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Glenn D. Braunstein, M.D. Headshot

When Common Acid Indigestion Takes You Beyond the Pink

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Most people often dismiss heartburn as common and trivial, an ailment to be treated with a grimace and a glug of thick, chalky pink liquid. But, while acid reflux is very common, it is far from insignificant. If you're chugging a pink drink or chewing up antacid tablets twice a week or more, pay attention.

You could be showing signs of gastroesophageal reflux disease, or GERD. This chronic digestive disease occurs when stomach acid or bile flows back into the esophagus -- the food pipe - and irritates the lining, causing inflammation.

Common symptoms include:
  • heartburn
  • a burning sensation in the throat
  • sour or bitter taste in the mouth
  • chest pain
  • difficulty swallowing
  • dry cough
  • hoarseness or sore throat
  • regurgitation of food or sour liquid

According to The American College of Gastroenterololgy, more than 60 million people in the United States experience heartburn at least once a month. Some studies suggest that more than 15 million Americans experience heartburn symptoms daily. An estimated 20- to 40-percent of these individuals, in fact, suffer from reflux disease. Because many control their symptoms with over-the-counter medications and don't tell their doctors about it, the number of cases likely is highly underreported.

For about 10 -- percent of those with chronic GERD, the condition turns into Barrett's esophagus, a serious pre-cancerous condition. In Barrett's, cells lining the esophagus change, forming tissue that resembles the lining of the intestine. This increases the risk 30-fold of developing esophageal cancer. Other GERD complications include stricture -- or narrowing -- of the esophagus, ulceration, bleeding and severe chest pain that often is mistaken for a heart attack.

Heartburn occurs when the esophagus comes in contact with too much fluid from the stomach, including acid and digestive enzymes, causing burning discomfort. This often occurs because the muscular valve at the bottom of the esophagus -- the lower esophageal sphincter -- relaxes too frequently and doesn't do its job of keeping acid in the stomach and out of the food pipe.

The first line of defense is over-the-counter medications and changing behaviors. Occasional heartburn may be treated with over-the-counter acid blockers or proton pump inhibitors, drugs that reduce gastric acid production. If you find you must take these products more than twice weekly, you should consult your physician to ensure you aren't suffering from a more serious problem. Prescription-strength versions of these drugs are available as part of a treatment plan developed with a doctor.

Those prone to heartburn also should:

  • Eliminate food and drink that bring on heartburn. These include chocolate, coffee, peppermint, citrus fruits, fatty, fried or spicy foods, garlic, onion, tomato products and alcohol.
  • Stop smoking. Besides the dozens of other reasons to kick the habit, tobacco stimulates stomach acid production, relaxes the lower esophageal sphincter, and inhibits the protective flow of saliva. In short, smoking promotes all the major causes of heartburn.
  • Lose weight, if you're overweight.
  • Avoid eating two to three hours before bedtime. Nighttime acid reflux can be especially harmful as it strikes while a person is lying down, leaving the digestive fluids washing into the esophagus.

For those with serious reflux disease, the modifications are more extensive. Besides the suggestions listed above, acid reflux disease patients often are advised to raise the head of the bed or use an under-mattress foam wedge. Lying down should be avoided for at least two hours after eating. They also should avoid tight clothing.

Patients absolutely should watch for these signs that they already have suffered serious reflux damage: difficulty swallowing, or a feeling that food is trapped behind the breast bone; bleeding, including vomiting blood or tarry, black stools; choking; shortness of breath; coughing or hoarseness; and unexplained weight loss.

Surgical options to treat this condition include minimally invasive care such as endoscopic treatments and a radiofrequency electrosurgery (in which energy is delivered to the tissue through a catheter). The electrosurgery causes tissue to constrict and the muscle wall to thicken. Fundoplication is another surgical possibility. In this procedure, part of the stomach is folded to form an anti-reflux valve. This surgery can be performed laparoscopically, where tiny incisions are made in the abdominal area, and even through the mouth with no incisions at all.

Acid indigestion is a common enough ailment that most of us can probably hum a jingle or two advertising one of the many over-the-counter remedies on the market. But, if you find yourself calling those dissolving tablets to the rescue too frequently, call your doctor instead.