Heartburn. Just about everyone who’s ever overdone it at the buffet line has experienced the fire-down-below sensation. But before you pop your favorite antacid and shrug off your symptoms, listen up: Anything more than occasional heartburn—otherwise known as gastoesophageal reflux (GERD)—needs to be taken seriously. Why? It could raise your risk for cancer of the esophagus. Here’s what you need to know to stay healthy.
How it happens: GERD occurs when the sphincter muscle, which keeps stuff in your stomach, doesn’t do its job, allowing food and digestive juices, including acids, to travel back up the esophagus. Over time, the acidic juices can damage the lining of the esophagus, causing abnormal cells, a condition called Barrett’s esophagus. Common in men and in middle-aged and older people, Barrett’s esophagus increases the risk of developing esophageal cancer 30- to 125-fold. If Barrett’s esophagus is diagnosed, your doctor will perform a biopsy to see if you have dysplasia—which means abnormal cells have changed and could progress to cancer.
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The root of the problem:GERD is characterized by lots of bothersome symptoms including heartburn, regurgitation of food, chest pain, a sour taste, coughing, choking or wheezing, trouble swallowing, belching, hoarseness, a sore throat and a feeling food is stuck behind the breastbone. Barrett’s esophagus, on the other hand, doesn’t come with such symptoms. In fact, sometimes Barrett’s sufferers experience an easing of heartburn pain, prompting people to think it has cleared up. “One theory is that the Barrett’s esophagus is less sensitive to acid than a normal esophagus,” says Dr. Bruce D. Greenwald, chairman of the board of the Esophageal Cancer Action Network. “Acid still refluxes but the lining doesn’t have the same sensors as a normal lining.” The only way to know if you have Barrett’s esophagus is to have an endoscopy, in which a thin, flexible tube is threaded down your esophagus to your stomach to examine the esophageal lining.
Related: How to Diagnose Barrett’s Esophagus
Treating GERD: The key to keeping GERD from becoming more serious is to, well, take it seriously. “If you have GERD, don’t say, ‘It’s no big deal’ and live with it,” says Greenwald, professor of medicine in the division of gastroenterology and hepatology at the University of Maryland School of Medicine in Baltimore. “GERD can be treated effectively.” First step: Tell your doctor about your heartburn. He can then determine whether your GERD is mild or serious and recommend treatment. Lifestyle changes are usually the first line of defense. These include:
- Don’t overeat. “More food means more food time in the stomach, which triggers more acid production over a longer period of time,” says Greenwald.
- Avoid eating within two to three hours of bedtime. “When you lie down you produce more acid,” explains Greenwald.
- Limit your intake of greasy, fried foods, chocolate and citrus. “They weaken the sphincter muscle and make more acid,” says Greenwald.
- Avoid tobacco and alcohol, which also weaken the sphincter muscle.
- Lose some weight. It decreases pressure on the sphincter.
- Avoid tight-fitting clothing, which can put pressure on the muscle.
- Sleep with your head elevated to keep gastric contents in the stomach.
GERD medications:Doctors often recommend GERD medications to be used along with lifestyle changes. The type you need will depend upon the severity of your GERD and your response to the medicine. For mild, intermittent symptoms, Greenwald recommends over-the-counter antacids, which neutralize stomach acid. If these don’t do the trick, you may need an OTC or prescription H2 blocker, which reduces acid production. If neither the antacid nor the H2 blocker help and/or your GERD flares up more than a few times per week, you may need an OTC or prescription proton pump inhibitor (PPI), which also reduces stomach acid.
Surgery for GERD:If you don’t want to take pills, can’t handle drug side effects, or have a large hiatal hernia—a common risk factor for GERD—surgery is an option. During the procedure, known as the Nissen fundoplication, the upper part of the stomach—the fundus—is wrapped around the bottom of the esophagus to reinforce the sphincter muscle and repair the hernia. Done laparoscopically, the procedure involves an overnight stay in the hospital and a few weeks of recovery. For more on GERD and steps you can take to lower your risk for esophageal cancer, visit the Esophageal Cancer Action Network at http://www.ecan.org. Find a free patient guide at http://www.ecan.org/site/PageNavigator/Patient_Guide.html