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If all of the Tums® and Rolaids® that Americans have chewed over the years were stacked on top of each other, they would reach from here to …
Well, who knows how far? Maybe to the moon.
Americans have a lot of heartburn. Of course, it really isn’t the heart that is burning. It’s the lining of our esophagus. And it’s burning—or feels like it—because stomach acid is leaking up into the esophagus where it doesn’t belong. That is called reflux.
A little heartburn every now and then isn’t a big deal. But if your heartburn is severe or occurs nearly every day, you probably should see your doctor. You might have GERD, which is short for gastroesophageal reflux disease. |
GERD is chronic acid reflux that irritates the lining of the esophagus. If it isn’t treated, it can cause chronic inflammation and a greater risk of cancer. Most people who have heartburn, even serious and frequent heartburn, won’t develop cancer. But GERD can also cause a narrowing of the esophagus, which makes swallowing difficult.
It is estimated that 41 million Americans have GERD. In one study, 10 percent of the people responding reported having symptoms of acid reflux every day.
“A number of studies have looked at the quality of life of people who have chronic acid reflux,” says Wayne Lucas, M.D., a gastroenterologist with Pinehurst Medical Clinic. “The quality-of-life score is atrocious, approaching that of someone with schizophrenia. It makes people miserable. If you have it every single day and it wakes you up at night, it can definitely take its toll.”
Greg Blakely, M.D., an internal medicine specialist with Pinehurst Medical Clinic, says more patients come to him because of heartburn and excessive belching, another common symptom of acid reflux, than for any other problem of the digestive system.
“If they have tried over-the-counter acid blockers and they are still having symptoms, I often prescribe one of the proton pump inhibitors like Nexium or Prevacid,” he says. “Most patients respond very well to those, which reassures me that their problem is acid reflux and not something more serious.”
If the symptoms persist, he may refer the patient for an endoscopy, a visual examination of the esophagus. With the patient under sedation, a gastroenterologist inserts a scope into the throat and down the esophagus to check for inflammation or other abnormalities.
Some people have so much acid in their esophagus so often that it causes changes in the lining of the esophagus called Barrett’s mucosa.
“Once that forms, there is a risk of developing dysplasia (abnormal tissue growth), which can sometimes progress to esophageal cancer,” Dr. Lucas says. “The percentage of cases in which that occurs is very small, but with so many Americans having reflux disease, the number of people who go on to develop more serious problems is significant.” Physicians at FirstHealth Moore Regional Hospital will soon begin using a new tool, esophageal ultrasound, for diagnosing esophageal problems. While an endoscope can look only at the outer lining of the esophagus, the ultrasound can reveal details of the entire thickness of the esophageal wall.
“We can tell if there is a tumor in the wall that we can’t detect visually,” says Andy Kiser, M.D., a cardiothoracic surgeon with Pinehurst Surgical and medical director of both the Chest Center and Esophageal Center at Moore Regional. “With the ultrasound, we can even look at lymph nodes and suspicious masses outside the esophagus that, otherwise, we wouldn’t know were there.” |
Wayne Lucas, M.D.
Wymann McGuirt, M.D.
Greg Blakely, M.D.
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Cancer of the esophagus is typically treated with both radiation and chemotherapy, sometimes in addition to surgery.
Blame a faulty valve
Acid reflux occurs when the sphincter muscle at the base of the esophagus doesn’t work the way it should. The muscle is supposed to function as a valve, opening the esophagus to let food and drink pass through and then closing it tightly to keep the contents of the stomach from splashing back up into the esophagus. If you have heartburn, it usually means the esophageal sphincter has let you down.
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“If you have (chronic acid reflux) every single day and it wakes you up at night, it can definitely take its toll.” —Wayne Lucas, M.D. |
If your esophageal sphincter is just a little lax, you might not have much trouble with heartburn unless your stomach produces an excessive amount of acid. You can help prevent that by avoiding hot, spicy and highly acidic foods.
A device called a pH monitor has traditionally been used to measure the level of acid in the esophagus. Physicians at Moore Regional now have a new technology called impedance monitoring.
“The pH study only detects acid, but many people have symptoms of reflux simply because of the presence of fluid in the esophagus,” says Dr. Lucas. “The impedance monitor measures resistance as well as acid. If there is fluid in the esophagus, the resistance to an electrical current goes down, and we can measure that.”
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