Heartburn. Just about everyone experiences that uncomfortable burning sensation in the chest at some time or another. Turn on the television and you'll see countless advertisements for remedies - both over the counter and prescription.
While first-tier treatments such as antacids and H2-receptor antagonists provide relief for occasional cases of heartburn, if you find yourself taking them with increasing regularity, tell your doctor so the possibility of a more serious condition such as gastroesophageal reflux disease (GERD) or Barrett's esophagus can be investigated.
Heartburn is a hallmark of both acid reflux and GERD. Acid reflux is the backward flow of stomach acid into the esophagus. In addition to heartburn, acid reflux may produce a sour taste in your mouth.
You can reduce acid reflux with lifestyle changes such as avoiding fried, fatty and other trigger foods, eating smaller portions and not lying down within two hours of eating. Raising the head of your bed by 4 to 6 inches and limiting alcohol and nicotine use sometimes can help as well.
Losing excess abdominal weight is highly effective way to decrease upward pressure on your stomach, which helps reduce reflux.
When the signs and symptoms of acid reflux occur at least twice a week and interfere with activities of daily living, the condition is called GERD. In addition to frequent heartburn, other signs of GERD can include regurgitation of food, wheezing and chest pain. Your doctor may prescribe daily use of H2-receptor antagonists or proton pump inhibitors (PPIs) to reduce the amount and flow of acid into your esophagus.
While these medications can be effective, they are not a substitute for lifestyle changes. Long-term use or overuse of these treatments can cause a new set of problems and side effects, such as osteoporosis, which contributes to the risk of wrist, hip or spine fractures, as well as anemia and deficiencies in iron, magnesium and B12. Ongoing reduction of acid in the stomach can make you susceptible to certain types of pneumonia as well as C. Difficile infection, which causes diarrhea.
Barrett's esophagus, a consequence of long-term GERD, is a precancerous change in the cells in the lower portion of your esophagus. There is a one-in-10 chance that GERD will progress to Barrett's esophagus, and then a one-in-10 chance that Barrett's esophagus will progress to esophageal cancer.
Alarming signs that should immediately be brought to the attention of your doctor include frequent heartburn, difficulty swallowing food, chest pain, upper abdominal pain and dry cough.
These symptoms, as well as new onset symptoms after the age of 50 or bloody stools, require investigation by a specialist called a gastroenterologist. To diagnose Barrett's esophagus, the gastroenterologist conducts an endoscopy which is a visual study of your upper gastrointestinal tract, including the esophagus, using a tiny video camera. Tissue from the esophagus is sampled and biopsied to check for precancerous cells.
If you are diagnosed with Barrett's esophagus, continued use of PPIs is recommended to limit progression of the condition. Periodic endoscopies and biopsies are also necessary to monitor the cells of the esophagus. In some cases surgery or other endoscopic procedures may be recommended to treat Barrett's esophagus.
Schaefer is a specialist in colonoscopy, endoscopy and gastroenterology at Susquehanna Health's Digestive Disease Center.