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more articles by Brennan, Peter , MD  |  author's bio

Recurring Heartburn Can Lead to Serious Problems

Recurring Heartburn Can Lead to Serious Problems

By Peter Brennan, MD

From time to time everyone experiences acid reflux. The typical scenario is on Thanksgiving when you've eaten too much, and you decide either to stretch out on the couch for a nap or play a family game of touch football to burn off some calories. As you lay your head on the pillow -- or bend over to hike the football -- that burning sensation that rises up in your throat is acid reflux. The pressure in your stomach from overeating has caused you to regurgitate stomach acid into the esophagus (the swallowing tube that leads from the back of your mouth to your stomach). It's an unpleasant sensation, but not serious.

Persistent acid reflux, on the other hand, is more serious and can develop into a condition called gastroesophageal reflux disease, more commonly known as GERD. If you experience acid reflux (what many people call "heartburn") as often as once a month, you should reduce the factors that produce acid reflux.

What can I do to reduce acid reflux?

The factors that contribute to acid reflux typically relate to lifestyle. If you are overweight, eat large, erratic meals that are high in fat, or regularly skip meals, you should modify your diet and eating habits. You should also avoid lying down right after eating. If you undertake these lifestyle changes and the acid reflux persists, follow up with your doctor to determine if you have GERD.

How is GERD diagnosed?

If your health background reveals the classic symptoms of acid reflux over an extended period of time, GERD is a likely diagnosis. However, if you are an older patient with the sudden onset of feelings of heartburn, your doctor may recommend an evaluation of your heart because your symptoms could indicate cardiac problems.

If you have had acid reflux symptoms for a number of years, your doctor may recommend that your esophagus be examined with an endoscope for signs of chronic inflammation and scar tissue. Approximately ten percent of patients with GERD require endoscopy to assess the lining of their esophagus.

What is endoscopy?

This examination is done on an outpatient basis at both Cayuga Medical Center and at Surgicare on the Ithaca Convenient Care Campus and is very easily tolerated by most patients. Under light sedation, a thin, flexible tube with a light source and a tiny camera is inserted through the mouth and into the esophagus. This allows the gastroenterologist to carefully examine the lining of the esophagus.

Why is it important to have GERD treated?

It is important to treat GERD to prevent chronic anatomic changes in the lower esophagus caused by persistent stomach acid burn. These changes can lead to stiffness and narrowing of the channel, which leads to impaired swallowing. Over time people can develop ulcers in the esophagus, which bleed and can lead to anemia. Left untreated for a period of years, GERD can lead to a condition called Barrett's esophagus, which is precancerous. Without treatment Barrett's esophagus sets the stage for cancer of the esophagus.

How is GERD treated?

Changes in lifestyle are a key component in treating GERD. There are also effective, safe medications available now to reduce stomach acid and secretions. The most potent of these medications are called proton pump inhibitors or PPIs, with brand names like Prilosec and Nexium. They reduce both the concentration and the amount of acid or gastric juice.

These medications are advertised frequently on television for symptom relief. However, you should not take these drugs for symptom relief without also changing your lifestyle. Advertising leads viewers to believe that by taking these medications for their GERD symptoms, they can continue to consume large meals that overfill the stomach. PPIs tend to work slowly, so taking them sporadically is not an effective treatment. For a more sustained result, PPIs should be taken for several days. By treating your GERD with lifestyle changes in addition to medication, not only will your heartburn resolve, your overall health will improve as well.

Dr. Brennan is board certified in gastroenterology and internal medicine. He is on the medical staff at Cayuga Medical Center and in practice with Gastroenterology Associates of Ithaca, where he can be reached at (607) 272-5011. Dr. Brennan completed his fellowship in gastroenterology at the Medical College of Virginia in Richmond. He did his internship and residency in internal medicine at the University of Virginia Medical Center in Charlottesville after earning his medical degree at SUNY Upstate Medical University in Syracuse.

Last update:  August 2006

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