Monday Medical: Know the signs of gastroesophageal reflux disease
November 24, 2013
Steamboat Springs — There are many things to look forward to on Thanksgiving. Heartburn isn't one of them.
Heartburn is a burning sensation in your chest or throat caused by acid reflux or stomach acid flowing back into your esophagus. Occasional heartburn is normal, but frequent or severe heartburn can affect your daily life and result in serious complications if not treated.
Gastroesophageal reflux disease, or GERD, occurs when recurrent acid reflux irritates and inflames the esophagus, resulting in heartburn or other symptoms such as regurgitation, difficulty swallowing, hoarseness and sore throat.
GERD is common, affecting about one in five adults in the U.S., according to the International Foundation for Gastrointestinal Disorders.
"Everybody has acid reflux, but only a portion of us reflux to the point where it bothers us," explained Dr. Mark McCaulley, an internal medicine physician at Yampa Valley Medical Associates.
McCaulley performs a test called upper endoscopy, in which he uses a small camera inserted through the mouth to assess damage in the esophagus such as sores or ulcers. He performs about five to 10 of the procedures each month.
The test also might reveal abnormalities in the esophagus lining, a condition called Barrett's esophagus, which is linked to an increased risk for esophageal cancer. About five in 100 people with acid reflux develop Barrett's esophagus, and the cancer risk among those is relatively low. However, those diagnosed with the condition need regular endoscopy exams to watch for warning signs of cancer.
Acid reflux occurs when the band of muscles between the stomach and esophagus, the lower esophageal sphincter, does not close properly. It's not always clear why this happens. Sometimes, large meals can cause the muscles to become relaxed.
A hiatal hernia, which is when part of the stomach protrudes up through the diaphragm, can result in acid reflux in some people. Other risk factors for GERD include obesity, pregnancy, smoking, asthma and diabetes.
The International Foundation for Gastrointestinal Disorders recommends you consult with your doctor if you have heartburn two or more times per week or have had it occasionally for several years, your heartburn happens at night and is affecting your sleep, or heartburn discomfort or pain is interfering with your daily activities.
It's particularly important to seek medical attention if you are having difficulty or pain swallowing, which can indicate narrowing of the esophagus or esophageal cancer, or if you have chest pain, which can be a sign of a heart attack.
Various treatment options are available to control acid and provide patients relief. Proton pump inhibitors such as omeprazole (Prilosec) can be particularly effective in reducing stomach acid but may come with trade offs.
McCaulley noted that stomach acid's role is not to help digest food but to sterilize the upper digestive tract. So reducing acid could make a person more susceptible to infections from digested pathogens.
There is some evidence that proton pump inhibitors could inhibit calcium absorption, increasing a person's risk of bone fractures. It's important to work with your doctor in developing a medication strategy appropriate to your risk factors, McCaulley said.
Individuals who do not respond to medication may be candidates for surgery to reinforce, strengthen or replace the lower esophageal sphincter.
Lifestyle changes that can help reduce heartburn include maintaining a healthy weight, quitting smoking, eating smaller meals, waiting at least three hours after eating before going to bed and elevating the head of your bed.
Foods and drinks that may trigger heartburn include fatty or fried foods, tomato sauce, alcohol, chocolate, caffeine and onions. Anti-inflammatory medications such as ibuprofen and naproxen also can aggravate GERD.
To learn more about GERD, visit http://www.aboutgerd.org.
Tamera Manzanares writes for Yampa Valley Medical Center. She can be reached at firstname.lastname@example.org.