Most of us have experienced heartburn at some point in our lives. For most of us, it’s after a fatty meal or eating too much spicy food. However, it can become a significant problem for many people, both young and old. I am hearing more and more patients tell me about their children or others that they know who are on medication for gastric reflux. It is almost becoming epidemic. Most people who suffer from persistent heartburn have it two or more days per week. Heartburn is also known as gastroesophageal reflux disease or GERD. What happens is contents of the stomach, including digestive juices, back up into the esophagus, usually because the sphincter between the esophagus and stomach is not working properly. Digestive juices backing up into the esophagus is a problem because the lining of the esophagus wasn’t designed to handle the acidity of the digestive juices so it gets irritated by them. That irritation is what causes the burning sensation of GERD.
Typically the heartburn related to GERD comes after eating a meal. But heartburn isn’t the only symptom, other symptoms include chest pain, wheezing, coarseness in the throat, breathing problems, a bitter taste in the mouth, dry coughing, interrupted sleep, tightness in the throat, and halitosis or bad breath. Prolonged gastroesohageal reflux can cause serious health problems. The constant irritation to the lining of the esophagus can lead to the development of scar tissue and swallowing problems. In severe cases Barrett’s esophagus, which is pre-cancerous changes to the lining of the esophagus, can develop. Eventually Barrett’s esophagus can even lead to esophageal cancer. Just like other health conditions, there is not one specific cause of acid reflux. However, a malfunction of a band of muscle tissue called the Lower Esophageal Sphincter (LES) is a major cause. The LES is a complex area of smooth muscles and various hormones that opens and closes the lower end of the esophagus when we eat and swallow. It normally keeps the stomach contents from regurgitating, but due to certain physical conditions it can weaken and lose its contraction control. If this happens, the LES fails to close up and cannot maintain the pressure barrier between the stomach and esophagus. As a result, digestive juices from the stomach can back up into the esophagus. Medical Treatment of GERD Over-the-counter medicines usually come in two types: antacids and acid reducers. Antacids include medications such as tums, alka-seltzer, and pepto bismol.
Antacids basically neutralize stomach acid to help with heartburn. Acid reducers come in two forms: histamine antagonists (H2 blockers) and proton pump inhibitors. They reduce the production of acid in the stomach. Examples of H2 blockers include Pepcid AC, Tagamet, and Zantac. Proton pump inhibitors include Prevacid and Prilosec. The problem with neutralizing or reducing stomach acid is acid is important in the digestion of proteins. Proteins need to be broken down into short chains of amino acids. If the proteins are not broken down, longer chains of amino acids may get through your intestinal wall if it is more permeable than it should be. Long chains of amino acids in your blood stream can lead to food allergies and even autoimmune diseases. 60% of your immune system is associated with the lymphatic system around your gut.
Because of that, if your immune system picks up on a chain of amino acids that is longer than there should be in your blood stream, it will try to attack it. That leads to food allergies. If that chain of amino acids happens to match another chain of amino acids that is found naturally in your body, your immune system can start attacking your body. This leads to autoimmune diseases. So reducing acid in your stomach may lead to other problems. Proton pump inhibitors used long term can also cause problems. Emerging data illustrates that prolonged PPI therapy can lead to vitamin B12 deficiency, an overgrowth of Clostridium difficile which leads to diarrhea, and hip fracture. (Joel J Heidelbaugh; Kathleen L Goldberg; John M Inadomi. The American Journal of Gastroenterology 2009;104 Suppl 2():S27-32). If you are interested in a more natural approach to treating acid reflux, stay tuned for my next blog post…