The most common test is an endoscopy. This involves passing a small flexible tube through the mouth and into the esophagus and stomach. A mild sedative is usually given. This test enables the physician to identify esophagitis (an inflamed esophagus) and Barrett’s esophagus. It also enables the physician to dilate the esophagus if a narrowing is noted. Heartburn is a common condition. For most people, it can be managed with simple measures. For others, it is a sign of a more significant problem called GERD, which if left untreated is potentially serious. For more information or to schedule an appointment with Dr. Peller call 715.830.9990 or visit www.southsideclinic.com. Dr. Peller sees patients in Eau Claire, Chippewa Falls and Cumberland. |
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