If you're from a Western country, there's a 10-20 percent chance that you suffer from classic symptoms of acid reflux: chronic heartburn and/or acid regurgitation.
But if you don't have those classic symptoms you may still have acid bubbling up from the stomach into the esophagus, a condition called "gastro-esophageal reflux disease" (GERD). Over the past decade, research has suggested that acid reflux can cause atypical symptoms such as cough, hoarseness, sore throat, asthma, and even chronic sinusitis. GERD can also cause chest pain, especially if the acid causes the muscle in the esophagus to go into spasm.
As an internist and gastroenterologist, I've seen patients who have suffered for years with atypical symptoms of GERD get better with treatment. Although I usually prescribe acid-reducing medication, I try to avoid an approach that relies exclusively on "better living through chemistry." In fact, my goal is to treat the symptoms with life-style adjustments alone if possible. Smoking and obesity both increase acid reflux and must be addressed. I tell my patients to limit alcohol, caffeine, chocolate, peppermint, and fatty foods (I know, basically anything that gives them even an iota of pleasure in life). I also suggest keeping a food diary to try to identify culprits such as tomato-based products or certain spicy foods. If their symptoms resolve then they can try to reintroduce the things they miss the most. Elevating the head of the bed can sometimes help.
The most serious consequence of chronic acid reflux is esophageal cancer. About ten percent of patients with long-standing acid reflux develop changes in the swallowing tube that increase the risk of developing adenocarcinoma, a deadly cancer with a 5-year survival rate of less than fifteen percent. The condition is called "Barrett's esophagus. "Fortunately, only about one in 200 patients with Barrett's esophagus develops cancer each year. And over the last year a treatment called "radiofrequency ablation" has been found to be extremely effective in treating Barrett's esophagus that is starting to show signs that it may turn into cancer.
It's estimated that almost 15,000 Americans will die from esophageal cancer this year. Fifty years ago, more than 95% of esophageal cancers were "squamous cell" -- the kind caused by smoking and excess alcohol use. As smoking has declined, the incidence of squamous cell carcinoma has dropped. But for reasons that are not clear, esophageal adenocarcinoma -- the kind linked to acid reflux (and smoking) -- has dramatically increased over the past forty years and now accounts for about half the cases of esophageal cancer. From 1975 to 2001 there was a 600 percent rise in esophageal adenocarcinoma. The obesity epidemic may well be playing a role by increasing the number of adults with acid reflux.
Gastroenterologists can diagnose acid reflux by slipping a thin, flexible instrument (endoscope) through the mouth and down the esophagus. It's a lot easier than it sounds. Patients are usually given sedation and the back of the throat is sprayed with numbing medicine to avoid gagging. There's no problem breathing because the tube doesn't go into the breathing tube (the trachea). Biopsies can be taken from the last part of the esophagus to look for microscopic evidence of Barrett's and inflammation (esophagitis) caused by acid reflux.
There is currently a controversy about who should be endoscopically screened to look for evidence of Barrett's esophagus. Only a fraction of the millions of patients with chronic reflux will ever develop Barrett's. And many patients with Barrett's have no symptoms at all. In a study in Sweden, 1.6% of the population had Barrett's but only about 40% had heartburn. And only about half of esophageal adenocarcinoma is estimated to be a result of reflux.
The American College of Gastroenterology recommends against screening the entire population but says it may be appropriate in certain populations at higher risk - such as Caucasian males over 50 with longstanding heartburn. That would be me. So for this week's episode of CBS Doc Dot Com, I underwent an upper endoscopy, explained and performed expertly by Dr. Mark B. Pochapin, director of The Jay Monahan Center for Gastrointestinal Health at New York-Presbyterian Hospital/Weill Cornell Medical Center. For more information about the Jay Monahan Center, click here.
For information about GERD from the American Society for Gastrointestinal Endoscopy, click here:
To watch my upper endoscopy, click here:
I choose life and now I eat better and drink far less Curveo Gold. But at the FIRST SIGN of heartburn, I treat with - usually with cheap, faster acting antacids. My cities drinking water is one of the worst offenders, unless I filter it. Then when it started to upset me stomach, I know it is time to change the filter.
