Acid reflux, which causes heartburn, is what Wayne Lucas, M.D., calls an “equal opportunity disorder.”
It affects men and women in roughly equal numbers, and those numbers
An estimated one-third of Americans have heartburn at least occasionally. As many as 14 percent—that’s 42 million people—have frequent heartburn, according to Dr. Lucas, a gastroenterologist with Pinehurst Medical Clinic.
Heartburn is a symptom of GERD (gastroesophageal reflux disease) in which stomach acid backs up into the esophagus. It can happen at any time, but is most common after a person consumes fried foods, alcohol or caffeine, and is lying down. Tobacco also promotes acid reflux.
Heartburn typically feels like what its name suggests, a burning sensation
in the chest. Sometimes the discomfort is so great that it can be mistaken
for the pain of a heart attack.
While heartburn feels about the same to men and women, the symptoms
of coronary heart disease and heart attacks can be very different.
“Symptoms are often less specific in women,” says Olujide Lawal, M.D., a cardiologist with Sandhills Cardiology in Rockingham.”
Men with blocked coronary arteries, which lead to heart attacks, are more likely to experience angina, an aching pain beneath the breastbone, according to Steven Kent, M.D., a Pinehurst Medical Clinic cardiologist.
“Angina pain often radiates down the left arm and up to the jaw,” he says. “Unlike heartburn, it usually gets worse with exertion and better with rest.”
Women with severe coronary heart disease often have heartburn-like symptoms or shortness of breath rather than the classic chest pain and pressure of angina.
Wayne Lucas, M.D.
Olujide Lawal, M.D.
Steven Kent, M.D.
Heartburn or heart attack?
“It’s not unusual for someone to come in after taking several bottles of antacids for what they think is indigestion, and it turns out to be a heart attack,” Dr. Lawal says.
In most cases, though, what feels like heartburn really is heartburn, and Dr. Kent says the difference is often pretty clear.
“If the discomfort is worse at night, if there’s an acid taste in the back of the throat, and if it gets better with antacids, then it’s most likely heartburn,” he says.
And while heartburn is much less serious than a heart attack, it is far more common
and can greatly diminish one’s quality of life. In one study, 75 percent of people who experienced heartburn at night said it kept them from sleeping. Forty percent said it made them less effective at work.
Like most gastroenterology specialists, Dr. Lucas sees patients with chronic acid reflux disease nearly every day. The underlying cause of GERD is the failure of a muscle at the base of the esophagus to remain closed and keep stomach acid in the stomach. When the acid splashes up into the esophagus, it can cause irritation and inflammation, which creates the sensation we know as heartburn.
Chronic GERD can cause changes in the lining of the esophagus
that can, in turn, lead to cancer.
Overweight people tend to have more problems with acid reflux. Heartburn is also more common following large meals, when the stomach is overly full. Lying down soon after eating makes it easier for stomach acid to flow into the esophagus and cause heartburn.
From Rolaids to surgery
Antacids available without a prescription are often effective in treating occasional heartburn. If frequent heartburn doesn’t respond to over-the-counter remedies, physicians can prescribe stronger acid-blocking medications. For a small percentage of people with severe, chronic reflux, the only permanent solution is surgery. Surgeons can wrap part of the upper section of stomach around the base of the esophagus to reinforce the muscle that allows acid reflux to occur.
Acid reflux is so common, and in some people so serious, that FirstHealth has created a special center for diagnosing and treating
GERD and other diseases of the esophagus. The Esophageal Center brings together gastroenterologists, surgeons, and ear, nose and throat specialists, along with speech and swallow therapists, to tackle some of the most serious and complex cases.
“There is a subset of patients with reflux whose conditions are very challenging and difficult to sort out,” says Dr. Lucas, who is medical director of the Esophageal Center.
The center’s physicians and therapists in the various clinical specialties meet regularly
to discuss their patients’ problems and decide on the best treatments.
“We are finding that those conferences are very useful, and I think it helps us manage each other’s patients better,” Dr. Lucas says.
Acid reflux specialists have several tools to help them diagnose GERD and find out how much damage it has done. They use a special scope to look all the way down the esophagus and a test to measure the amount of acid and fluid in the esophagus.
Last year, ENT physicians at Moore Regional Hospital began using a new instrument
called a videostroboscope to look for cancer and other abnormalities on the vocal cords that can be caused by acid reflux.
For more information on the Esophageal Center, call (800) 213-3284 toll-free.
If someone has acid reflux disease, that doesn’t mean they can’t also have coronary heart disease.
“Patients may have angina and GERD at the same time,” says Olujide Lawal, M.D., of Sandhills Cardiology. “We see that quite often. Sometimes the nature of their pain changes between the time they go to their primary care physician and the time they are referred to me. It changes from a burning sensation to constant pressure.”
As a cardiologist, Dr. Lawal focuses first on the possibility that a patient with chest pain or pressure has heart disease.
“If they also have other symptoms like shortness of breath or excessive sweating, that’s definitely not heartburn,” he says.
And it probably isn’t heartburn if exercise brings on the discomfort or makes it worse, according to Steven Kent, M.D., of Pinehurst Medical Clinic.
“That suggests that the heart isn’t getting enough oxygen due to blockages in the coronary arteries,” he says.
Physicians typically look to a patient’s medical history for clues as to what is causing their symptoms.
“If someone has known heart disease or strong risk factors for heart disease, that makes us suspicious that they are having heart pain and not heartburn,” Dr. Kent says.
E lectrocardiograms (EKGs) and stress tests can help confirm or dispel suspicions of heart disease. Cardiac catheterizations can show the location and extent of any blockages in the coronary arteries. Cardiologists at Moore Regional recently began using a new diagnostic procedure, cardiac CT angiography, to diagnose clogged coronary arteries.
“This has greater sensitivity to blockages, so our surety level will go up,” Dr. Kent says.