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
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
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
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
University in Syracuse.
Last update: August 2006