Nearly everyone suffers from heartburn from time to time, but frequent episodes (two or more times weekly) can signal a condition that must be taken seriously. Chronic heartburn, also known as gastroesophageal reflux disease (GERD), can lead to internal bleeding and scarring-even a deadly form of cancer. More than 20 million Americans have GERD.
Alarming finding: The number of people hospitalized for conditions related to GERD doubled between 1998 and 2005, according to the US government's Agency for Healthcare Research and Quality.
What Goes Wrong
When you eat or drink, food and liquid move from your mouth to the esophagus, where a valve, called the lower esophageal sphincter, relaxes to allow the food and liquid to pass into your stomach. The lower esophageal sphincter then squeezes shut to keep stomach contents from backing up (a process known as reflux) into the esophagus.
Some degree of reflux occurs normally-including after meals. But when reflux becomes excessive, causes complications or affects quality of life, it is called GERD.
Symptoms that may be misdiagnosed: GERD-with or without heartburn-also can be characterized by chronic hoarseness or cough, sore throat or asthma, conditions that Occur when gastric contents come in contact with the upper respiratory tract.
A Life-Threatening Danger
No one knows exactly why some people suffer from frequent reflux. But regardless of the cause, chronic reflux can lead to injury and bleeding in the esophagus, which sometimes affects swallowing. With time (sometimes just a few years), cells lining the esophagus can become precancerous as a result of chronic inflammation. This condition, known as Barrett's esophagus, can lead to esophageal cancer, which is often fatal and is the most rapidly increasing cancer in the US.
Important: Because GERD can lead to serious, even life-threatening complications, see a doctor if you have heartburn two or more times weekly-or if you have symptoms (difficulty swallowing, unexplained chronic cough or hoarseness) that don't respond to standard treatment, such as medication and lifestyle changes.
Getting The Right Diagnosis
A primary care doctor or gastroenterologist usually diagnoses GERD on the basis of the symptoms described earlier. In some cases, the doctor will perform endoscopy, in which a thin, flexible, fiber optic tube is passed through the throat to examine the esophagus and upper part of the stomach.
Ask your doctor about: An esophageal acidity test. With this procedure, a tiny device is placed in the esophagus to monitor levels of acidity for 24 hours (very high levels usually indicate GERD). This test typically is used when a patient has not responded to treatment or has atypical symptoms (such as chronic cough or hoarseness).
Best Medication Choices
Over-the-counter (OTC) antacids, such as TUMS, Rolaids and Maalox, neutralize stomach acid and may help relieve heartburn, but they do not heal the injury to the esophagus caused by reflux.
People who have frequent heartburn usually get better results from acid-reducing prescription medication, such as H2 blockers, including ranitidine (Zantac) and famotidine (Pepcid), or proton pump inhibitors (PPI), including omeprazole (Prilosec) and esomeprazole (Nexium). Some of these medications are available OTC.
Ask your doctor about: Potential side effects of long-term use of PPIs, which include reduced absorption of vitamin B-12, calcium and magnesium, higher risk for bone fractures and increased risk for respiratory infections.
Small Changes That Help
If followed conscientiously, lifestyle changes can eliminate the need for medication in up to 20% of GERD sufferers. My advice…
- Check your medications. Calcium channel blockers and beta-blockers taken for high blood pressure or heart disease, as well as some antidepressants and anti-anxiety medication, can reduce lower esophageal sphincter (LES) pressure and may worsen GERD. If you have heartburn symptoms, ask the doctor who prescribed your medication about alternatives.
- Modify your eating habits. Small, frequent meals leave the stomach quickly, thus providing less opportunity for reflux.
Avoid foods that may worsen GERD: Onions, chocolate and fatty foods reduce LES pressure, allowing reflux to occur.
- Sleep right. If you're troubled by reflux when you sleep, place a foam wedge under the mattress or wooden blocks under the bedposts to elevate the head of your bed by four to six inches.
Important: Extra pillows under your head will not do the job. They will raise your head, but won't change the angle between your stomach contents and your LES.
Stress causes the LES to relax more often. This will increase the occurrence of reflux episodes. Practicing a regular stress-reduction technique, such as deep-breathing exercises, has been shown to reduce the amount of acid in the esophagus. Also helpful…
- Acupuncture. This ancient Chinese practice is most likely to help people diagnosed with "slow stomach"-that is, their GERD is worsened by food taking longer to leave the stomach. Acupuncture can improve the movement and emptying of stomach contents.
- Probiotics, such as Lactobacillus acidophilus and Lactobacillus bifidus, are "friendly" bacteria that reduce the harmful effects of acid in the esophagus.
My advice: Eat yogurt or kefir containing "live, active" cultures twice daily.
The Surgical Option
Surgery usually is an option if drug treatment and alternative approaches have failed.
In the standard procedure, called fundoplication, part of the upper stomach is wrapped around the LES to strengthen it. This operation can be performed with tiny incisions (laparoscopically), rather than by opening the chest.
In one study of 100 individuals, 90% expressed overall satisfaction with the surgery. Although 80% continued to take anti-reflux medications, most took lower doses than before the surgery. Some new procedures, which involve injections or sutures to tighten the LES, are promising but as yet unproven.