An estimated two-thirds of all adults get occasional heartburn. But for some 15 million Americans, including pregnant women and even children, heartburn is a frequent, even daily, ailment. Worse, it’s often accompanied by chest and abdominal pain, hoarseness, coughing and difficulty swallowing.
Doctors call this group of chronic symptoms gastroesophageal reflux disease, or GERD. Left untreated, GERD can result in Barrett’s esophagus, a chronic inflammation of the esophageal lining that causes cancer in a small percentage of cases.
But the good news is that in nine out of every 10 cases, physicians can treat GERD effectively.A door that won’t stay shut
GERD develops in people with a weakened sphincter—the ring of muscle that keeps stomach acid from refluxing back into the food pipe.
Normally, the sphincter stays tightly sealed; when it leaks, we get heartburn. In GERD, the sphincter becomes weak and stomach acid begins to continually scald and damage the tender esophageal lining.
Experts don’t fully understand what causes reflux disease. Some people with GERD don’t have heartburn, for example—though it’s the disease’s hallmark.
People with a hiatal hernia, in which the upper part of the stomach extends above the diaphragm, have a higher risk of developing GERD. Other likely culprits include:
How to fight back
- Asthma. Half of all asthma sufferers get GERD. Though the reason is unclear, doctors think asthma-related coughing and sneezing, as well as bronchodilator medication, somehow weaken the sphincter
- Ulcer treatment. Up to 30 percent of people who take medicine to rid the stomach of peptic ulcer–causing Helicobacter pylori bacteria go on to develop GERD. Some experts think H. pylori, which neutralizes stomach acids, somehow protects against reflux, and ulcer drugs may remove this protection.
- Crohn’s disease. This inflammatory condition usually attacks the small intestine, but Crohn’s can strike the esophagus and, researchers suspect, foster the onset of GERD.
Thankfully, many GERD cases respond to lifestyle changes, medication or both. Typical therapies include:
- lifestyle changes such as avoiding foods and beverages that trigger heartburn, changing meal times and eating habits, losing weight and sleeping with the head somewhat elevated
- not smoking or drinking alcohol—both weaken the sphincter
- medications like antacids; over-the-counter H2 blockers—Tagamet HB, Pepcid AC or Zantac—which slow acid production; proton pump inhibitors, like Prilosec or Nexium, which stop acid production; prokinetics to tone and strengthen the sphincter; or drugs that coat irritated esophageal linings
If you’re having frequent heartburn or abdominal pain or have taken antacids for more than two weeks without relief, see your doctor. While there, be sure to list all the prescription and over-the-counter drugs you are taking. Muscle relaxants, pain relievers, hormones or high blood pressure medications can cause or worsen GERD symptoms. Endoscopes and surgery
Endoscopic procedures and surgery as a last resort can often improve more difficult cases of GERD and Barrett’s esophagus. Doctors can explore the affected area with an endoscope, a miniature camera device that can also take tissue samples. Another test, the barium swallow radiograph, provides an X-ray outline of the esophagus and can detect hiatal hernia and severe inflammation.
The standard surgical procedure, called Nissen fundoplication, wraps excess stomach tissue around the sphincter to strengthen it. Newer procedures place either stitches or tiny cuts on the sphincter, leaving scar tissue that firms and toughens the passageway into the stomach. Lasers are now being used to burn away Barrett’s cells so the esophagus can heal.