If you have heartburn, you're not alone: heartburn strikes approximately 25 million Americans daily. Classic heartburn is described as a burning sensation under the breastbone that radiates upwards to the throat or mouth. It is caused by stomach acid and contents from the duodenum (top of the small intestine) entering the esophagus, usually one to two hours after a meal or from heavy lifting or bending over. Patients who eat late in the evening or who have alcohol during meals are prone to nighttime symptoms. Commonplace as it is, individuals who regularly suffer from heartburn should seek care from a physician.

Heartburn is the most common symptom of gastroesophageal reflux disease -- GERD. This occurs when the lower esophageal sphincter, a muscular ring at the end of the esophagus, is not functioning properly. This allows the rising, or reflux, of stomach acid into the esophagus.

GERD can cause symptoms that are not consistent with classic heartburn, including chest pain, repetitive throat clearing, bronchitis, wheezing or coughing at night, sleep apnea, chronic sinusitis, ear pain, bad breath and loss of dental enamel. Because these are not symptoms of classic heartburn, GERD often is undiagnosed.

The most severe outcome of longstanding GERD is Barrett's esophagus, in which cells lining the esophagus change. It is thought to be a precancerous state and requires regular surveillance by a gastroenterologist.

Endoscopy, a procedure using a fiber-optic tube, is the most practical and informative test for GERD. It is the only diagnostic method that allows evaluation of the type and extent of reflux-induced injury to the esophagus.

Burning issues:
Substances that contribute to heartburn

• Fats
• Citrus products
• Chocolate
• Tomatoes
• Onions
• Spicy foods
• Coffee, colas, tea
• Beer
• Smoking
• Aspirin
• Progesterone
• Nonsteroidal anti-inflammatory drugs (NSAIDS)
• Exercise

Lifestyle changes and treatment options
Until the mid-1970s, lifestyle alterations remained the treatment of choice for GERD. Although they still are recommended and may have a large impact on symptoms, many other therapies are available now, the most common being pharmaceutical.

Recommended lifestyle modifications include:

• Elevate the head of the bed by six inches during sleep.
• Avoid tight-fitting clothes.
• Restrict alcohol use and the foods listed above.
• Stop smoking.
• Lose weight, if overweight.
• Avoid lying down after meals.
• Avoid eating meals three hours or less before bedtime.
• Review all medications with your physician, as some may be reflux-provoking.

If this approach doesn't work, use of medications such as Tagamet, Zantac, Pepcid and Axid provides relief and offers esophageal healing approximately 50 to 75 percent of the time. Newer drugs such as Prilosec, Prevacid, Aciphex, Protonix and Nexium eliminate stomach acid almost entirely and have become the treatment of choice for severe GERD symptoms and esophageal healing.

A last method of treatment when all others fail is surgery. A procedure called fundoplication usually is reserved for patients with extremely severe GERD or healthy individuals who do not wish to take medication long-term.

Gastroenterologist George Vagujhelyi, MD, has joined Nevada Gastroenterology on the campus of Northern Nevada Medical Center in Suite 207, 2385 E. Prater Way, Sparks Medical Building (connected to Northern Nevada Medical Center). For more information or an appointment, please call 356-0100.

Northern Nevada Medical Center 2375 E. Prater Way, Sparks, NV 89434 775-331-7000