Feeling the Burn?

Bet you’ve been eating rich, greasy, and spicy foods the past month or so. Maybe a few cocktails to wash it all down or some cold bubbly soda, and delicious desserts followed by coffee. It all tastes so good going down. But unfortunately, for millions of Americans, it doesn’t taste as good coming back up as acid indigestion, or heartburn.

More than 60 million American adults experience heartburn at least once a month, and more than 15 million adults suffer daily from heartburn. Many pregnant women experience daily heartburn as well. For some people, it’s just too much of a good thing, and in a day or two the indigestion is gone.  But for those suffering regularly, it’s far more insidious and upsetting, and can cause long-term damage.

Gastroesophageal reflux disease, or GERD, is a digestive disorder that affects the lower esophageal sphincter, the ring of muscle between the esophagus and stomach. In most cases, GERD can be relieved through diet and lifestyle changes; however, GERD can result in serious complications. Esophagitis can occur as a result of too much stomach acid in the esophagus. Esophagitis may cause esophageal bleeding or ulcers. In addition, a narrowing or stricture of the esophagus may occur from chronic scarring. Some people develop a condition known as Barrett’s esophagus. This condition can increase the risk of esophageal cancer.

Gastroesophageal refers to the stomach and esophagus. Reflux means to flow back or return, so gastroesophageal reflux is the return of the stomach’s contents back up into the esophagus. In normal digestion, the lower esophageal sphincter (LES) opens to allow food to pass into the stomach and closes to prevent food and acidic stomach juices from flowing back into the esophagus. Gastroesophageal reflux occurs when the LES is weak or relaxes inappropriately, allowing the stomach’s contents to flow up into the esophagus.

What is hiatal hernia?

Some doctors believe a hiatal hernia may weaken the LES and increase the risk for gastroesophageal reflux. Hiatal hernia occurs when the upper part of the stomach moves up into the chest through a small opening in the diaphragm. The diaphragm is the muscle separating the abdomen from the chest. Many people with a hiatal hernia will not have problems with heartburn or reflux. But having a hiatal hernia may allow stomach contents to reflux more easily into the esophagus.

Coughing, vomiting, straining or sudden physical exertion can cause increased pressure in the abdomen resulting in hiatal hernia. Obesity and pregnancy also contribute to this condition. Many otherwise healthy people age 50 and over have a small hiatal hernia. Although considered a condition of middle age, hiatal hernias affect people of all ages.

Hiatal hernias usually do not require treatment. However, treatment may be necessary if the hernia is in danger of becoming strangulated or twisted in a way that cuts off blood supply, or is complicated by severe GERD or esophagitis. In these cases, your doctor may perform surgery to reduce the size of the hernia or to prevent strangulation.

To help your doctor diagnose GERD or hiatal hernia, an upper GI series may be performed during the early phase of testing. This test is a special X-ray that shows the esophagus, stomach, and duodenum (the upper part of the small intestine). While an upper GI series provides limited information about possible reflux, it is used to help rule out other diagnoses, such as peptic ulcers.

Endoscopy is an important procedure for individuals with chronic GERD. By placing a small lighted tube with a tiny video camera on the end (endoscope) into the esophagus, the doctor may see inflammation or irritation of the tissue lining the esophagus, and can easily and painlessly biopsy tissue samples.

What you can do to feel better

Doctors recommend lifestyle and dietary changes for most people needing treatment for GERD. Treatment aims at decreasing the amount of reflux or reducing damage to the lining of the esophagus from refluxed materials. Other tips for reducing or controlling reflux include:

  • Avoid foods and beverages that can weaken the LES. These foods include chocolate, peppermint, fatty foods, coffee, and alcoholic beverages. Foods and beverages that can irritate a damaged esophageal lining, such as citrus fruits and juices, tomato products and pepper also should be avoided.
  • Decrease the size of portions. Eating less at mealtime may also help control symptoms.
  • Eat meals at least two to three hours before Avoid eating within a few hours of going to bed or lying down. This may lessen reflux by allowing the acid in the stomach to decrease and the stomach to empty partially.
  • Lose weight. Being overweight often worsens symptoms.
  • Stop smoking cigarettes. Cigarettesmoking weakens the LES. Stopping smoking is important to reduce GERD symptoms.
  • Elevate the head of the bed. Raising your bed on six-inch blocks or sleeping on a specially designed wedge reduces heartburn by allowing gravity to minimize reflux of stomach contents into the esophagus. Do not use pillows to prop yourself up; that only increases pressure on the stomach.
  • Prescription and over-the-counter medications. Along with lifestyle and diet changes, your doctor may recommend over-the-counter or prescription treatments.

Antacids can help neutralize acid in the esophagus and stomach and stop heartburn. Many people find that nonprescription antacids provide temporary or partial relief. Long-term use of antacids, however, can result in side effects including diarrhea, altered calcium metabolism (a change in the way the body breaks down and uses calcium), and buildup of magnesium in the body. Too much magnesium can be serious for patients with kidney disease. If antacids are needed for more than two weeks, a doctor should be consulted.

For chronic reflux and heartburn, your doctor may recommend prescription medications to reduce acid in the stomach. Some of these medicines are H2 blockers, which inhibit acid secretion in the stomach. H2 blockers include cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), and ranitidine (Zantac). Additionally, doctors may prescribe proton pump inhibitors, which also decrease the amount of acid produced in the stomach. Prilosec (omeprazole) and Nexium also are commonly used to promote healing of damage to the esophagus caused by stomach acid, but these medications are not for the immediate relief of heartburn.

We can’t always prevent acid reflux or hiatal hernia, but we can choose to moderate our diets and behaviors to produce more favorable results. It’s a new year – consider adding the reduction or elimination of heartburn to your 2017 wish list!

 


Be sure to check out the CBIA Healthy Connections wellness program at your company’s next renewal. It’s free as part of your participation in CBIA Health Connections!