When it comes to stomach and digestion woes, finding the cause of your discomfort can sometimes seem harder than solving an advanced Sudoku. But if indigestion is making your chest feel on fire, the culprit is likely heartburn, acid reflux or gastroesophageal reflux disease (GERD). In most cases, these conditions can be easily treated by keeping stomach acid at bay. But when severe and untreated, it’s possible for these conditions to lead to cancer of the esophagus, according to Dr. Jason Knudtson, a physician specializing in gastrointestinal conditions at Rose Medical Center. Use this “gastro guide” to recognize symptoms and learn about treatment options.
Heartburn, a burning sensation in the chest or throat, is extremely common. “At least one-third of Americans have heartburn several times a month and 10 percent have it every day,” Knudtson says. Even though the smoldering feeling in your chest is a sign of heartburn, it has nothing to do with your heart. Heartburn is caused by acid flowing backward from the stomach, up the throat and into the esophagus, the tube that runs from the back of your mouth to your stomach.
Fried, fatty foods and big meals produce more stomach acid, making it more likely that the acid will splash back up. Although the risk of heartburn isn’t necessarily higher in boomers than younger people, putting on weight, which often happens after midlife, can increase the risk. “Heartburn is more common in obese people,” Knudtson says. “And the burning is usually worse after you eat a big meal and when you lie down.”
Making lifestyle changes is the first remedy option. “Try to go to bed with an empty stomach and elevate the head of your bed,” Knudtson advises. This helps because lying flat accelerates the backup of stomach acid. Knudtson also recommends losing excess weight, eating smaller meals and avoiding foods that trigger heartburn, such as fried fatty foods. Chocolate and peppermint can also trigger heartburn in some people.
If you smoke, quit. “Smoking increases the risk of getting heartburn, as does drinking too much alcohol,” Knudtson says. Antacids are the other remedy option. These over-the-counter medicines cool the burn by turning off secretion of acid in your stomach. Knudtson recommends taking an antacid, such as Tums, if you get heartburn occasionally. You should feel relief within 30 minutes.
Acid Reflux and GERD
If you taste bitter fluid in the back of your mouth, you may have acid reflux, also known as acid regurgitation. Acid reflux occurs when the esophageal sphincter, a ring of muscle at the bottom of the esophagus that acts as a valve between the esophagus and stomach, opens spontaneously or doesn’t close properly, allowing digestive juices and acids to escape from the esophagus into your mouth. Sometimes reflux progresses to GERD, a more severe form of acid reflux.
Heartburn usually accompanies reflux and GERD. “Heartburn that occurs more than twice a week is a sign you may have GERD,” Knudtson says. Other symptoms of GERD include hoarseness in the morning, a dry cough, bad breath and the feeling that you have food stuck in your throat. The same behavioral modifications recommended for heartburn can be helpful for reflux and GERD, Knudtson says.
Continuing or worsening symptoms call for medicines beyond antacids. There are two types of drugs for treating reflux and GERD: H2 blockers (Tagamet, Pepcid, Zantac and Axid) and Proton Pump Inhibitors, or PPIs (Prilosec, Prevacid, Nexium, Aciphex and Protonix). Like antacids, they shut down acid production, but they use a different mechanism. “H2 blockers and PPIs don’t work as fast as antacids, but they work better and last longer,” Knudtson says. “It takes a good three days before these medications take effect and you need to take them every day.” You can buy H2 blockers and some PPIs over the counter; other PPIs require a prescription. Your doctor can recommend the best medicine for your situation.
In some cases, surgery to repair the sphincter may be appropriate. There are various surgical procedures available to treat GERD. “A procedure to tighten the valve can be performed through the mouth using a special probe,” says Knudtson, who is a surgeon at Western Surgical Care in Denver. Other kinds of valve-repair procedures require an abdominal incision.
Treating your GERD effectively is extremely important. In fact, it could be life-saving. Severe, untreated GERD can lead to serious complications, including Barrett’s esophagus, a pre-cancerous condition, and esophageal cancer, or cancer of the esophagus. Although this type of cancer is not common, it’s serious. According to the American Cancer Society, the five-year-survival rate for early-stage esophageal cancer is 37 percent, but the survival rate drops to 3 percent when the disease is detected later. “The problem is that esophageal cancer usually has no early symptoms and we don’t have an effective screening tool, so the disease is usually well advanced by the time it is diagnosed,” Knudtson says.
Reducing risk factors is the best way to protect yourself. Long-term irritation of the esophagus increases the risk of developing this type of cancer. “Using tobacco products of any kind is the worst thing you can do as far as esophageal cancer,” Knudtson says. Drinking alcohol in excess is another strong risk factor. Humphrey Bogart, a legendary hard drinker, died from esophageal cancer in 1957. “Drinking in moderation doesn’t appear to raise the risk, but excessive drinking over many years is definitely a risk factor for esophageal cancer,” Knudtson says.
The disease is more common in men than in women. Symptoms include difficulty swallowing, weight loss, fatigue and frequent choking while eating. Severe, sudden coughing when you swallow is also a red flag, as advanced esophageal cancer can erode the esophagus and create a hole in your windpipe. Staying on top of your heartburn symptoms can prevent these serious complications. Don’t ignore your heartburn, particularly if it is frequent and severe. “It’s important to have the source of your heartburn evaluated and treated,” Knudtson says. If you have frequent heartburn, talk to your doctor, who may refer you to a HealthOne gastrointestinal specialist.
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