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More than a Little Heartburn: Gastro-Esophageal Reflux Disease (GERD)Most people suffer now and then from heartburn. Heartburn has nothing at all to do with the heart. It occurs when acid from the stomach regurgitates, or backs up into, the lower esophagus, the tube connecting your mouth and stomach. Most people describe it as ranging from a sour taste in the back of the mouth to a powerful burning sensation in the mid or lower chest and throat.
Normally, this regurgitation is prevented by the esophageal sphincter, a sort of one-way valve that allows food and drink to pass down the esophagus to the stomach while preventing gastric acid and other stomach contents from traveling in the opposite direction. Heartburn often comes after you lie down with a full stomach, for instance in bed after a large or late dinner, or after exposing the esophagus to tobacco smoke, alcohol, coffee or other substances that tend to increase stomach acid or to relax the esophageal sphincter.
Heartburn is much more common than it is serious. If the symptoms are only occasional and they go away when you take an over-the-counter antacid, it is usually nothing to worry about. If, on the other hand, you have chronic problems that are not helped by over-the-counter medicines, you should talk to your doctor. You may have Gastro-Esophageal Reflux Disease or GERD.
What is GERD?Like heartburn, GERD is caused by stomach acid moving the wrong way through the esophageal sphincter into the throat. Unlike garden-variety heartburn, however, GERD can be a serious long-term health problem. It can also lead to esophagitis, an inflammation of the esophagus caused by regular reflux of stomach acid back into the esophagus. Some patients with GERD develop a condition called Barrett's esophagus, in which the esophagus undergoes unhealthy changes that may increase the risk of a change to so-called dysplasia. Cells that have developed dysplasia have an increased risk of developing into a cancer.
Long-term exposure to stomach acid caused by GERD can cause a variety of problems that are grouped under the term esophagitis. These include loss of the esophagus's protective mucus layer, at times with the development of sores or ulcers. Over a prolonged period, such ulcers may produce scarring, leading to narrowing of the esophageal tube and consequent resistance to passage.
Although the effects of GERD are most often felt after going to bed, daytime regurgitation problems are not uncommon. As esophagitis worsens and becomes chronic, producing a narrowing of the esophagus, in addition to heartburn-like symptoms, such as a sour taste in the mouth or a feeling of pressure in the chest area, sufferers may feel pain when swallowing food (odynophagia) and experience the sensation that swallowed food has become stuck (dysphagia). About three-fourths of those with the disease have persistent and disturbing symptoms over many years. At least half of these experience heartburn on a daily basis and one-third need to take an anti-heartburn drug at least once a day.(1)
TreatmentIn the past, esophagitis sufferers were told to raise the position of their head while sleeping and were given alkali antacids to neutralize the acid or other medicines that reduce stomach acid production, such as H2-receptor antagonists. While these can still be effective treatments, they do not work for everyone. Fortunately, today's doctors have a whole range of other types of drugs to choose from, including the very effective proton pump inhibitors (PPIs) (omeprazole or Prilosec®; lansoprazole or Prevacid®). In the many cases where esophagitis is not helped by antacids or H2-receptor antagonists, a single capsule per day of omeprazole or lansoprazole provides relief from heartburn and sour regurgitation, and promotes healing of sores and lesions within four weeks in the vast majority of patients.(2)(3)
Many of these new drugs also have the added advantage of being more convenient and less expensive.(4)(5)
Barrett's EsophagusLeft untreated, chronic regurgitation of gastric contents can set in motion a process that may end in the development of cancer, or adenocarcinoma, of the lower esophagus. The process works like this: the body tries to protect the esophagus from the damaging effects of stomach acid by bringing tissue to the esophagus from the lining of the upper stomach, an area of the body that is able to handle contact with stomach acid safely. Unfortunately, however, moving to a new environment puts the stomach lining tissue under great stress. This stress causes a series of changes in the new tissue that can eventually lead to the development of cancer. These changes are called Barrett's esophagus.
How likely are you to develop this condition? Your risk of developing Barrett's esophagus is significantly greater if you have a history of regular GERD symptoms, if you are over 50 years old, or if your doctor finds esophageal inflammation caused by acid reflux.(6)(7)(8) Barrett's esophagus is far from rare, found in 10% of patients whose persistent symptoms of GERD lead to a "scoping" of their esophagus by a physician. Not all Barrett's esophagus sufferers develop cancer, but their cancer risk is 30 to 125 times greater than that of someone without Barrett's changes.9 Recent studies suggest that there has been a dramatic increase in incidence in recent years, to the point that Barrett's esophagus now results in the most common type of upper gastrointestinal tract malignancy, especially among white men.(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)
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