Acid Reflux: It's not just “My doctor said Mylanta.”

By Maria Fisher

Most people tolerate heartburn as an uncomfortable part of life and treat it with “quick fix” over-the-counter medications. But, left unchecked, heartburn can be a sign of a more serious ailment that could permanently damage your esophagus and may even lead to cancer.

As many as 7 million people in this country suffer from acid reflux, a condition that causes heartburn, according to the National Digestive Diseases Data Working Group and the National Institutes of Health at the U.S. Department of Health and Human Services. Under normal conditions, the muscle at the bottom of the esophagus, the lower esophageal sphincter, contracts once you swallow food and closes the gateway to the stomach. Acid reflux, often called "reflux," or gastroesophageal reflux disease (GERD), occurs when the esophageal sphincter reopens and stomach contents back up into the esophagus. Most everyone experiences acid reflux occasionally, but more frequent bouts plague many people.

Heartburn isn't the only symptom of acid reflux, but it is the most common one. If you have it you experience a burning sensation in your chest after meals or exercise, once you lie down, when you are under stress, and after you eat certain foods. Other esophageal symptoms include a sore or burning throat, a lump sensation in your throat, and regurgitation. Symptoms aren't exclusive to the esophagus, either. You can experience chest pain as well. “It can mimic a heart attack almost exactly,” says Dr. Michael S. Epstein of Digestive Disorders Associates in Annapolis . In fact, about 70 percent of people with non-cardiac chest pain are experiencing acid reflux. Sufferers also report hoarseness in the morning, trouble swallowing, or a dry cough and bad breath, according to the National Institutes of Health (NIH).

What Causes Acid Reflux?

Why is acid reflux so prevalent in the United States ? The Western diet, with its processed foods, carbonated beverages, coffee, mints, and chocolate, plays a large part in developing reflux, says Epstein. Certain medications—blood pressure treatments, for example—can exacerbate reflux. Obesity and diabetes can contribute to it, and over-the-counter medications such as ibuprofen can damage the esophagus as well. Antibiotics, such as tetracycline, can cause reflux, as can alcohol consumption and smoking.

Every puff of a cigarette creates a vacuum effect in the esophagus, forcing acid up from the stomach. Stress can cause the lower esophageal sphincter to relax intermittently, allowing acid to creep up the esophagus.

We hear a lot about acid reflux these days, but is it really as common as it sounds or is it just a “trendy” diagnosis? Dr. Ibrahim Razzak, chief of gastroenterology at Greater Baltimore Medical Center, weighs in, saying “We hear more about it because people are more health conscious—they didn't pay as much attention in the past.” Thanks to the media, we hear about acid reflux everywhere, and it may be overdiagnosed, but our awareness makes it sound more common, he says. Atypical manifestations of acid reflux in particular can be misdiagnosed. Patients who complain of a sore throat, hoarseness, coughs, or vague chest pain are often diagnosed as suffering from acid reflux, but it turns out not to be the main problem.

Diagnosing Acid Reflux

Because acid reflux can cause different problems, there are many ways to arrive at a diagnosis. When a patient complains of heartburn, doctors usually prescribe acid-reducing medications. If the medications control the symptoms, they conclude that acid reflux is the culprit.

For some, though, the diagnosis process goes further. One procedure is the standard upper endoscopy, in which doctors insert into the patient's numbed throat an instrument that allows them to view the esophagus, showing any reddening of the lining, ulcers, or scarring that might be there. They also use a “pill cam”—a camera housed in a multivitamin-sized pill that the patient swallows.

A transnasal endoscopy involves an ultrathin scope that reaches the esophagus through the patient's nose. Doctors also use a probe, attached to a computer, which measures acid output in the esophagus. Doctors measure motility—muscle function—to determine whether the esophageal sphincter is working properly and to detect a hiatal hernia—a portion of the stomach that has migrated through the diaphragm into the chest. Every breath a hiatal hernia sufferer takes creates negative pressure to pull acid up the esophagus. Under normal circumstances, the diaphragm functions to prevent acid reflux, but the hernia compromises its protective properties. An experienced surgeon can repair the condition by wrapping the stomach around the lower esophagus, which reduces reflux.

Seeking Relief: Treatments

When a patient is diagnosed with acid reflux, treatments can take several paths. First, doctors recommend lifestyle changes. Patients are advised to quit smoking and drinking alcohol, to lose weight, to eat small meals, to avoid lying down for 3 hours after a meal and to elevate the head of their bed 6 to 8 inches.

For short-term relief of acid reflux from, say, overeating, doctors recommend over-the-counter remedies such as Pepcid Complete, Zantac, Maalox, or Mylanta. Antacids offer the quickest fix, but slower-acting medications such as Zantac or Pepcid work for bedtime relief and are effective for about half of sufferers, according to the NIH.

The family of drugs called proton pump inhibitors can control reflux in almost all sufferers, the NIH says. These drugs, such as Prilosec, Nexium, Aciphex, Protonix, and Prevacid, work for patients who suffer from chronic heartburn several times a week. “They're very safe, they're very effective,” and one dose a day is enough for most, Epstein says. Patients with extra-esophageal symptoms, such as laryngitis, a chronic cough, or wheezing, may need a higher dosage for months or longer before symptoms abate. A family of drugs called prokinetics works to strengthen the sphincter muscle and facilitate the stomach's emptying, but they have frequent side effects.

A Serious Condition

Acid in the esophagus is cause for concern. It can cause esophageal ulcers, which can bleed and then form scar tissue, a condition called erosive esophagitis. The scar tissue can narrow the esophagus, leading to an esophageal stricture, a narrowing of the lower esophagus. Sufferers complain of intermittent bouts of food sticking in their throat, usually meats or breads. Many don't report the problem and end up with a food impaction—food stuck in their lower esophagus. To treat this condition, doctors sedate the patient and dilate the esophagus, using balloons or a tapered dilator. Doctors advise patients to seek treatment before the condition leads to a food impaction. Typical sufferers rise from the dinner table, having to clear their throat or drink to force food down, or even having to regurgitate food.

When Heartburn Leads to Cancer

Heartburn can be even more dangerous. Chronic acid reflux can lead to Barrett's esophagus, a precancerous condition, and eventually, cancer. To diagnose Barrett's, doctors must view the esophagus by performing an endoscopy. Doctors look for salmon-pink coloring in the lower esophagus and biopsy the tissue. Not everyone develops cancer and doctors don't know why or how long it takes for it to develop, says Razzak.

Patients with Barrett's need periodic screenings to monitor the progression of the disease. If the condition worsens, doctors can treat it with laser therapy or surgery. In laser therapy, doctors use a laser to burn off precancerous tissue. Some patients need traditional surgery to remove the tissue.

Heartburn is dangerous, and should not be dismissed as a common discomfort that many of us must simply live with. If you frequently suffer from this malady, seek diagnosis immediately. A doctor's visit could save your life.

Maria Fisher (formerly Bellos) is a freelance writer based in Shady Side.