Published January 10, 2023
For most people, heartburn might seem like a small price to pay after a meal full of fried foods or a decadent dessert. But that burning sensation in the chest is due to acid reflux, which could be the sign of a more serious condition.
The term reflux refers to stomach contents coming back into the esophagus. Most patients with reflux have reflux on a daily basis. This type of reflux, referred to as “physiologic reflux,” is infrequent, returns back to the stomach quickly, and usually doesn’t cause any symptoms.
Gastroesophageal reflux disease or GERD manifests in patients who reflux more often and in whom the refluxed stomach contents remain in the esophagus for a long time. This is referred to as “pathologic reflux.” In addition to causing burning in the chest, patients with pathologic reflux may present with non-burning chest pain, irritation of the throat and difficulty swallowing.
Gastroenterologist William Ravich, MD, who specializes in swallowing disorders and esophageal disease, says reflux usually is caused by one of two things. The first is a hiatal hernia, which occurs when the upper part of the stomach extends into the chest. That change in positioning promotes reflux.
“If you eat a lot but the stomach’s in a normal place, the pressure that builds up in the stomach is actually applied to the lower end of the esophagus and helps prevent reflux. But if the lower end of the esophagus is in the chest, it’s like a tube of toothpaste. That same pressure is forcing stomach contents up into the esophagus,” Dr. Ravich said.
The second cause of reflux is when the the lower esophageal sphincter, a circular muscle located at the junction of the esophagus and stomach, that stays closed most of the time and opens when you swallow, is weaker than normal.
For most people, occasional reflux is nothing to worry about and does not cause long-term problems. However, those who experience frequent heartburn multiple times a week that is not caused by behaviors such as overeating should mention it to their doctor.
Excessive amounts of reflux can cause esophageal inflammation, referred to as esophagitis, which may cause the esophagus to become narrow due to scarring, referred to as a stricture. In some patients, It can also eventually lead to esophageal cancer. Therefore, Dr. Ravich says anyone with frequent or severe heartburn or trouble swallowing should be evaluated.
Recurring heartburn or reflux that does not respond to over-the-counter medication also warrants a trip to the doctor. In many patients, a change in diet and life-style can control symptoms. In others, medication may be required. In some patients, tests to determine the severity of reflux including endoscopy, during which a gastroenterologist can look at the lining of the esophagus using a flexible telescope to help identify signs of serious esophageal damage.
Patients with severe reflux may be candidates for surgery. A fundoplication is a procedure that reduces a hiatal hernia and creates an artificial barrier against reflux. While it is effective, it is still an operation that comes with its own set of risks. Even when successful, the fundoplication may deteriorate over time. Surgery is usually considered only when medical management fails.
Medication is available that is usually successful at controlling symptoms and healing esophagitis when present. Proton pump-inhibiters and H2 blockers work by decreasing stomach acid.
However, those finding relief with medication may still need to adjust their lifestyle. Overeating, eating rich and fatty foods, drinking excessive amounts of coffee and smoking all contribute to reflux.
“Changing the way you eat and your daily habits can go a long way in making symptoms better and if you do need medication, it makes it possible to be on less medication,” Dr. Ravich said.
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