Q: I have occasionally had heartburn, often after meals, for as
long as I can remember. I usually take an antacid and it clears up,
but I have been wondering what’s causing the heartburn. Are there
more permanent solutions?
Q: I have occasionally had heartburn, often after meals, for as long as I can remember. I usually take an antacid and it clears up, but I have been wondering what’s causing the heartburn. Are there more permanent solutions?
A: The cause of heartburn is gastroesophageal reflux disease (GERD), a condition in which stomach contents, which contain acid, rise up from the stomach into the food pipe (esophagus). Normally, a ring of muscle at the bottom of the food pipe keeps stomach contents from rising up. The ring is called the lower esophageal sphincter, or LES. It opens when you swallow food, but closes when you are not swallowing. When that natural protective barrier fails, you’ve got GERD.
Symptoms of GERD can run the gamut from annoying to debilitating. Heartburn is usually felt in the chest just below the breastbone (sternum) but can extend upward to the neck. It may be accompanied by a sour taste in the mouth or a stinging sensation in the throat.
An irritated esophagus may also cause pain behind the sternum that can feel like food is stuck there.
GERD can also cause other problems you might not associate with heartburn, such as laryngitis, hoarseness, wheezing or a chronic cough. GERD should not be taken lightly. Fortunately, effective treatments are available, from simple changes in lifestyle to powerful acid-blocking medications and new, minimally invasive surgical procedures.
Most symptoms of GERD are temporary; for example, you may get heartburn only after a big meal or when you bend over or lie down. Certain foods, such as coffee, tea, chocolate and alcohol, may loosen the LES that normally protects against GERD.
So may nicotine. People who are overweight and pregnant women may suffer from heartburn because of increased pressure within the abdomen that pushes stomach contents upward.
Saliva helps neutralize acid in the esophagus, so anything that hampers saliva production can slow this process. That includes smoking and certain medical conditions. Finally, mental stress can boost stomach acid production, adding fuel to the fire.
There are a number of simple lifestyle changes you can make to avoid reflux episodes. Avoid chocolate, peppermint, alcohol, caffeinated beverages and fried and fatty foods that can cause reflux.
Avoid acidic foods, such as orange juice, wine and tomatoes. Various medications, such as aspirin, ibuprofen and similar anti-inflammatory drugs can also irritate an already inflamed esophagus.
Avoiding large meals and instead eating smaller meals more frequently will help as well. Be sure to also eat at least two to three hours before going to bed, especially if you have nighttime symptoms.
Elevating your head by putting blocks under your bed’s upper legs or a foam wedge under the mattress will help.
However, raising your head with pillows can bend the torso and increase abdominal pressure, causing further heartburn.
If your symptoms don’t respond to these lifestyle changes, the following conditions warrant a visit to a clinician: you have heartburn twice a week or more, you have difficulty swallowing or feel that food is getting caught, you notice blood or black tarry material in your bowel movement, or you are (unintentionally) losing weight.
A clinician can usually diagnose GERD just from your history and symptoms.
For mild, occasional heartburn, she or he will usually suggest over-the-counter medications. Antacids are readily available, but only provide relief after heartburn occurs. They do not prevent it outright and are only short-acting. They can also cause various side effects, including constipation or diarrhea.
For frequent or severe heartburn, medications that block acid production in the stomach are more effective. Some are available over-the-counter, in low doses. Stronger versions are available by prescription.
The strongest acid-blockers should eliminate symptoms in a few weeks, after which you may be able to stop or reduce the medication.
However, the symptoms might reoccur, in which case you will need to keep taking medication indefinitely. Long-term use of these drugs appears safe and effective, however. Sometimes, drugs that increase the strength of the LES are prescribed.
Surgery may be the best option for symptom relief, especially for young patients who need high doses of medication.
The most common procedure is the stomach wrap in which the upper part of the stomach is wrapped around the lower esophagus.
This creates a stronger seal above the stomach to prevent acid from going up. It’s not always a cure, however, and up to 50 percent of patients require acid-blocking medication within three to 10 years after the procedure.
New, less-invasive surgical methods have been introduced, and seem to be effective in the short-term, and long-term studies are still under way.
But before considering surgery, take time to examine your diet and lifestyle habits and to discuss medication options with your doctor. GERD can often be effectively controlled through the right steps.
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