HEALTH MATTERS: Frequent heartburn may signal trouble

If you are experiencing regular acid reflux, it’s important to consult your physician for diagnosis and treatment.

By Eric H. Shen, M.D. Princeton HealthCare System
    Maybe you had a big plate of spaghetti with tomato sauce for dinner or perhaps you drank one too many of cups of coffee during the day, or maybe it was that dense piece of chocolate cake you had for dessert.
    Whatever it was, you’re paying for it now with a burning sensation in your chest and a bitter taste in your mouth. You likely have a case of acid reflux— also known as heartburn.
    A case of heartburn every now and then — while uncomfortable — is not uncommon for most people.
    If your heartburn regularly occurs more than twice a week, however, you may have gastroesophageal reflux disease (GERD) and may be at greater risk for a more serious condition called Barrett’s esophagus.
    Between 10 and 20 percent of Americans experience GERD symptoms every day, making it one of the most common medical conditions in the United States, according to the National Digestive Diseases Information Clearinghouse.
    In people with GERD, the valve that keeps the contents of the stomach out of the esophagus (the lower esophageal sphincter) doesn’t close adequately or relaxes at the wrong time. This allows digestive juices to flow backward up the esophagus, causing irritation and heartburn.
    In more mild cases, GERD can be managed with lifestyle changes, such as weight loss and avoiding alcohol, caffeine, nicotine and other substances known to relax the lower esophageal sphincter and trigger heartburn. GERD is also effectively treated with over-the-counter and prescription medications that neutralize stomach acid or block the production of stomach acid.
    People with more severe or prolonged GERD, however, can sustain damage to the esophagus caused by repeated exposure to stomach acid. This damage can result in Barrett’s esophagus, a condition in which the lining of the esophagus undergoes a change and begins to resemble the lining of the stomach.
    While Barrett’s esophagus affects about 1 percent of adults in the United States, it increases the risk of esophageal cancer if left undetected and untreated.
    Given that there are no outward symptoms associated with Barrett’s esophagus, the most reliable way to identify the condition is through a procedure known as endoscopy. During endoscopy, a thin, flexible tube carrying a light and video camera is passed down the throat and into the esophagus. The procedure, which is best performed by a board-certified gastroenterologist in a specialized center, lasts 15 minutes and requires light sedation. Patients may experience a mild sore throat when they wake up.
    During endoscopy, the gastroenterologist examines the lining of the esophagus for any changes indicating Barrett’s esophagus. Endoscopy can also inspect for inflammation (called esophagitis), along with bleeding, as well as narrowing of the esophagus. The procedure is especially recommended for patients who have been taking medication for an extended period of time or who have persistent or recurrent heartburn. By learning the extent of damage to the esophagus, doctors can determine whether the patient is taking the correct medication, correct dose or whether they require drug therapy at all.
    If changes indicating Barrett’s esophagus are detected, a biopsy of the lining will be performed to confirm the diagnosis and to determine whether there is any pre-cancerous tissue present. In most cases, Barrett’s esophagus is detected early enough before it progresses to cancer and can be monitored with endoscopy every three to five years. In more advanced cases, patients may need endoscopy annually. Patients may also need to continue drug therapy to control and treat GERD.
    In the rare instance that cancer is detected, treatments may include endoscopy to remove the esophageal lining and encourage the growth of new esophageal tissue or surgery. Surgery usually involves removing most of the esophagus, pulling a portion of the stomach up to the chest and attaching it to the remainder of the esophagus.
    While GERD is a significant risk factor for Barrett’s esophagus, people without GERD can also develop the condition, although there is no exact cause. Men develop Barrett’s esophagus twice as often as women, and Caucasian men are affected more frequently than men of other races, according to the National Digestive Diseases Information Clearinghouse.
    Patients can help prevent GERD and reduce their risk for developing Barrett’s esophagus by making lifestyle changes such as:
    • Controlling weight through exercise and diet;
    • Waiting at least three hours after eating before lying down;
    • Elevating the head of the bed so gravity helps keep stomach acids down;
    • Avoiding smoking;
    • Avoiding foods that may trigger heartburn, such as tomatoes, fried or fatty foods, alcohol, chocolate, peppermint, garlic, onions, and caffeine;
    • Avoiding wearing tight pants or belts that put pressure on your abdomen and aggravate reflux.
    If you are experiencing regular acid reflux, it’s important to consult your physician for diagnosis and treatment. Moreover, if you’re having trouble swallowing, losing weight unexpectedly or noticing blood in your stool or vomit, these are red flags that something more serious may be occurring and you should visit your doctor immediately.
Dr. Eric H. Shen is a board certified gastroenterologist and is a member of the medical staff at Princeton HealthCare System.
To find a physician with Princeton HealthCare System, call 888-742-7496 or visit www.princetonhcs.org.
Free memory screening
at Senior Resource Center
    Free confidential memory screenings will be available on Tuesday, Nov. 18 as part of National Memory Screening Day, an annual initiative of the Alzheimer’s Foundation of America (AFA) designed to improve overall health maintenance and promote proper detection of memory problems.
    AFA encourages adults, including those with memory concerns, a family history of Alzheimer’s disease or a desire to establish a baseline score, to take advantage of the screenings and to pick up educational materials about memory concerns, successful aging and caregiving.
    The face-to-face screening takes only 5 to 10 minutes and consists of a series of questions and tasks. It is administered by a qualified health care professional, such as a physician, nurse, psychologist or social worker. The results do not represent a diagnosis, and AFA advises those individuals who score poorly or who have normal scores but are still concerned to follow up with their physician.
    On Nov. 18, Princeton Senior Resource Center will hold memory screenings at both the Suzanne Patterson Building, and Spruce Circle, from 10 a.m. to 2 p.m. by appointment. For more information and appointments, call 609-924-7108.
    For more information about National Memory Screening Day, visit www.nationalmemoryscreening.org, www.alzfdn.org, or call 866-AFA-8484.