Heavy evening meals. Working lunches. Spicy, rich foods. Exercising too soon after eating. Just about everyone feels the burning pain of occasional heartburn that these foods and activities can cause. But how do you know when you need to see your doctor about it?
“Persistent heartburn — the burning sensation or pain in the middle of the chest — could be a symptom of a more serious condition called GERD, or gastroesophageal reflux disease,” says gastroenterologist Prashant Kedia, MD, medical director, Methodist Interventional Endoscopy Center of Excellence. He recommends seeing a doctor, preferably a gastroenterologist, if you have heartburn:
More than twice a week
Over an extended period of weeks or months
That wakes you up at night
That persists after you’ve taken over-the-counter antacids
Indications of GERD
Heartburn plus any of these symptoms could mean that you have this more serious condition:
Loss of appetite
Asthma, laryngitis, and pneumonia can also be signs of GERD. During an episode it’s possible for some of the stomach acid to aspirate into the lungs, causing these symptoms.
Causes of GERD
Anyone can experience GERD at any point in life — adults, teenagers, even infants — and about 10 to 20 million Americans have symptoms, according to the Society of Thoracic Surgeons.
There are many theories as to the underlying causes, but most focus on the valve-like muscle located at the junction of the esophagus and stomach. This muscle, the lower esophageal muscle, is supposed to tighten to prevent stomach contents from refluxing — or coming back up — into the esophagus.
When something is wrong with this muscle — it becomes loose with a pressure that is lower than normal, it opens at inappropriate times, or it is in the wrong place (a condition known as hiatal hernia) — stomach contents, including stomach acid, bile salts, and pancreatic digestive juices, can leak into the esophagus and irritate and damage the lining.
Consequences of untreated GERD
Over time stomach acid can erode the lining of the esophagus and cause bleeding and lesions. Left untreated, these lesions can develop into cancer.
It’s like a domino effect. Dr. Kedia explains: “When acid is continually going inside the esophagus, it can cause ulcers and esophagitis, a type of inflammation or swelling. Esophagitis can lead to narrowing in the esophagus, which makes it hard to swallow food. Over time this continual irritation can lead to worsening lesions in the esophagus and a condition called Barrett’s esophagus. Barrett’s esophagus is precancerous and can become cancer if it is not controlled.”
Diagnosing and treating GERD
Fortunately, there have been significant advances in the diagnosis and treatment of GERD. Most procedures are minimally invasive and done as outpatient procedures.
Diagnosis and treatment centers on the endoscope. An endoscope is a flexible tube with a camera and light at the tip that is is guided through the mouth or rectum and into the esophagus. The physician looks for telltale signs of GERD — narrowing of the esophagus, bleeding or lesions, and the function of the lower esophageal muscle.
Treatment often involves tightening this muscle in a procedure called TIF, transoral incisionless fundoplication. Using the endoscope and working inside the body — there are no cuts through the skin — doctors wrap the top part of the stomach around the esophagus. This tightens the muscle, keeping stomach acid in the stomach. Most patients go home the same day.
“With this procedure, patients generally have little discomfort, they recover quickly, and their satisfaction rates are high,” says Dr. Kedia. “Studies show that TIF does a better job of improving acid reflux than high-dose medication therapy. Ninety percent of patients will be off their medications in six months, and six years after the procedure patients still show improvement of their symptoms.”If you’re concerned that you may have GERD, visit Answers2.org to find a gastroenterologist who can help or call 214-947-6296.