Understanding Heartburn and GERD
The symptoms are all too familiar: a burning sensation just under the breastbone startles you awake in the middle of the night, or an unbearable acidic or sour taste in your mouth. Your stomach feels bloated, full. This scenario repeats itself for several nights, possibly over several weeks and months.
Getting a Diagnosis
Upon visiting your doctor, you learn you have heartburn, otherwise known as gastroesophageal reflux disease, or GERD, if it occurs regularly. This common condition occurs when a muscle at the end of the esophagus fails to close properly, allowing the contents of your stomach to leak into the esophagus.
Usually, doctors can diagnose heartburn from your medical history, but they may want to check you for ulcers or other problems through x-rays of your esophagus, stomach, and upper intestine. Your doctor also may want you to undergo an endoscopy, in which a thin flexible tube with a tiny camera is inserted into your mouth and down into your stomach so a gastroenterologist can view of your insides.
A gastroenterologist is a medical doctor who specializes in digestive disorders.
Over-the-counter antacids are widely used to relieve heartburn symptoms, but their effects are sometimes short-lived and can cause diarrhea or constipation, particularly if you ingest a large amount, says Dr. William Chey, a gastroenterologist at the University of Michigan Health System.
Another group of over-the-counter medications, Histamine 2-Receptor Antagonists, include medications such as Pepcid or Zantac. While these medications have longer-lasting effects than antacids, Chey explains, overuse of such medications may lessen their effectiveness in some patients.
The most effective options for heartburn sufferers are proton pump inhibitors, including Prilosec, which is available over-the-counter or by prescription, Chey says. "While these drugs don't work as quickly as other over-the-counter options, they are by far the most potent drugs in terms of suppressing acid production by the stomach, and relieving acid-reflux symptoms," Chey says. "They're also good to use before a big meal, such as Thanksgiving dinner, to help prevent symptoms of acid reflux."
An Ounce of Prevention
Karen Collins, nutrition advisor to the American Institute for Cancer Research in Washington, D.C., says that being overweight increases your odds of suffering heartburn by more than 50 percentand more than that if you're extremely overweight. In fact, a weight gain of more than 10 to 20 pounds is linked with almost tripling the development of frequent heartburn symptoms, she adds.
The link between overweight and risk of GERD is not new, but research is beginning to explain why it occurs, Collins says. One recent study found that each increase in body mass index that corresponded to a 10- to 20-pound weight jump was linked to a 10 percent increase in stomach pressure.
Excess body fat, particularly around the belly, increases pressure in the abdomen, which, in turn, increases pressure in the stomach. The pressure to the stomach pushes the sphincter muscle between the stomach and esophagus to open.
Overeating might also increase that pressure. In addition, certain spices and acidic food and drink may cause pain in an esophagus already raw from stomach acid reflux, but these foods get the blame for episodes that are due to excessive portions of food intake, Collins explains.
Risks and Complications
With all the jokes about heartburn, it's easy to regard it as just an uncomfortable inconvenience, Collins says. Although occasional heartburn is not a worry, frequent heartburn can lead to serious complications if left untreated.
GERD is an established risk factor for esophageal adenocarcinoma, a type of esophageal cancer. If both obesity and GERD are present, the risk of esophageal adenocarcinoma increases even more than with GERD alone, Collins explains.
If the cause of heartburn is unhealthy eating habits or excess weight, it is probably hurting your health in other ways, too, Collins says. Instead of trying to make unhealthy eating tolerable, it may be time to develop better eating habits and shape up to a healthy weight to reduce GERD and risk of esophageal cancer.
If heartburn occurs several times a week, your doctor will also need to rule out more serious conditions, such as cancer of the esophagus. And anyone symptoms don't go away within 15 minutes of treatment for heartburn should seek emergency care if they experience shortness of breath; sweating; weakness; or arm, back, or chest pain. This may be a sign of something more serious, such as a heart attack.
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