Heartburn Treatment -- July 7, 2008 -- Dr. Hank Russell - NewsChannel5.com | Nashville News, Weather & Sports

Medical Mondays
July 7, 2008
Heartburn Treatment

Heartburn is a condition where stomach acid backs up into the lower esophagus. When a muscular valve called the lower esophageal sphincter relaxes and allows acidic stomach fluids to come back up, reflux occurs. Unlike the lining of the stomach, which is equipped to handle high levels of acid, the lining of the esophagus is sensitive and easily inflamed.

Heartburn usually begins as a burning pain that starts behind the breastbone and radiates upward to the neck. Severe heartburn can be confused with heart problems and vice-versa, therefore obtaining proper diagnosis and care is very important. If left untreated, chronic acid reflux can damage the esophagus and possibly lead to cancer of the esophagus. As many as 60 million Americans experience heartburn at least once a month. There are varying degrees of heartburn.

• Episodic, or occasional, heartburn is characterized by infrequent bouts of heartburn that are usually manageable or predictable in the short term.
• Frequent heartburn occurs two or more days per week. Frequent heartburn sufferers also may be those who medicate heartburn symptoms more than two days per week.
• Severe, or chronic, heartburn occurs more than two days per week and persists while taking appropriate medications despite dietary and lifestyle changes.

Chronic heartburn can lead to a more serious disease þu gastroesophageal reflux disease. Heartburn, regurgitation, belching, bloating, hoarseness, chronic sore throat, difficulty breathing, difficulty sleeping or lying flat are all signs of GERD.

Find out if you have symptoms of GERD:

• I get a burning feeling in the middle of my chest.
• I often have this feeling after a meal or at night.
• This burning feeling gets worse when I lie down or bend over.
• Over-the-counter medications, such as acid reducers or antacids, help the burning go away.
• I frequently regurgitate (burp up) my food.
• There is a bitter or sour taste in the back of my throat.

If you experience one or more of the symptoms above, there is a good chance you have GERD. Untreated, GERD can lead to more serious health problems such as bleeding or ulcers, difficulty swallowing or even esophageal cancer.

Some factors that can make GERD worse include:

• Certain foods, such as fatty foods, spicy foods, chocolate, caffeine, onions, tomato sauce, carbonated beverages and mint
• Alcohol
• Large meals
• Lying down soon after eating
• Certain medications, including sedatives, tranquilizers and calcium channel blockers for high blood pressure
• Cigarette smoking

Risk factors

Conditions that cause difficulty with digestion can increase the risk of heartburn or GERD. These include:

• Obesity. Excess weight puts extra pressure on your stomach and diaphragm - the large muscle that separates your chest and abdomen - forcing open the lower esophageal sphincter and allowing stomach acids to back up into your esophagus. Eating very large meals or meals high in fat may cause similar effects.
• Hiatal hernia. In this condition, also called diaphragmatic hernia, part of your stomach protrudes into your lower chest. If the protrusion is large, a hiatal hernia can worsen heartburn by further weakening the lower esophageal sphincter muscle.
• Pregnancy. Pregnancy results in greater pressure on the stomach and a higher production of the hormone progesterone. This hormone relaxes many of your muscles, including the lower esophageal sphincter.
• Asthma. Doctors aren't certain of the exact relationship between asthma and heartburn. It may be that coughing and difficulty exhaling lead to pressure changes in your chest and abdomen, triggering regurgitation of stomach acid into your esophagus. Some asthma medications that widen airways also may relax the lower esophageal sphincter and allow reflux. Or it's possible that the acid reflux that causes heartburn may worsen asthma symptoms. For example, you may inhale small amounts of the digestive juices from your esophagus and pharynx, damaging lung airways.
• Diabetes. One of the many complications of diabetes is gastroparesis, a disorder in which your stomach takes too long to empty. If left in your stomach too long, stomach contents can regurgitate into your esophagus and cause heartburn.
• Peptic ulcer. An open sore or scar near the valve in the stomach that controls the flow of food into the small intestine can keep this valve from working properly or can obstruct the release of food from the stomach. Food doesn't empty from your stomach as fast as it should, causing stomach acid to build up and back up into your esophagus.
• Delayed stomach emptying. In addition to diabetes or an ulcer, abnormal nerve or muscle functions can delay emptying of your stomach, causing acid backup into the esophagus.

Treatments
Upper Endoscopy
Your physician will use this procedure to evaluate the condition of tissue in your esophagus and stomach. Using a slender scope, your physician can take pictures and biopsies of these areas as necessary. Any damage to the esophagus from GERD is assessed.

Esophageal Manometry
This procedure measures pressure in the esophagus and provides information about its function.

24-hour pH Study
This study involves recording actual acid levels (pH) in the esophagus for 24 hours while you are at home and carrying out your daily activities. This information accurately establishes whether or not GERD is the cause of your symptoms.

Medical Therapy
The array of medications for heartburn treatment is rapidly changing. Physicians can help you make decisions on medication benefits versus its expense.

Minimally Invasive Surgery
When medicine isn't the best option, minimally invasive surgical procedures can be performed. These surgeries involve tiny incisions and usually require only an overnight stay.

Barrett's Esophagus

Over time, irritation to the esophagus can cause the normally white lining to stop growing back and to be replaced by a precancerous red one, known as specialized intestinal metaplasia. The condition - Barrett's Esophagus - is being diagnosed in more and more patients and should be taken seriously, doctors say. Physicians estimate that 10 to 12 percent of patients with GERD also have Barrett's Esophagus, which has been linked to a form of cancer called esophageal adenocarcinoma. Though the cancer still is somewhat rare, the incidence definitely is on the rise, increasing fivefold in 30 years. While the risk of developing cancer is seemingly low at 0.5 percent per year in patients who have GERD, the disease often goes undetected until a person is in their 60s and the esophageal lining has been changing for 10 to 20 years. Warning signs including difficult or painful swallowing and other non-specific symptoms such as unexplained weight loss also should mandate evaluation by a physician. The American College of Gastroenterology cites additional risk factors for Barrett's Esophagus including age, male sex, Caucasian ethnicity and GERD symptoms of longer than 10 years.