About 25 million Americans suffer from heartburn. This common ailment is felt as a burning sensation behind the breastbone and sometimes in the neck and throat as the result of stomach acid refluxing (splashing up) into the esophagus. Occasional heartburn is nothing to be concerned about. However, anyone who has heartburn on a regular basis should consult a physician. Constant exposure to stomach acid can irritate the lining of the esophagus and cause other medical problems. Serious, persistent heartburn is called GERD – or Gastroesophageal Reflux Disease.
Click on the statements/questions below to reveal the answers to the causes, symtoms and signs of this particular disease.
The esophagus carries food and liquid into the stomach. At the lower end of the esophagus where it enters the stomach is a strong muscular ring called LES (Lower Esophageal Sphincter). The LES should remain closed except to allow food and liquid to pass INTO the stomach. It may relax for periods of time throughout the day and night, or it may be constantly too weak to function properly – when this happens, stomach acid refluxes (splashes up) into the esophagus. The severity of the disease is dependent upon how weakened the LES is, and the amount and duration of acid refluxed into the esophagus.
It is also common to find a hiatal hernia complicating GERD. With a hiatal hernia, the upper part of the stomach actually pushes up into the chest through a weakness in the diaphragm. When part of the upper stomach is stuck above the diaphragm, stomach acid is retained there for a longer period and is more likely to reflux into the esophagus.
Frequent heartburn is the most common symptom of GERD. You may also experience one or more of the following:
- sour or bitter taste
- bitter stomach fluid coming into the mouth, especially during sleep
- persistent hoarseness
- repeatedly feeling a need to clear your throat
- difficulty swallowing food or liquid
- wheezing or coughing at night
- worsening of symptoms after eating, or when bending over or lying down
Certain diet and lifestyle choices can also contribute to the condition. Certain foods, for example, can increase acid production, and fatty acids increase the time food remains in the stomach. Chocolate, peppermint, coffee, alcohol and the nicotine in cigarette smoke weaken the LES. Obesity places added pressure on the upper abdomen, so you should maintain a healthy weight. The LES is also weakened during pregnancy.
Long-term or severe GERD can lead to complications including inflammation of the esophagus, ulcers and bleeding. As a result, anemia or low blood count may develop. Over time, scarring and narrowing of the esophagus can also occur, making it difficult to swallow foods and liquids – this is known as a stricture. Some patients also develop a condition called Barrett’s esophagus, which is a serious change in the cells lining the esophagus and may be a precursor to esophageal cancer.
The condition is often suspected by the physician, simply by taking the medical history. After that, your doctor may order a barium X-ray of the esophagus and stomach. By ingesting the barium liquid, it makes it possible to see the reflux and a hiatal hernia on the X-ray. Endoscopy is the most effective test for patients and is done under light to medium sedation. Certain conditions, including stricture in the esophagus, can often be corrected while performing the test. Your physician will also look for signs of Barrett’s esophagus and perform a biopsy if precancerous changes have occurred.
There are other tests that may be done including an esophageal manometry. A thin tube is passed through your mouth and into your stomach to measure the stomach's electrical and muscular activity to determine the rate of digestion. It also measures the pressure in the LES and any abnormal muscle contractions in the main part of the esophagus. Another possible exam is a 12-24 hour recording of the acidity in the esophagus.
Here are some things you can do to help reduce acid reflux and strengthen the LES (Lower Esophageal Sphincter).
- Avoid eating anything within 3 hours of bedtime.
- Avoid smoking and tobacco products. Nicotine in the blood weakens the LES.
- Avoid chewing gum or hard candy. They increase the amount of swallowed air which, in turn, leads to belching and reflux.
- Avoid or reduce consumption of fatty foods, milk products, chocolate, mints, caffeine, carbonated beverages, citrus fruits and juices, tomato products, pepper seasoning and alcohol (especially red wine).
- Eat smaller meals. Avoid tight clothing or bending over after eating.
- Review all medications with your physician, especially your gastroenterologist. Certain drugs can weaken the LES.
- Elevate the head of the bed about 6-8 inches, using blocks under the mattress or bed. This helps to keep acid in the stomach. Propping yourself up on extra pillows actually has the opposite effect as it tends to bend the body at the waist, pushing more fluid back up into the esophagus.
- Maintain a healthy weight.
While lifestyle changes are often enough, some patients experience GERD that is severe enough to require medications. Click below to learn about drugs and surgical options.
For patients who have more severe GERD or don’t respond to conservative treatment (click above), drugs or surgery may be necessary. A category of drugs known as Proton Pump Inhibitors (PPIs) are the main tool used to significantly reduce stomach acid. Common ones include Prilosec (omeprazole), Prevacid (lansoprazole) and Nexium (esomeprazole) taken once or twice a day. Other acid reducing drugs including Zantac, Pepcid and Tagamet are available. Reglan (metoclopramide) is a drug that can strengthen the LES, which helps reduce the reflux (splashing up) of acid into the esophagus.
Some patients with GERD may need surgery to strengthen the LES. This is called fundoplication and is generally performed laparoscopically. Using surgical instruments inserted into several small incisions, the upper curve of the stomach (the fundus) is wrapped around the esophagus and sewn into place so the lower portion of the esophagus passes through a small tunnel of stomach muscle. This procedure strengthens LES, which is the valve between the esophagus and stomach. The helps to prevent acid from refluxing up into the esophagus as easily, which enables the esophagus to heal.
If you have a hiatal hernia, it will also be repaired with this procedure.