GERD: It's More Than Just Heartburn

Acid reflux can cause serious problems, but beneficial treatments exist

TUESDAY, Nov. 23, 2004 (HealthDayNews) -- Dinner is done and, predictably, that miserable fire beneath your breastbone has reignited. Time and again, you've reached for antacids and acid blockers, but nothing seems to extinguish your internal inferno.

Maybe it's more than a really bad case of indigestion. Frequent heartburn can be a sign of a potentially serious condition called gastroesophageal reflux disease (GERD). Unlike many chronic diseases, this one is highly treatable if patients take their medication and commit to certain lifestyle changes.

"Eighty to 85 percent of patients will get very good relief of their symptoms," said Dr. William Chey, a spokesman for the American Gastroenterological Association (AGA) and an associate professor of internal medicine at the University of Michigan Medical Center.

It's among the messages gastroenterologists will share during GERD Awareness Week, Nov. 21 to 27.

GERD is the backward flow of acid from the stomach into the esophagus. Under normal conditions, a muscle called the lower esophageal sphincter acts as a valve between the esophagus and stomach, helping to prevent acid reflux. When it fails to close properly, acid can leak back into the esophagus, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

GERD affects an estimated 5 percent to 7 percent of the world's population, according to the International Foundation for Functional Gastrointestinal Disorders, a nonprofit education and research group. And although common, the problem often goes unrecognized.

People who have acid reflux commonly experience chronic heartburn, but that's not the only symptom. Sometimes sufferers report chest pain, trouble swallowing, hoarseness, chronic irritation in the throat and bad breath. Doctors say anyone who experiences frequent or severe symptoms should seek medical care.

Without proper treatment, acid reflux can cause serious complications, including a type of tissue damage known as erosive esophagitis, an inflammation of the esophagus. People who have this condition may experience moderate to severe heartburn, bleeding or vomiting, according to the AGA.

Commercials for prescription acid reducers highlight the long-term damage that GERD can cause. Yet Chey noted that 75 percent or so of people with acid reflux don't have erosion of the lining of esophagus.

"Some of this emphasis on erosive esophagitis, I think, is a bit overblown," he asserted.

GERD sufferers also face a higher risk of Barrett's esophagus, a cellular change in the lining of the esophagus that can lead to a rare but deadly type of cancer of the esophagus, the NIDDK said. To diagnose this condition, a physician must insert a flexible tube called an endoscope into the esophagus and remove a sample of any suspicious tissue for biopsy.

While the exact cause of GERD isn't known, having a hiatal hernia may contribute to the problem, making it easier for stomach acid to rise up. Other factors -- being overweight, using alcohol, smoking or being pregnant -- also may contribute to the disease.

Certain foods known to trigger heartburn should be limited, as well. The list of potential culprits includes spicy foods, fried foods, tomato-based products, alcohol, chocolate, citrus, caffeine and peppermint. You don't have to cut them out entirely, just don't overindulge, said Dr. J. Patrick Waring, a professor of medicine at Emory University School of Medicine in Atlanta.

Avoiding meals close to bedtime and eating smaller meals also may help quell symptoms. "Overeating is probably the biggest problem," added Waring, a member of the International Foundation for Functional Gastrointestinal Disorders advisory board.

But even people who feast on an occasional meal of sausage, onions and peppers needn't suffer the consequences. There are plenty of over-the-counter medications to relieve the burn.

Antacids, typically the first line of defense against heartburn, work by neutralizing acid in the stomach and esophagus. While safe, they typically provide only short-term relief. Over-the-counter acid blockers, including Tagamet, Pepcid, Axid and Zantac, also are effective and well-tolerated for mild GERD, the AGA noted.

GERD sufferers also might try one of the so-called proton pump inhibitors -- drugs that work by stopping acid production in the stomach. These drugs, including prescription Prilosec, Prevacid, Protonix, Aciphex and Nexium, provide long-term symptom relief and heal erosive esophagitis. One drug, Prilosec OTC, is now available to consumers without a prescription, further expanding treatment options for frequent heartburn sufferers.

"Prilosec is a very powerful medicine and really works very, very well for heartburn," Waring said.

However, new research suggests that taking proton pump inhibitors for prolonged periods may increase the risk of developing pneumonia. A Dutch study of 364,000 patients, published in the Oct. 27 issue of the Journal of the American Medical Association, found the risk of pneumonia nearly doubled for people taking the drugs for prolonged periods.

Still, with such potent treatments at hand, GERD sufferers who don't get better are becoming a rare breed, doctors say. In turn, researchers are focusing on the small slice of individuals who suffer persistent symptoms despite treatment.

"The patients that we see as specialists are the ones that don't get better when the primary-care doctors do all the right things," Chey said.

More information

The International Foundation for Functional Gastrointestinal Disorders has more facts about GERD.

SOURCES: William Chey, M.D., spokesman, American Gastroenterological Association, and associate professor, internal medicine, University of Michigan Medical Center, Ann Arbor; J. Patrick Waring, M.D., advisory board member, International Foundation for Functional Gastrointestinal Disorders, and professor of medicine, Emory University School of Medicine, Atlanta; National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Md.
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