Heartburn
Treatment, Acid Reflux & GERD
Everyone
occasionally has heartburn. This occurs when stomach acid flows
backward into the esophagus, the food pipe that carries food to
the stomach. People usually experience heartburn symptoms after
meals as a burning sensation or pain behind the breastbone. Often,
regurgitation of food and bitter-tasting stomach acid accompanies
heartburn. Antacids or milk temporarily relieves heartburn for
most people.
Why
Does Heartburn Occur?
To understand heartburn, lets look at the body's anatomy.
The esophagus carries food and liquid to the stomach. A sphincter,
or muscular valve, is located at the end of the esophagus. Known
as the lower esophageal sphincter (LES) this muscle contracts
much the same as the anus does. The sphincter should maintain
a certain pressure to keep the end of the esophagus closed so
that stomach juices are not admitted. The LES muscle should only
open when food is passed into the stomach.
However,
the LES muscle does not always work perfectly. It can be easily
overcome by a number of factors, the most common being eating
a large meal. Along with swallowed air, a large meal causes an
upward pressure in the stomach to rise, thereby overpowering the
LES muscle which can cause heartburn symptoms or acid reflux.
Other factors that reduce the LES pressure and allow acid
reflux are:
-
Nicotine
(cigarettes)
-
Fried
or fatty foods
-
Chocolate
-
Coffee
-
Citrus
fruits and juices
-
Peppermint
-
Pregnancy
-
Lying
flat
- Hiatus
hernia
- Certain
prescription medications
Is
Heartburn Common and Serious?
Heartburn and reflux are extremely common, with 10 percent of
the population experiencing them daily. Twenty-five percent of
pregnant women have heartburn. Even though heartburn is common,
it is rarely life threatening. Severe cases, however, can result
in injury to the lower esophagus that requires heartburn treatment.
What
is Hiatus Hernia?
The esophagus passes through a muscle, called the diaphragm, which
separates the lungs from the abdomen. When the opening in the
diaphragm enlarges, a portion of the stomach can protrude (herniate)
through it into the chest. This is called a hiatal hernia. A persistent
hiatal hernia may produce significant heartburn. Many people with
a hiatus hernia do not experience heartburn. However, 40-50% of
patients with a hiatal hernia have reflux. A hiatal hernia and
GERD can occur independently from one another.
Heartburn
C omplications
Besides heartburn, the major problems that can develop with long-term
acid reflux are:
-
Chronic
bleeding and anemia.
-
Scar
formation and narrowing of the lower esophagus ehich may cause
swallowing difficulty. A stricture usually can be treated
by dilatation.
-
Barretts
Esophagus, which occurs when long-term reflux irritates
the lower esophagus so that the stomach lining actually grows
into the esophagus. In these cases, there is a small, but definite,
risk of a subsequent malignancy. Barrett's Esophagus requires
periodic monitoring with endoscopy to detect early cancer states.
-
Lung
problems when reflux of stomach fluid trickle into the breathing
tubes, causing wheezing, bronchitis and even pneumonia. This
often occurs at night when a patient is lying down.
Heartburn
Treatment
General measures the patient can take to reduce acid reflux and
relieve heartburn symptoms are:
-
Eat
smaller and more frequent meals.
-
Avoid
eating before going to bed.
-
Eliminate
excessive bending, lifting, abdominal exercises, girdles and
tight belts, all of which increase abdominal pressure and provoke
reflux.
-
If
overweight, lose weight. Being overweight promotes
reflux.
-
Eliminate
the use of nicotine (cigarettes), fatty foods, alcohol, all
coffees (yes-including decaf), chocolate and peppermint.
-
Elevate
the head of the bed 8" to 10" by placing pillows
or a wedge under the upper part of the mattress. In this way,
gravity keeps stomach juices out of the esophagus while the
patient sleeps. It is not enough to use two pillows under the
head.
-
Prescription
medications - check with the physician regarding side effects
of prescription drugs. Some drugs actually lower the strength
of the LES muscle. These include anti-spasmotics (Levsin, Librax,
Bentyl), calcium channel blocks (Procardia, Cardizem, Calan,
Isoptin), anti-depressants (Elavil, Doxepia) and others.
Heartburn
Diagnosis
The primary tests used to diagnose heartburn symptoms are:
-
Upper
GI Endoscopy- The patient is mildly sedated and a flexible
videoscope is inserted into the esophagus to visually inspect
it and the stomach
-
Upper
GI Series- The patient drinks liquid barium and x-rays are
taken of the esophagus and stomach showing how they function..
-
Esophageal
manometry- This test measures the pressure within the esophagus,
especially the LES pressure.
-
24
hour Ambulatory pH (acid) Monitoring- Ambulatory pH (acid)
monitoring is considered the gold standard for objectively assessing
acid reflux activity and can confirm significant gastroesophageal
reflux disease. pH monitoring is usually performed prior to
any antireflux procedure. Traditionally, a tiny tube is placed
through the nose and into the esophagus (food tube) above the
lower esophageal sphincter. The test runs for 24 hours and measures
the number of times acid enters the esophagus. A newer technology
is now available called The BRAVO System. Click here
to learn more about BRAVO. BRAVO is a wireless transmitting
capsule which is placed usually following endoscopy. It is introduced
through the mouth and attached to the esophagus by way of a
clipping system. It will measure acid reflux activity for 48
hours and the capsule will usually fall off within 3 to 5 days
and is passed. Bravo offers longer data collection times and
better patient comfort. Both types of pH testing are available
through Greenwich Village Gastroenterology at St. Vincent's
Hospital in Manhattan (New York).
For
more information on heartburn or acid reflux, visit these pages:
Heartburn | acid
reflux symptoms | acid
reflux treatment
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