Heartburn revisited

Posted on 9 October 2012

Meet our expert, Dr Peter Barrow, a gastroenterologist at Mediclinic’s Wits Donald Gordon Medical Centre.

I suffer from pretty bad heartburn and now I have been told it is GERD. What does that mean?
In my last post I wrote about heartburn, which is nothing to do with your heart, but the result of reflux. This happens when your food washes from your stomach back up your food pipe or oesophagus, in a searing mix with digestive acid. Heartburn may give you a burning feeling in the centre of your chest or even your throat, an acid taste in your mouth, unexpected regurgitation or trouble swallowing. But if you have GERD, or gastro-oesophageal reflux disease, chances are that you suffer this at least twice a week. You might also have stomach pain, persistent hoarseness, laryngitis or a sore throat and a chronic cough.

My doctor thinks I have GERD. What next?
GERD is usually diagnosed by your symptoms and if you show no signs of complications, chances are you’ll go on a trial run of dietary changes and perhaps non-prescription medication such as antacids to sort it out. However, if your diagnosis was unclear or symptoms are worrying your doctor may want to use:
• An upper endoscopy, or small flexible tube with a light and camera, which is threaded through your mouth into the oesophagus, stomach and small intestines to look for possible damage and take small tissue samples.
• A 24-hour pH study to measure the frequency of your acid reflux. A thin tube with a tiny acid-measuring device will be passed through your nose and attached to the wall of your oesophagus during an endoscopy.
• A manometry study would pass a thin tube into your oesophagus to measure your muscle contractions or peristalsis which sends food down your oesophagus, and also to assess your lower-oesophagus sphincter, or the little ring of muscle that should stop food escaping your stomach.

Is GERD bad news?
Chances are that if you are like most patients, you will not develop serious complications from GERD, especially if it’s treated. But there are serious complications that can occur:
• Ulcers can form in the oesophagus from acid burn.
• The oesophagus can get scarred and narrowed, causing a stricture which can make it hard to swallow.
• If acid reflux reached your throat, it could cause irritation to the throat and vocal cords resulting in coughing, hoarseness and breathing problems.
• Repeated damage to the lower oesophagus can cause the lining to become abnormal. Known as Barrett’s Oesophagus, this has a small risk of turning into cancer. In this case, you should have a periodic endoscopy to look for early signs. The good news is only a small percentage of people with GERD develop Barrett’s, and an even smaller percentage develop adenocarcinoma.

How should I take care of myself and manage my GERD?
1. Lifestyle changes:
• Losing weight can help to slow down reflux.
• Elevating the head of your bed can be helpful, especially if reflux wakes you.
• Stop smoking.
• Watch what you eat. Avoid acid reflux-inducing foods such as excessive caffeine, chocolate, alcohol, peppermint and fatty foods.
• Avoid large meals.
• Try not to lie down within three hours of eating.
• Try chewing gum or oral lozenges to increase saliva production which helps to clear stomach acid in the oesophagus.

2. Medications
• Antacids are commonly used for short-term relief.
• Histamine antagonists, such as Zantac, reduce the production of stomach acid.
• Proton pump inhibitors are currently the most effective acid-reducing medications available. These are used by patients who have failed to respond to lifestyle changes and over-the-counter medications.

Am I likely to need surgery?
In these days of potent acid-reducing medications, surgery is only necessary if you have ongoing symptoms as a result of reflux and are not responding to other treatments. Generally surgery strengthens the lower oesophageal sphincter through keyhole surgery.

 

Published in Expertise

In the interest of our patients, in accordance with SA law and our commitment to expertise, Mediclinic cannot subscribe to the practice of online diagnosis. Please consult a medical professional for specific medical advice. If you have any major concerns, please see your doctor for an assessment. If you have any cause for concern, your GP will be able to direct you to the appropriate specialists.

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