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Don’t Ignore Persistent Heartburn Problems

Chad Stepke, M.D., Gastroenterologist, Columbia St. Mary’s

Posted: April 1, 2006

Gastroesophageal reflux disease, otherwise known as GERD, is a very common disorder. It is a chronic condition involving the back-flow of stomach acid into the esophagus. The majority of Americans experience an episode of heartburn or acid reflux at least once a year. But 20 percent of our population suffers from it one or more times a week– a frequency at which prescription strength medicine should be considered.

Although GERD is a treatable disease, serious complications can result if it is untreated or not treated properly. Over time it could lead to permanent damage of the esophagus and even cancer.

There are multiple causes for GERD, but the most common is a hiatal hernia, an abnormal opening in the diaphragm. The diaphragm is the muscle that separates the abdomen and chest and it helps keep acid from backing into the esophagus.

A hiatal hernia allows the uppermost part of the stomach to bulge through the diaphragm into the chest area, and this can lead to reflux. When the gastric acid reaches the esophagus, it causes the heartburn that most people occasionally experience.

For many patients with GERD, inappropriate diet can precipitate acid reflux. Therefore, it is a good idea to stay away from foods high in fat, which prolong the emptying time of the stomach; and foods high in acidity, which increase gastric acids. Eating late-night meals and then lying on your back in bed can cause acid reflux. Smoking and alcohol consumption also are contributing factors.

Symptoms of GERD vary from person to person. The majority of people with this disease have mild symptoms, with no evidence of tissue damage and little risk of developing complications.

Persistent heartburn is the most frequent symptom of GERD, but not the only one. Other symptoms can include belching; waterbrash, which is a sudden excess of saliva; chronic sore throat; chronic laryngitis; inflammation of the gums; erosion of tooth enamel; chronic irritation in the throat; hoarseness in the morning; a sour taste; and bad breath. Heartburn is also a cause for asthma attacks.

Chest pain may indicate acid reflux. But any type of chest pain calls for immediate medical evaluation because a possible heart condition must be ruled out.

There are other complications associated with reflux, conditions that traditionally require a more intensive evaluation. Patients presenting with such symptoms as prolonged nausea, difficulty in swallowing food, bloody or dark stool, or unexplained weight loss or appetite change, may have a more serious illness and should be examined carefully.

How can GERD be treated?
It is important to note that GERD is a recurrent and chronic disease that usually responds well to long-term medical therapy. The condition does not resolve itself.

There is not yet a cure, but there is a wide spectrum of possible treatments for this condition, depending on how severe it is. Treatment options include lifestyle modifications, medications, surgery or a combination of those methods.

Treatments range from antacid tablets that neutralize stomach acid to prescribed proton pump inhibitors and H2 blockers. The latter two effectively shut down gastric acid production. Proton pump inhibitors cut stomach acid production by 80 percent and H2 blockers cut it in half.

However, not everybody needs a prescribed medication. Many reflux problems can be managed by diet and lifestyle changes, as well as over-the-counter products. But once an active inflammation of the esophagus occurs, your doctor will prescribe an appropriate medication.

Stricture or scar tissue of the esophagus caused by gastric acid can cause a narrowing of that organ. This may require not only medication, but possibly endoscopic evaluation and treatment.

It is important to know that GERD is a disease that should not be ignored or self-treated. Heartburn is so common that you may underestimate its potential for more serious problems. If you think you may have GERD, the first thing to do is visit your physician for a diagnosis.

Chad Stepke, M.D.
Gastroenterologist
Columbia St. Mary’s
414-326-1745

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