Heartburn. Acid reflux. By whatever name, when stomach acid backs up into your esophagus, the pain and discomfort felt can be the sign of a potentially serious condition. Gastroesophageal Reflux Disease (GERD), the technical name for this malady, is both common and treatable. Recognition is important, because severe and persistent disease is associated with significant complications.
The reflux of acid from the stomach into the esophagus is almost universal, and usually brief and without symptoms. GERD refers to the condition where exposure of the esophageal lining to acid causes symptoms such as heartburn, vomiting or pain with swallowing. If the reflux goes all the way up to the back of the throat, the acid can irritate your vocal cords, or even be inhaled in the lungs and cause cough and asthma-like symptoms.
The esophagus is the tube connecting the mouth to the stomach. Made of muscular tissue which enables food to be pushed down, it is protected from acid exposure by the lower esophageal sphincter (LES). The LES is a circular muscle at the junction of the stomach and esophagus which opens during the swallow reflex, but otherwise stays closed to prevent stomach contents from “going backwards”. It is weakness, or inappropriate relaxation, of the LES which is the basic cause of GERD.
Every one of us has probably had an occasional symptom of heartburn. However, if they occur more than two or three times a week, you should consult your primary care physician to see if further evaluation is necessary. Of particular concern would be if the symptoms are associated with unexplained weight loss, or the feeling of food “sticking” in your chest.
A number of conditions are associated with, or are potential contributors to GERD. Obesity, cigarette smoking, certain foods (chocolate, peppermint, alcohol and caffeine) and large meals followed by laying down can all increase acid entry into the esophagus.
There are a number of ways to make the diagnosis of GERD. Sometimes a thorough history and physical examination are adequate. For certain patients an endoscopic evaluation via a small tube passed into the stomach is required. The diagnosis is important because untreated GERD leads to chronic irritation of the esophagus, which can lead to irritation, ulcers, bleeding and, in the most severe form, cancer.
There are treatments available. For symptoms which occur once a week or less, antacids may be adequate. Many patients are advised to take “H2” blockers or proton pump inhibitors (PPIs), which work by decreasing acid production. In severe cases there are surgical options. In a recent report in the February 21, 2013 edition of the New England Journal of Medicine, a magnetic brace-like device wrapped around the end of the esophagus showed promise in patients who were not able to manage their symptoms with medications.
So eat smart, and be on the lookout for frequent heartburn symptoms. For an appointment to see a specialist in heartburn at Nassau University Medical Center, please call (516) 486-6862.