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November 22, 2011 > Heartburn May Be More Complicated Than You Think

Heartburn May Be More Complicated Than You Think

GERD May Require Lifestyle Changes and Long-Term Medical Therapy

Most likely, you've experienced heartburn before - perhaps when going to bed at night soon after eating a large meal. That burning sensation in your chest, right behind the breastbone, can disrupt your sleep and leave you feeling tired the next day, but it's nothing to worry about, right? That depends.

"Frequent heartburn may be a symptom of a more serious condition called gastroesophageal reflux disease, also known as GERD or acid reflux," says Dr. Arun Srivatsa, a gastroenterologist on the medical staff at Washington Hospital. "Acid reflux happens when the contents of the stomach back up into the esophagus - the 'food pipe' that leads from the throat to the stomach. Some reflux is normal, and almost all people have it sometimes. Reflux becomes a concern, however, when it is chronic and damages the esophagus."

Every year since 1999, Thanksgiving week in November has been designated as GERD Awareness Week. This year's observance is November 20 to 26.

In addition to heartburn and the flow of stomach contents up into the throat (regurgitation), symptoms of GERD may include nausea, sore throat and a hoarse voice. More serious complications of GERD might include:
* difficulty swallowing,
* weight loss,
* chronic cough or asthma,
* inflammation or infection of the lungs, and
* collection of fluid in the sinuses and middle ear.

"GERD may also cause ulcers in the esophagus and strictures - or narrowing of the food pipe - and inflammation called esophagitis that can result in bleeding," says Dr. Srivatsa. "In rare cases, GERD may cause a pre-cancerous condition called 'Barrett's esophagus,' in which the lining of the esophagus changes. Barrett's esophagus must be monitored carefully because it can lead to cancer."

Dr. Srivatsa notes that GERD is often caused by a weakness in the "sphincter" muscle that separates the esophagus from the stomach. "If the sphincter is too loose, or relaxes too often, some of the stomach contents can escape back up into the esophagus," he explains.

Treatment Options for GERD

In many cases, you can treat uncomplicated GERD by making a few simple changes in your lifestyle.

"Changing your eating habits may be useful," Dr. Srivatsa asserts. "For example, GERD can be worse after eating large meals, so smaller and earlier evening meals may reduce reflux. Also, certain foods and beverages - such as fatty or spicy foods, chocolate, alcohol, caffeinated drinks and carbonated sodas - often promote reflux, so you should avoid them if they cause reflux. Acid-containing foods including citrus fruits and juices also should be avoided."

Some other lifestyle changes that may reduce GERD symptoms include:
* Don't lie down within three hours of eating. When you are sitting or standing, gravity helps move food and acids down the digestive tract.

* Try losing weight if you are overweight, since excess weight puts pressure on the abdomen and causes stomach acid to back up into the esophagus.

* Wait at least two hours after a meal before exercising, since exertion may trigger heartburn. Or exercise before meals, since it can suppress your appetite and help you eat smaller portions.

* Stop smoking. Nicotine can cause the sphincter muscle to relax, resulting in acid reflux.

In addition to lifestyle changes, various medications such as antacids, histamine blockers and proton pump inhibitors may help control acid reflux. You should consult your physician as to which medications might work best for you.

When To See a Doctor Right Away

"First and foremost, you should seek immediate medical attention if you have a burning sensation and chest pressure accompanied by shortness of breath," Dr. Srivatsa emphasizes. "Don't assume it's just heartburn. It could be a symptom of heart disease, especially if it happens after physical exertion.

"From a gastrointestinal standpoint, you should consult your doctor right away if you have persistent heartburn that isn't controlled by medications - especially if you have trouble swallowing, unexplained weight loss, or blood in your vomit or stools," he adds. "In those cases, we might want to perform an endoscopy, especially if we suspect Barrett's esophagus."

In an upper gastrointestinal endoscopy, the patient is sedated, and a thin flexible tube with a miniature camera is inserted down the throat, allowing the doctor to examine the esophagus, sphincter muscle and stomach. New high-definition endoscopes now produce clearer, higher resolution images. "At the Washington Surgery Center, we now have PENTAX i-SCAN equipment that uses both a high-definition video chip and HD monitors that are like HD TVs," Dr. Srivatsa says. "The i-SCAN provides better visualization than standard equipment."

For patients with Barrett's esophagus that may have progressed to cancer, another high-definition tool called endoscopic ultrasound (EUS) may be used to stage any suspected tumors and remove them without surgery. "EUS combines endoscopy and ultrasound to obtain very detailed images and provide information about the spread of cancer," says Dr. Srivatsa. "With EUS we can biopsy and remove the suspicious area without having to make any incisions. It's a less invasive method of performing such procedures."

If acid reflux isn't controlled with medication and an endoscopy doesn't provide a conclusive diagnosis, the gastroenterologist may use a Bravo pH Probe. This miniature probe is inserted into the food pipe and allows doctors to monitor the sphincter for a couple of days to see when acid reflux occurs. When an endoscopy shows damage to the esophagus despite use of medications and a Bravo pH Probe shows continued acid reflex, the patient may be a candidate for a surgical procedure called Nissen Fundoplication. "In this procedure, the surgeon strengthens the sphincter muscle with sutures," Dr. Srivatsa explains.

"Surgery is considered only if other treatments aren't effective, and it isn't very common," he emphasizes. "If people learn more about the symptoms and treatments for GERD - including lifestyle changes that can improve their overall health - it could make a big difference and further reduce the need for surgery."

To search for a gastroenterologist on the Washington Hospital medical staff, visit and click on "Find My Physician."

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