If you’ve ever eaten too much rich, greasy or spicy food – especially before going to bed – you likely know what heartburn feels like. Acute, meal-related heartburn can be normal if it only occurs once a month or less, but what if you have heartburn-like symptoms more frequently? Gastroenterologist Preston Stewart, M.D., says that as much as 10 to 20 percent of the Western Hemisphere’s population suffers from some form of heartburn that is reflective of gastroesophageal reflux disease (GERD) once a month or more.
“GERD occurs when stomach acid from the stomach refluxes into the esophagus and mouth, resulting in symptoms like heartburn, regurgitation, chest pain, coughing, throat clearing, voice hoarseness and nausea,” he explains. It’s unclear if genetics play a role in the development of the disease, but certain people are more susceptible. “We see GERD in people who are obese, have high-fat diets, consume excessive caffeine and alcohol, and smoke,” says Dr. Stewart. “It affects both men and women equally, and can be seen in children as well as adults.”
Treating GERD Dr. Stewart typically treats GERD by first asking patients to make lifestyle modifications and lose weight if they need to. “From a diet standpoint, we ask them to minimize or modify their consumption of caffeinated and alcoholic beverages, chocolate, peppermint, fatty foods and spicy foods,” he says. “We also encourage smaller portion sizes so you don’t overfill the stomach and waiting two to three hours after a meal before you lie down.”
GERD symptoms can also be managed by not smoking, elevating your head six inches while sleeping and adopting a moderate aerobic exercise program, with your physician’s sign-off. “If this fails, we move on to medical therapy,” says Dr. Stewart. “There are two main types of acid suppressants – the first class is histamine-2 (H2) blockers, which includes Pepcid and Zantac. These can be found over the counter. They are often effective in treating mild GERD and may be appropriate for select patients. The second class is Proton Pump Inhibitors (PPIs). These are very powerful acid-suppressants. They work over 12 to 24 hours and are taken once or twice a day. They are quite effective for most folks.”
Long-term effects of reflux disease
“If left untreated, not only is quality of life reduced, but there are other serious implications, one being the development of Barrett’s esophagus,” explains Dr. Stewart. “This is essentially a precancerous change that occurs in the esophagus due to stomach acid exposure over a period of years. A fraction of people with longstanding, untreated reflux disease can develop esophageal cancer.”
In addition to cancer, untreated reflux disease can lead to non-life-threatening complications, such as scar tissue that makes swallowing solids and pills difficult, and ulcerations in the esophagus. If you experience heartburn symptoms on an ongoing basis for more than a few weeks, it is wise to see your primary care physician. He or she may refer you to a gastrointestinal specialist for further evaluation.
For more information about GERD, visit Piedmont’s gastroenterology specialty directory.
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