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An occasional bout of indigestion or heartburn is generally nothing to worry
about, but if the pain and irritation become frequent or cause you to wake at
night, it’s time to talk to your doctor. Heartburn, known in medical terms as
gastroesophageal reflux disease or GERD, occurs when the stomach acid moves
beyond its usual bounds and flows into your esophagus, irritating the esophageal
lining. This happens because the ring of muscle (sphincter) that tightens and
normally blocks this flow between stomach and esophagus becomes weakened or
relaxed.
If left untreated, GERD can, over time, cause permanent structural changes to
the lining of your esophagus. Once these changes occur, you will require more
aggressive treatment and monitoring, since these changes put you at a slightly
higher risk of cancer. "If you’re having heartburn more than once a week,
and especially if you’re having complications, such as difficulty swallowing,
it’s time to see your doctor," says Edgar Achkar, M.D., chairman of the
department of Gastroenterology and Hepatology at The Cleveland Clinic.
Managing heartburn
When temporary and infrequent, GERD can usually be managed through use of
over-the-counter antacids and behavioral changes. Medications such as ranitidine
(ZantacÒ ), cimetidine (TagametÒ
), and famotidine (PepcidÒ ) are used to neutralize
excess stomach acid and provide immediate, short-term relief.
Lifestyle changes can help as well. Physicians recommend heartburn sufferers
eat smaller, more-frequent meals, instead of three large ones, to help limit
stomach acid production. Eating more slowly may also help, as well as avoiding
fried, spicy or rich foods. Reducing the use of alcohol or tobacco also is
advised since they can relax the sphincter muscle. To limit the backflow of
stomach acid, don’t lie down for at least two hours after eating and, when
sleeping, make sure the head of your bed is higher than the foot.
If behavior modification and antacids aren’t enough, your doctor may start
you on one of the prescription drugs that block production of stomach acid.
These medications—which include omeprazole (PrilosecÒ
), lansoprazole (PrevacidÒ ), pantoprazole (ProtonixÒ
), rabeprazole (AciphexÒ ) and esomeprazole (NexiumÒ
)—are known as proton pump inhibitors and are used for long-term management of
GERD.
Looking inside for treatment options
For those whose heartburn occurs several times a week and is not well
controlled by medications or behavior, your doctor may recommend that your
esophagus be examined with an endoscope. This flexible tube with a light on the
end allows a close look at the lining of your esophagus to determine the
presence and severity of inflammation and detect any complications. Also the
examination enables your physician to take a sample (biopsy) and study it in the
lab to determine if, or how, chronic exposure to acid irritation has changed the
cells. Follow-up endoscopic exams are scheduled every three months to every
three years, depending upon how the cells look.
"Our hope is to identify any changes in your esophageal lining while
still in the precancerous stage," says Dr. Achkar. "If we catch it at
this stage, we can treat it aggressively with a variety of proton pump
inhibitors to shutdown acid production, as well as continue to monitor for any
further change."
If the cells lining your esophagus become precancerous—a condition known as
Barrett’s esophagus—there is a small but increased chance that they will
eventually become cancerous. According to Dr. Achkar about 10 percent of those
with Barrett’s esophagus will develop esophageal cancer in their lifetime.
In the rare instances where medications fail to block acid production,
surgery is an option to strengthen the area of the sphincter muscle. In the
cancerous stage of the disease, a much more radical operation is necessary
When does your heartburn need to be ‘scoped?
According to Dr. Achkar, there is little connection between severity of
heartburn symptoms and risk of esophageal cancer. What, instead, determines need
for endoscopic exam is a series of risk factors which include:
- White male
- Over age 50
- Heartburn for 10 years or more
- Family history of esophageal cancer
- Cellular changes seen on previous endoscopic exam
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