Tough To Stomach

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The occasion of an “acid stomach” or “heartburn” is a common occurrence for many of us from time to time.  If the incidence and intensity increases over time, however, it may evolve into a more serious and long lasting form of reflux known as Gastroesophageal Reflux Disease (GERD).   A fairly common disease, the National Institute of Health estimates that one out of five individuals has some degree of GERD. 

Anyone can develop GERD, but individuals more prone to this problem tend to be overweight or obese.  It is also a common problem with women during pregnancy.  Smokers and those exposed to second-hand smoke seem to have a higher incidence of reflux disease as well. There are commonly used medications that treat asthma, allergy, blood pressure, depression, insomnia and painkillers all know to contribute to GERD.

GERD arises from irritation of the esophagus (connecting mouth to stomach) when stomach acid leaks upward through the lower esophageal sphincter that normally restricts acid from washing into the esophagus.  Most commonly, the complaint is that of a painful burning feeling behind the breastbone, back of the throat or middle of the abdomen.  Other symptoms may include bitter taste in the back of the throat, nausea and vomiting, painful swallowing, possible breathing problems and thinning of tooth enamel.     

As inflammation continues, there are complications of GERD that can develop.  When the acid irritates the airway and lungs, there can be persisting cough, sore throat or hoarseness. As inflammation increases, problems such as asthma and wheezing, chest congestion or fluid in the lungs, or even pneumonia can develop.  Persisting inflammation of the esophagus may lead to a condition called Barrett’s esophagus.  The tissues actually change in appearance over time, and for some individuals may lead to a rare cancer of the esophagus.

There are lifestyle changes that may help treat GERD.  Avoiding food and beverages such as greasy or spicy foods and alcoholic drinks may help.  Some other common foods that may worsen GERD include chocolate, peppermint, tomatoes or tomato products and coffee.  Not overeating and not eating within a few hours before bedtime may also be beneficial.  Additionally, sleeping on a mattress adjusted at a slight angle may help.  This can be achieved by safely putting six-inch blocks under the bedposts at the head of the bed.  Of course, weight loss and quitting smoking both may be helpful as well.

There are non-prescription medicines that are available to treat reflux.  Antacids such as Maalox, Mylanta and Rolaids work by buffering stomach acid.  H2 Blockers such as Tagamet, Pepcid AC and Zantac reduce the amount of acid produced.  Proton Pump Inhibitors (PPI’s) also reduce acid production, but more effectively than H2 Blockers.  Some brand names of this group include Nexium, Prilosec and Prevacid. 

It is important to see your doctor if GERD symptoms do not readily resolve within a few weeks of treatment.  There are several tests that may be appropriate if symptoms do not improve or return frequently.  You should be seen immediately if you vomit fluids that are green or yellow, look like coffee grounds or contains blood.  As well, you should be seen right away if you have problems breathing after vomiting, pain in mouth or throat with eating, or difficulty or pain with swallowing. 

Bradford Croft, DO

East Flagstaff Family Medicine