Esophageal Reflux, should I be worried? Or is ignorance bliss?
What is reflux you ask? Gastroesophageal reflux (GERD) is a chronic medical condition caused by the flow of stomach contents upwards into the esophagus (food pipe). Common symptoms of GERD are heartburn (a burning sensation behind the breastbone) and regurgitation (a feeling of food or fluid coming up into the chest). Many people experience both symptoms, however, you can have one without the other.
Why does this happen? The stomach is designed to handle gastric juices, acid, and bile, however, the esophagus is not. In fact, these fluids are toxic to the esophageal lining and can cause damage such as ulcers and pre-cancerous changes, i.e. Barrett’s esophagus.
Contrary to popular belief, GERD is almost never caused by ‘too much’ acid. It is the abnormal reflux of the stomach contents into the esophagus.
How can I modify or treat symptoms of infrequent heartburn at home?
- Lifestyle adjustments – avoid trigger foods and drinks: chocolate, coffee, carbonated beverages and caffeine, peppermint, spicy or greasy foods, tomato products, and alcoholic beverages.
- Stop smoking – tobacco can contribute to GERD and is one of the biggest risk factors for esophageal cancer.
- Minimize alcohol use – it contributes to GERD and esophageal cancer.
- Weight loss – excess abdominal fat and circumference are one of the biggest risk factors for GERD and Barrett’s esophagus. In fact, patients who are overweight are much more likely to have GERD compared to patients with a healthy body weight.
- Change eating and sleeping habits – Do not eat or snack for at least 2 hours before bedtime. This will decrease the amount of acid available for reflux. Do not lay flat for at least 2-3 hours after eating a meal or snack. You can also raise the head of your bed and use an under-mattress foam wedge to elevate the head of the bed 6-10 inches.
Who should be evaluated? If you are experiencing heartburn 2 or more times a week or are self medicating and still have symptoms or have symptoms despite prescription medication or treatment, you need to see a doctor and perhaps be referred to a gastroenterologist.
Symptoms that suggest that serious damage may have already occurred include: difficulty swallowing food, vomiting blood or having tarry black bowel movements, and unexplained weight loss. If you are experiencing any of these symptoms you should speak to your doctor immediately.
Untreated or undertreated reflux can lead to serious damage such as narrowing of the esophagus from acid damage otherwise known as a stricture. It can also lead to Barrett’s Esophagus which is a precancerous change caused by chronic acid exposure. Barrett’s esophagus is a risk factor for Esophageal cancer. In fact, in patients with longstanding, severe and unresolved heartburn, the risk of developing esophageal cancer was 43.5 times as great for those without chronic GERD.
A Gastroenterologist can perform an Upper GI Endoscopy or EGD. This is typically the 1st step in evaluating heartburn that does not go away with medication, or comes back after treatment is withdrawn, or if you have worrisome symptoms. During this test, a long flexible scope or tube with a light and camera is used to look directly at the esophagus, stomach, and 1st part of the small intestine while the patient is asleep. This can allow for direct visualization of abnormalities, biopsies, and in some cases therapy or treatment of narrow areas.
So what is the bottom line?
Heartburn is common. Very common. However, if left untreated (or undertreated), longstanding heartburn can contribute to decreased quality of life. It can masquerade as other diseases like chest pain, worsen asthma, and has been linked to chronic cough and hoarseness in some patients. It can lead to precancerous change (Barrett’s esophagus) and even esophageal cancer. Don’t ignore frequent heartburn – instead consult with your physician regarding an endoscopy and treatment to get help early before complications arise. Prevention is the key to good esophageal health.
