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Maybe It's More Than Just Heartburn

Untreated, GERD can lead to serious health problems

SUNDAY, Dec. 21, 2003 (HealthDayNews) -- Many people will admit to occasional bouts of heartburn.

And many will tell you they know just how to handle it -- with over-the-counter antacids.

But what many of those folks don't know is they may be ignoring the symptoms of a more serious, though treatable, digestive order called gastroesophageal reflux disease (GERD).

A recent national survey by Harris Interactive found 88 percent of those surveyed incorrectly assumed GERD is simply heartburn. And they remained unaware of other potentially damaging symptoms such as an acid taste in the mouth, trouble swallowing or regurgitation of food.

Perhaps more troubling, almost 70 percent of those suffering GERD symptoms haven't discussed them with a health-care professional. And nearly half rely on over-the-counter antacids, which may -- or may not -- be appropriate treatment, the survey found.

GERD occurs when stomach acid moves in the wrong direction, flowing back into the esophagus because a valve between the esophagus and stomach fails to close properly.

Many people suffer needlessly because they fail to take advantage of effective medications that now treat GERD, experts say.

More important, chronic cases of GERD, if untreated, can lead to serious health problems, including ulcers; bleeding from the lining of the esophagus; narrowing of the esophagus; and Barrett's esophagus, a change in the cellular makeup of the esophagus that increases the risk of esophageal cancer.

"People often dismiss symptoms of GERD as nothing more than an annoyance, but, if left untreated, it can lead to other, more serious medical conditions," says Dr. Stephen A. Brunton, vice chairman of the Department of Family Medicine at Carolinas Medical Center in Charlotte, N.C.

"The fact is that, yes, it's very common, and so people just assume well, 'It's just part of living.' The truth of the matter is that while it's common, there's no reason to suffer from it," Brunton says.

If you suffer GERD symptoms a few times a week, Brunton notes, it's time to see a doctor. In some cases, even once a week could signal the need for treatment.

Drugs known as proton pump inhibitors effectively shut off acid production and not only reduce symptoms but also help to cure inflammation of the esophagus, Brunton says.

"They're miraculous drugs, really, in the treatment of reflux disease," he says.

Even absent significant risk of more serious conditions, it's worth seeking treatment for persistent GERD, Brunton says. "The change in the person's quality of life will be so dramatic that there's no reason really not to go see a physician," he adds.

Dr. G. Richard Locke, director of the Esophageal Interest Group at the Mayo Clinic in Rochester, Minn., says many people can safely treat heartburn and an acid taste in the mouth using antacids. "For the vast majority of people, that's fine," Locke says.

"The challenge is that there will be a few people who will get into trouble [with more serious conditions], and it's difficult to clearly know who those people will be," he says.

Locke says people who have trouble swallowing food should get to a doctor because it could be a sign of conditions such as a narrowing of the esophagus or, at worst, cancer. White males face the highest risk of esophageal cancer, which has been on the rise in recent years, experts say.

Why people get GERD remains uncertain, according to the National Institute of Diabetes and Digestive and Kidney Diseases. But the institute says a hiatal hernia -- when part of the upper part of the stomach moves up in the chest above the muscle that separates the stomach and chest -- may contribute to GERD.

Other factors include alcohol use, smoking, being overweight and pregnancy. Citrus fruits, chocolate, garlic, onions and tomato-based and spicy foods could contribute to GERD, too.

So, lifestyle changes such as quitting smoking, avoiding alcohol, losing weight and eating smaller meals might help relieve symptoms.

Over-the-counter antacids are typically the first medications used to treat GERD. Other non-prescription and prescription drugs slow or stop acid production.

If lifestyle changes or medications fail, you may need tests that help spot abnormalities or inflammation of the esophagus.

Surgical treatment includes a procedure in which the upper part of the stomach is wrapped around the muscle connecting the esophagus with the stomach. Other, newer procedures help strengthen the muscle, but their long-term effects remain unknown, according to the National Institutes of Health.

More information

For more on GERD, visit the National Institute of Diabetes and Digestive and Kidney Diseases or the International Foundation for Functional Gastrointestinal Disorders.

SOURCES: Stephen A. Brunton, M.D., vice chairman, Department of Family Medicine, Carolinas Medical Center, Charlotte, N.C.; G. Richard Locke, M.D., director, Esophageal Interest Group, Mayo Clinic, Rochester, Minn.; Harris Interactive national GERD survey of 1,007 Americans
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