Heartburn: Harmless symptom or 'red flag' for more serious health problems?
Most people know what heartburn feels like. It's that uncomfortable, burning sensation in your chest that is also called acid indigestion or gastroesophageal reflux (GER). If you experience heartburn occasionally, it is not a cause for concern.
However, according to a recent study by the Gallup Organization, an estimated 25 percent to 40 percent of healthy Americans experience a more serious form of acid reflux, called gastroesophageal reflux disease or GERD. As many as 7 percent to 10 percent of adults has symptoms of GERD every day.
The National Institute of Diabetes and Digestive and Kidney Diseases warns, "Persistent reflux that occurs more than twice a week is considered GERD, and it can eventually lead to more serious health problems."
"GERD is a constellation of symptoms that most often includes heartburn, as well as a variety of other problems like regurgitation, bloating, and an acid or bitter taste in the back of your mouth," described Mary S. Maish, M.D., chief of thoracic and foregut surgery for Washington Township Medical Foundation. "Other symptoms commonly associated with GERD are nausea, chronic ear infections, chronic cough, recurrent pneumonia, hoarseness and oral cavity problems, such as dental decay or malodorous breath."
There is a range of possible causes for GERD, with obesity being the most frequent culprit, according to Dr. Maish. Other possible contributing factors include stress or taking a medication that causes your stomach to empty more slowly. GERD can also be due to a hiatal hernia, which occurs when the upper part of the stomach rises up inside the chest.
If you have irritable bowel syndrome, with chronic abdominal pain, discomfort, bloating, and alteration of bowel habits, this can also lead to reflux symptoms. In addition, anxiety-related problems like panic disorder can bring about symptoms of GERD.
"To confirm what you are experiencing is truly GERD, we have to perform four tests," explained Dr. Maish. "Unfortunately, none of these is very comfortable for patients, but together they give us the best picture of why the problem is occurring."
The tests include:
- Barium swallow - After you swallow a barium solution, X-rays are taken to get a good picture of the overall anatomy and function of your esophagus.
- Upper endoscopy - A thin, flexible plastic tube, with a light and lens on the end that acts as a tiny camera, is slid down your throat after you have been mildly sedated. This allows the physician to see the inside lining of your esophagus and search for abnormalities.
- Manometry - A catheter is slipped into your nose to check the pressure in the esophagus while you are swallowing liquids or semisolids. This will indicate how the esophagus and the sphincter valve between the esophagus and the stomach are functioning.
- pH monitoring - A catheter is inserted into your esophagus, resting there for one or two days while you go about your normal activities. This test measures how much acid and non-acid reflux material may be coming into your esophagus.
"Once the tests are completed, there is a variety of ways we can treat GERD, depending on the problem," said Dr. Maish.
If the tests show no anatomic abnormalities, you can take drugs called H2 blockers or proton pump inhibitors. H2 blockers provide short-term relief by decreasing the acid production in your digestive tract. They are available by prescription or over-the-counter.
Proton pump inhibitors are available by prescription to relieve symptoms while also helping to heal the lining of the esophagus.
"If, however, you have an anatomic or functional problem of the sphincter valve between the esophagus and the stomach, or if you have a hiatal hernia, you may need surgery," stated Dr. Maish.
"Today, we can do minimally invasive laparoscopic surgery to relieve the symptoms of GERD, improve function and restore the anatomy. This will prevent reflux from continuing to come back into the esophagus from the stomach," she continued.
Laparoscopic surgery for GERD takes about one hour. Afterwards, patients stay in the hospital for one or two nights before going home and can usually return to work or other normal activities in about a week. Patients are restricted from doing any heavy lifting for about six weeks after surgery to allow for proper healing.
"If you continue to have symptoms of GERD without being diagnosed and treated, it can have potentially devastating results," Dr. Maish warns.
Ongoing reflux can lead to inflammation of the esophagus, which can result in scarring and narrowing. In extreme cases, it might be necessary to surgically remove the esophagus. Continued reflux can also lead to Barrett's esophagus, a premalignant condition that increases your chances of getting cancer of the esophagus.
"When we consider how to treat someone for GERD, we look at the whole person and determine if the surgical option will be the most beneficial for them," explained Dr. Maish. "The important thing is that, through surgery, we can restore the barriers and prevent progression of the disease so that worse problems can be avoided. It's not just a matter of relieving symptoms."
To learn more about causes and treatment options for GERD, visit www.niddk.nih.gov, the Web site of the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health, and search under "GERD." To learn more about Mary S. Maish, M.D., go to www.mywtmf.com.