Are You Suffering From Heartburn?

Monday, November 01, 2010

Many people suffer from symptoms of heartburn and most associate the term with an upset stomach or burning sensation in the chest or throat. Often these symptoms occur as a result of certain dietary habits, such as citrus juice or tomato sauce intake. However, some people find they occur more frequently and regardless of food choices. These people might be experiencing gastroesophageal reflux disease, commonly referred to as GERD.

What is GERD?

Gastroesophageal reflux disease is a condition whereby acid from the stomach rises up into the esophagus. Normally, there is a tightening of muscles at the lower end of the esophagus which keeps stomach acid and contents inside the stomach. Sometimes this musculature, the lower esophageal sphincter, relaxes allowing stomach acid to rise into the esophagus causing heartburn or acid indigestion.Frequent heartburn sufferers experience mid-abdominal to mid-chest discomfort associated with bloating, belching, a sour taste in the mouth and sometimes nausea with regurgitation of the stomach contents.

What happens if GERD is not treated?

While the special cells that line the stomach are designed to withstand harsh stomach acid, the cells in the esophagus are not. These cells lining the esophagus can become damaged in the setting of persistent GERD. Sometimes they can become inflamed causing esophagitis or a pre-malignant condition such as Barrett’s Esophagus. If left untreated Barrett’s can proceed to cancer of the esophagus.

What increases the risk for GERD?

Some factors that can relax the lower esophageal sphincter, and therefore, increase the likelihood of GERD are gravity (reclining after meals), tight clothing, excess weight, and alcohol intake. The chemical make-up of nicotine, caffeine, and chocolate have been implicated in lower esophageal sphincter relaxation. Lifestyle modification is a mainstay of treatment for GERD. Many patients are instructed to elevate the head of the bed, always eat the last meal of the day two or more hours before bedtime and reduce intake of any offending agents.

How is GERD treated?

While over the counter antacids might be sufficient for occasional heartburn, persistent heartburn sufferers often require other medication to decrease the amount of stomach acid. There are two main classes of medications commonly used for this purpose – histamine blockers and proton pump inhibitors.

Histamine blockers include drugs such as ranitidine and famotidine. Proton pump inhibitor medications act by reducing how acid is produced in the stomach. Both classes of these acid reducing medications are available with and without a prescription.

Moreover, lifestyle modification is key in the effective treatment and prevention of GERD symptoms. While some patients respond after a short course of treatment, others require medications on a more long term basis. Medication choices should be discussed with your healthcare provider.

What if the symptoms do not improve?

GERD that is refractory to treatment might need further evaluation to determine if damage has been done to the esophagus or if other causes exist for the heartburn symptoms. When symptoms do not resolve after a reasonable course of medication, your primary care physician mght refer you to a specialist for additional testing such as an X-ray or endoscopic evaluation or even surgery.  

In closing, occasional heartburn is a common complaint of many people. If you are a frequent heartburn sufferer, you maight be experiencing GERD. While lifestyle modification and antacids might help, seek the care of a physician for persistent symptoms. It is essential to be evaluated by a healthcare provider to verify your diagnosis and follow an appropriate course of treatment - for some this may even include surgery.

Jewel W. Crockett, MDDr. Jewel Crockett
Specializing in Internal Medicine