And yes, I am fat. Even fatter now that that Time of Bleeding so long ago (about 20 years).
So it goes. Your mileage will vary.
i was finally referred to a surgeon and after more tests told me i needed a nissan wrap. that's where they pull
the stomach back into place, and pull the diaphragm and top of the stomach together and wrap it
around the esophogus. one will never have another hiatal hernia, and the esphogus is reinforced. that's probably not the "medical" explanation. anyway. it took 6 months for
the little lung air sacs to refill the" protein to function properly. the acid reflux and cough are gone.
with only part of my stomach left i am losing weight.........the kicker is all the little nerves at the top
of the stomach that
create hunger pains and the sensation of hunger have been changed somehow.. i can go all day before i realize
i haven't eaten anything.....but the relief from the acid reflux was instantaneous..
Also, the doctor's point about PPIs not necessarily decreasing the risk of BE/cancer is important. PPIs decrease symptoms, but not necessarily harmful reflux of bile acids, which are a likely cause of BE/cancer. Doctors get away with treating GERD with PPIs because the patient feels better, and the risk of developing BE/cancer is relatively low even with reflux. But the PPIs are as likely to promote BE/cancer (by hiding reflux) as much as prevent it. For this reason it is always better to treat GERD with lifelstyle changes that reduce reflux (smaller meals, raised head of bed, etc.).
If the ACID eats thru your esophagus it can eat a hole in that HIGH PRESSURE blood vessel. Scary huh ? Gurggle Gurrgle.
I stay erect somehow for at least 2 hours after I eat and I have never had the reflux come back.
But a Paramedic scared me strainght with this info.
The doctor told me (and this was 1989) that it was highly inoperable due to to very thin tissue. Reconstructon would have been difficult. It would migrate quickly into other organs.
I pray that treatment has advanced in the past 20 years, and that it will continue to progress.
Thank you so much for writing. How wonderful and uplifting to hear such a success story. You are right that esophageal cancer does not get enough attention. We desparately need more basic research into prevention and treatment. Amazingly, 800 million dollars are spent on treatment annually in the U.S. yet only 22M in research is being funded by the National Cancer Institute.
http://www.nci.nih.gov/aboutnci/servingpeople/esophageal-snapshot.pdf
Jon
And while we are at it, my health insurance has covered everything, in an expeditious and efficient way -- the way everyone's health insurance should work.
I wish this cancer had higher visibility, because the rate at which new cases are being diagnosed is truly frightening.
So many youngsters, harangued about chastity and virginity are doing "everything but intercourse" and I believe a time bomb is ticking.
Ulcers were thought to be solely lifestyle based (stress and diet) but a stubborn doctor in Australia suspected the bacteria heliobacter pylori and after years of ridicule was proven right.
Last year I had an incisionless transoral fundoplication at The Ohio State University and the results were fantastic. You can read about it at their website. http://cmis.osu.edu/8821.cfm.
I am sure this procedure is not right for everyone, but neither is diet, lifestyle or medication. May be worth looking into this.
As someone who has gotten his chronic acid reflux under control this year with a combination of medication and lifestyle adjustments and who has already reversed the damage caused thereby with no signs of Barrett's, let me make one suggestion.
If someone has any of the indicators of GERD (including but not limited to bad acid indigestion after every meal, taking enough Tums and other OTC meds to sink a battleship, waking up with symptoms in the middle of the night), be very PUSHY with your internist. Make him/her aware that this is more than just something a little unpleasant so s/he gets you to a gastroenterologist who can diagnose the condition, perform a baseline endoscopy and get you treated. It's more than possible for even good internists to downplay your symptoms, given the stress under which most folks live, as stress-related indigestion. You have to TELL your doctor that it's really bothering you.
Thanks again for this post, you might lengthen a life or two!
I'm being treated with effective medication and now have no cough. After reading this article, I realize that I've also been saved from getting cancer.
Thank you for increasing awarness.