If heartburn is your constant partner, have it checked out. A valve problem may be raising your risk profile.
That burning discomfort that hits once in a while
after a spicy burrito or too much pizza? Almost everyone gets it once in a while-heartburn, a.k.a. acid indigestion. About 15 million Americans get it just about every day, and about half of those deal with a more serious problem called gastroesophageal reflux disease, or GERD. In this condition, acid from the stomach flows up into the esophagus because the lower esophageal sphincter, a ring of muscle that acts like a valve between the bottom of the esophagus and stomach, fails to close normally. "Over time, with aging and weight gain, the lower esophageal sphincter weakens," says Mary Maish, MD, thoracic surgeon and surgical director of the UCLA Center for Esophageal Disorders. "Also, a hiatal hernia, common in people 50 and over, can cause symptoms of reflux."Recognizing GERD is important. Untreated, it can lead to serious complications in some people, and raise the risk of esophageal cancer.
Frequent heartburn
Refluxed stomach acid can cause a burning sensation in the chest behind the breastbone or throat and/or the taste of sour, regurgitated liquid in the throat. GERD isn't always experienced as chronic heartburn, however. Some people have chest pain, hoarseness, or trouble swallowing. Water brash-excessive saliva-is another common symptom. "Uncommon symptoms are cough, bloating, wheezing, adult onset asthma, recurrent bronchitis or pneumonia, ear infections, dental caries, and sinus problems," says Dr. Maish. "Many people will have only these vague symptoms and none of the traditional ones, so GERD can easily be missed."
When to see your doctor
Occasional heartburn doesn't necessarily mean you have GERD but, if it occurs more than twice a week, it's time to talk to your physician. "GERD-induced esophagitis-inflammation of the lining of the esophagus-can lead to strictures, causing eating difficulty," Dr. Maish explains. "GERD can also lead to cells at the bottom of the esophagus changing to colon-type cells-a condition known as Barrett's esophagus. In one of every 100 patients with Barrett's esophagus, these cells eventually become cancerous."
Diagnosis and treatment
Usually, a diagnosis can be made based on symptoms. If needed, an upper barium GI
X-ray, endoscopy, or other tests may be indicated. Lifestyle changes as well as acid suppressive medications can help calm GERD symptoms. Proton pump inhibitors (PPIs) are the most commonly prescribed reflux drugs; they work by blocking the site of acid production in the stomach. "Surgery is an option for those who have persistent symptoms of reflux, especially with regurgitation; those with severe reflux who don't want to take life-long medicine; those who have Barretts' esophagus or risk developing it; and those with a strong family history of esophageal cancer," Dr. Maish explains.
"At UCLA we do a minimally invasive surgery that uses a camera-guided laparoscope to restore the function of the lower esophageal sphincter. It takes one to two hours to perform and requires a one- to two- day hospital stay."
Reprinted with permission from UCLA Healthy Years and Belvoir Media Group, LLC (c) 2006. For subscription information, please call 1-866-343-1812.
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