Reflux: Avoiding the Burn

Some people feel burning in their chest after eating. Others complain of a cough, hoarse voice or trouble swallowing. And then there are those who experience frequent belching or taste acid in their mouth. All of these are symptoms of gastroesophageal reflux, a digestive disorder commonly known as heartburn, which is often humorously depicted in TV commercials touting over-the-counter remedies. But for the estimated 60-million-plus Americans who suffer regularly from gastroesophageal reflux, the condition is no laughing matter. And for a small percentage of people, it can lead to a serious precancerous condition. To learn more about heartburn and gastroesophageal reflux, we turned to Jim Williams, M.D., a family practitioner with JHCP at Sibley Memorial Hospital.

What causes reflux?

Gastroesophageal reflux occurs when acid comes up out of the stomach and travels up the esophagus. This happens because the esophageal sphincter, which opens to allow food into the stomach and closes to keep it in, becomes relaxed for too often or too long. “Certain foods that you eat will make this relaxation of the esophageal sphincter more likely to happen—anything with caffeine, nicotine, alcohol and peppermint,” says Williams. Medications, including those used to treat osteoporosis, can also cause heartburn. So can lying on the couch after dinner.

Who is most at risk?

People with large abdominal girth, smokers and pregnant women. Those who have a hiatal hernia—when the upper part of your stomach pushes up through your diaphragm and into your chest—are also more at risk. “With a hiatal hernia, stomach acid can slide up the esophagus more easily,” Williams says. Hiatal hernias occur in about 3 to 10 percent of people, are more prevalent with age and can be treated with surgery if necessary.

What can I do to prevent reflux?

“The most important thing you can do is to identify the habit that’s the problem and change it,” says Williams. “For example, people who find heartburn and reflux intolerable at bedtime need to avoid eating two hours before they go to bed.” In addition, losing weight, quitting smoking, cutting down on alcohol and avoiding overeating can all help prevent reflux.

What are the most effective treatments?

Over-the-counter antacids like Tums can be helpful in treating reflux, Williams says. For more persistent reflux, Williams recommends taking H2 blockers (acid reducers), like Zantac and Pepcid, which often have to be taken with every meal. “Far and away the best over-the-counter type of medication is a proton pump inhibitor known as Prilosec OTC,” he says.

When should I see my doctor?

Any regular need for H2 blockers or Prilosec OTC should be reviewed with a physician. “You don’t just want to put a bandage on a problem that needs something more,” Williams explains. Here’s why: Neglect your reflux for too long and the condition can become chronic. “If the esophagus is exposed to hydrochloric acid of the stomach repeatedly over time, it gets burned and injured,” he says. One can even develop adhesions in the esophagus that make swallowing difficult. Over years, the affected cells in the esophagus can become precancerous, a condition known as Barrett’s esophagus. “Heartburn ignored for long enough, especially in combination with smoking and too much drinking, puts you at increased risk for cancer of the esophagus,” says Williams.

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Bonnie C November 5, 2014 at 9:22 am

My PCP discovered my hiatal hernia years ago & prescribed Prilosec OTC twice a day. I took it for a couple of years, and then was told I had the early stages of osteopenia (a precursor for osteoporosis). If a change in diet will prevent the need for Prilosec (or other proton pump inhibitors - which can contribute to osteoporosis if taken over a long period of time) then the diet MUST change. I've been able to keep my GERD under control for quite some time, and it really only bothers me when I consume alcohol, caffeine, or chocolate (I can still have a very small amount, but even 2 cups of caffeinated beverages will cause heartburn).

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Marie November 5, 2014 at 8:29 am

Very helpful information. My PCP has recommended Endoscopy to check my esophagus ..I have a history of esophageal ulcers n ongoing acid reflux which is being medically managed. I have been putting it off. Will have to find a gastroenterologist at Hopkins for Consult n testing. Thank you.

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