At some point in your life, you might have heard some persons complaining that they have constant heartburn. But what exactly is it and why does it happen?
As we dive into that topic, it is important to first understand that constant and recurring heartburn is actually a disorder known as Gastroesophageal Reflux Disease, GERD for short.
GERD is a disease of the digestive system with the main pathology occurring at the lower esophageal sphincter or the LES. The LES is a circular muscle between the stomach and the tube leading to the stomach (the esophagus) that seals the stomach and prevents its contents from backing up.
Many persons, especially pregnant women and persons suffering from obesity, suffer from heartburn or acid indigestion caused by GERD. GERD is one of those diseases which can be fixed through lifestyle changes including diet and exercise. However, due to long term effects, some persons may require medical or surgical intervention.
In order to understand the disease we must understand the name. Gastroesophagealis the term used to refer to the stomach and esophagus while reflux means to flow back or return. As such, gastroesophageal reflux is the return of the stomach’s contents back up into the esophagus. Reflux occurs when the LES is weak or it opens up inappropriately thus allowing the contents of the stomach to flow into the esophagus.
For some, the causes of GERD is multifactorial, however certain diets and lifestyle choices are the main contributors to this disease. Foods like chocolate, peppermint, fried or fatty foods and drinks like coffee and alcohol, can trigger reflux and heartburn. Cigarette smoke causes relaxation of the LES, along with the obesity factor and pregnancy. These, therefore have significant roles to play in the symptoms of GERD.
The most major complaint of anyone suffering from GERD is heartburn. It is also called acid indigestion and is characterized by a burning chest pain on the left side of the upper chest, radiating to the neck and throat. To put it into context, it usually feels like food coming back into the mouth and leaving a sour or bitter taste.
These symptoms can last up to two hours and are exacerbated especially after eating. Two other phenomena that could cause heartburn occur upon lying down or bending over. As such it is not unusual for a lot of persons to obtain relief by standing up or through the use of an over the counter antacid to neutralize the acid in the esophagus.
A common issue is with this issue is that sometimes the associated pain is mistaken for that of heart disease or cardiac arrest. The differences, however, are easily distinguished. For heart disease, the pain is aggravated with exercise and can ease when resting. It is can also radiate to the left arm, axilla, shoulder, neck and jaw. Heartburn pain is not affected by physical activity and radiates only toward the neck and throat.
The number one recommendation for the treatment of GERD is modification of lifestyle and diet. The mainstay of treatment is in actuality attempting to decrease the amount of reflux or reducing the damage caused to the esophagus by the acidic materials of the stomach.
Foods and drinks that cause the LES to weaken should be avoided. These, as was mentioned can include chocolate, peppermint, fatty foods, coffee and alcohol. Legumes and some large amounts of foods rich in carbs should be looked out for as well since persons have reported them as causation factors. Foods and drinks that cause irritation of the esophageal lining, such as acidic fruits and juices and pepper should also be avoided if they cause symptoms.
Managing portion sizes at mealtime so that you do not overeat could also be essential in symptom control. Also, eating meals at least 2 to 3 hours before going to bed can help to decrease reflux. This allows the acid in the stomach to decrease and the stomach to partially empty, thereby ensuring that there is minimum content in the stomach to back up. Being overweight tends to worsens symptoms so weight loss is key to gaining symptomatic relief in the long run.
As smoking weakens the LES, quitting can help to decrease GERD symptoms.
Keeping your head elevated when sleeping at night could also help since it allows the minimizing of reflux through gravity. Along with these lifestyle modifications, over the counter or prescription antacids may also be recommended
Antacids help to neutralize acid in the esophagus and stomach, thereby stopping heartburn. These have been known to help some persons partially or temporarily. Combined with foaming agents, antacids can form a foam barrier on top of the stomach that prevents acid reflux from occurring.
Antacids are not without their side effects though. Using them for prolonged periods can cause diarrhea, altered calcium metabolism, and magnesium build-up which is detrimental to persons with kidney disease.
Chronic sufferers of reflux are usually recommended medications that reduce acid in the stomach itself. These could include H2 blockers that stop the secretion of acid in the stomach partially. In this group of drugs are cimetidine, famotidine, nizatidine and the popular, ranitidine.
Yet another kind of medication that can be prescribed is the proton pump inhibitor. These prevent the action of an enzyme that is necessary for the secretion of acid. Popular proton pump inhibitors include omeprazole, lansoprazole, pantoprazole, rabeprazole and dexlansoprazole, using the trade names Prilosec, Prevacid, Protonix, Aciphex and Dexilant respectively.
Some persons with severe, chronic esophageal reflux or with symptoms that are not relieved by the treatments described may require more a complete diagnostic evaluation. Some of the tests that might be necessary are an upper GI series X-ray, endoscopy, esophageal manometric and impedance studies and pH testing of the stomach contents.
In the end, only a small number of persons require surgery for GERD. This is due to severe reflux and very poor response to all forms of medical treatment. Fundoplication is a technique that allows for the increase of pressure in the lower esophagus while endoscopic procedures that assist in making the LES function better are all options in surgical treatment.
Some complications that can occur because of long-term GERD include inflammation of the esophagus, called esophagitis, leading to esophageal ulcers and bleeding. Narrowing of the esophagus can also occur due to excessive scarring, as well as an increased risk for esophageal cancer.