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Heartburn strikes an estimated 20 percent of Americans at least once a week. The American Gastroenterological Association reports that 60 million Americans experience heartburn symptoms each month. Though uncomfortable, heartburn does not usually present a serious health problem for most people. However, if heartburn, or its more advanced form known as gastroesophageal reflux disease (GERD), occurs frequently, it can lead to damage to the esophageal lining and even a pre-cancerous state."
Known by a variety of names, including acid indigestion, heartburn and sour stomach, gastroesophageal reflux is an irritation of the esophagus caused by acid that refluxes (comes up) from the stomach. If the lower esophageal sphincter (a muscular valve) opens too often or does not close tightly, stomach acid can reflux, or seep back into the esophagus, damaging it. The most common symptoms are a burning feeling in the upper abdomen that occurs after eating and lasts a few minutes to several hours, and a burning sensation radiating upward from the chest to the back of the throat. Less common symptoms include chronic cough, sore throat, hoarseness and dental problems. Danger or "scare" symptoms include:
First Step: Lifestyle Changes For anyone who is experiencing reflux, the first recommendation by physicians is lifestyle and dietary change. Dr. Ruffini relates that reflux is more commonly experienced after consuming certain acidic foods and is made worse in those who are over- weight. Pregnant women often experience reflux problems as their pregnancy progresses. Reflux often occurs after:
Other Irritants:
Next Step: Treatment Most treatments for reflux aim to reduce the amount of reflux or reduce the potential for damage to the esophageal lining from refluxed substances. The major medications for reflux fall into four categories: antacids, H2 blockers and proton pump inhibitors (PPI) and prokinetic agents. Dr. Ruffini says that general antacids neutralize the acid and can be purchased over-the-counter (Rolaids, Tums, Mylanta, Maalox, Alka-Seltzer). H2 blockers are stronger and neutralize more of the returning acid. The medications, formerly prescription, are now over-the-counter remedies (Pepcid, Zantac, Tagamet). PPI medications (Prevacid, Prilosec, Protonix, Aciphex, Nexium) dramatically reduce the production of acid in the stomach, and are the most potent. "Rather than neutralizing the stomach acid, prokinetic agents stop the reflux from occurring and are the fourth class of reflux medications," says Dr. Ruffini. "The overwhelming majority of those who suffer from reflux, about 90 percent, are helped by one of these four groups of medications, combined with lifestyle modification," says Dr. Ruffini. Surgical Treatment
A small percentage of people with chronic reflux may require surgical treatment. Those who do not respond to medication, who risk esophageal cancer or who balk at the thought of taking medication daily for the rest of their lives, may choose laparoscopic antireflux surgery. "These patients were just miserable before," says Michael Nusbaum, M.D., attending general surgeon at the Medical Center. "After the surgery most are returned to normal life." Laparoscopic antireflux surgery is a minimally-invasive procedure that corrects GERD by creating an improved valve mechanism at the bottom of the esophagus. The surgeon wraps the upper part of the stomach around the lower portion of the esophagus. This creates increased pressure at the gastroesophageal sphincter so that food will not reflux back into the esophagus. While some patients may initially experience a sensation of difficulty swallowing, Dr. Nusbaum says most soon adjust to the feeling caused by the tightened sphincter. "In about 75 percent of the cases it solves the problem," says Dr. Nusbaum. "Another 20 percent have significant improvement, while only about 5 percent are not helped by the surgery. [ top ] |
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Anyone with symptoms considered potentially dangerous, or with long-term or severe symptoms, would be a candidate for complete diagnostic testing that includes an upper endoscopy test," says Robert Ruffini, M.D., Co-Section Chief of Gastroenterology at Saint Barnabas Medical Center.
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