IF YOU CAN’T TAKE THE HEAT….. IT’S PROBABLY HEARTBURN

What’s in a name?  Heartburn by any other name, indigestion, GERD, pyrosis, the devil….would still burn as bad.

Have you ever thought to yourself… Why do I have such severe chest burning every time I eat pizza or pasta???  What is this fiery ball in the middle of my chest attacking me from the inside?? Why is food constantly getting stuck in the middle of my chest???  Why is my voice constantly hoarse???

The answer to all of these questions is..…Acid Reflux!!

Patients ask me questions about acid reflux all the time.  I have compiled a list of the most commonly asked questions and guess what…I’m giving you the answers too!!

As it is with many facets of medicine, to know it and to ultimately treat it….you have to understand it!

Question 1: What is GERD?

We all have a “valve” at the end of our esophagus called the lower esophageal sphincter. This valve is meant to stay closed to protect our esophagus from acid.  For various reasons, this valve can become “weak” and allow acid to backflow into the esophagus as the stomach is releasing acid and churning to help break down and digest food. The stomach has a lining which is meant to come into contact with acid, whereas the esophagus does not!  Over time, this constant reflux will cause damage and inflammation to develop.  This backflow is what most people feel when they are having symptoms of heartburn. Some people will feel this sense of burning in their chest while others will not.  This is called silent reflux and can often manifest as difficulty swallowing foods or liquids, a persistent cough,  a change in the quality of your voice, constant clearing of your throat and sometimes even hiccups.

Question 2: Are there any foods which can make my reflux worse?

There are certain foods that can cause your lower esophageal sphincter to relax and/or increase stomach acid production.  These are:

  1. meals high in fats and oils
  2. tomatoes or tomato based foods
  3. citrus foods
  4. garlic and onions
  5. chocolate
  6. products high in caffeine
  7. alcohol
  8. peppermint

The valve found in your lower esophagus should only allow flow of food or liquids in one direction, from your esophagus to your stomach. However any state that promotes higher pressures to build in your stomach such as an obese belly, or pregnancy will cause reverse  flow, and therefore “reflux”.

Question 3:  Are there things I can do at home to treat reflux that  does not involve medication?

If your acid reflux is mild, obviously you want to try things that will help you avoid medication.  Keeping the foods listed above that may trigger your reflux to a minimum is one way to do it. Other techniques involve:

– weight loss

– keeping the head of your bed elevated at night to help gravity keep acid in your stomach while you sleep

– avoid laying down right after eating and make sure your last meal is at least 2-3 hours before bedtime

– avoidance of tight fitting clothing

–  chewing gum or sucking on a lozenge can help promote salivation which can      help neutralize acid

– stop smoking as this decreases salivation and promotes the effects of acid reflux

 

Question 4: When do I need to see a doctor for my acid reflux?

If lifestyle modifications have not worked and you continue to have persistent symptoms your physician can prescribe medications to decrease acidity and help promote healing of inflamed tissue in your stomach and esophagus. Sometimes a short term regimen is all that is needed.  Other times you may require longer courses of treatment. If your symptoms are not able to be controlled with medication or you develop what we call “alarm symptoms” you may need an endoscopy for further evaluation.

Alarm symptoms are:

-new onset of symptoms at age 60 or older

-blood in your stool

-vomiting blood

-unintentional weight loss

– an ongoing poor appetite

-difficulty swallowing food or liquids

– painful swallowing

– a deficiency in iron

-persistent vomiting

If you have an alarm symptom your provider will often times suggest to first proceed with an endoscopy vs trying a course of medication first.

Dr. Apsara Prasad

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