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April 30, 2021

What you need to know about acid reflux

What goes down, might come up!

Illness Acid Reflux

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Man holding his chest in pain

Have you ever experienced heartburn or the feeling of fluid in your throat? These are classic symptoms of acid reflux.

The term “GERD” stands for Gastro (stomach) Esophageal Reflux Disease, a condition caused by back-up of stomach contents such as acid, bile, or even food in the esophagus causing bothersome symptoms.

But sometimes the symptoms are atypical – like difficulty swallowing, hoarseness, or a chronic cough. Even worse, symptoms may include squeezing chest pain, making it hard to tell if it’s heart burn or a heart attack. It’s very important to distinguish between reflux and heart or lung disease, so you must tell your doctor if you have these symptoms. Don’t be Dr. Google and treat yourself with over-the-counter meds. You could be ignoring a life-threatening condition.

Recently on “Your Radio Doctor,” our guest was Dr. Anthony Infantolino, a professor from Thomas Jefferson University, gastroenterologist and international expert on the topic of reflux and its possible complications.

Limited - Dr Marianne Ritchie MD

Marianne Ritchie, MD

The esophagus is made of muscle. Episodic acid reflux can cause esophageal spasm, which is responsible for the feeling of chest pressure. Chronic acid reflux can lead to scarring or even a narrowing called a stricture. If the opening of the esophagus narrows, it can feel as though your food is getting “stuck” because it probably is. Worse yet, narrowing can signal the presence of esophageal cancer.

Reflux is more likely when the sphincter (round muscle) in the lower esophagus is weakened by nicotine (smoking), excess caffeine (coffee, tea, energy drinks, colas), fatty foods and alcohol.

Another possible result of chronic acid washing the lining of the esophagus is Barrett’s esophagus. During upper GI endoscopy, we see the pale pink, smooth lining of the esophagus. The normal stomach lining is the color of salmon. If we see any spots of that salmon color in the esophagus, we take tissue samples (biopsies). If the cells have changed from normal esophagus cells to normal intestinal cells, this is Barrett’s esophagus, which can increase your risk of cancer of the esophagus. This is why we recommend close follow-ups with your GI doctor and periodic endoscopy exams with biopsies to check for any changes.

The risk of Barrett’s turning to cancer is a small due to advances in techniques that find pre-cancer and improved treatments of the pre-cancer stages.

You can’t feel these color changes, so tell your doctor if you have continued heartburn.

In recent years we have seen an increase in cases of esophageal cancer. This is partly because of the rise in obesity in the U.S., and obesity increases the likelihood of reflux. It is also because so many people treat themselves for years and don’t have an endoscopy exam.

Risk factors for Barrett’s Esophagus include:

 GERD for over 5 years
• Age 50 and over     
• Male sex
• Caucasian
• An elevated waist to hip ratio (WHR) - a reflection of central obesity
• Night-time reflux
• Smoking
• First-degree relative with Barrett’s esophagus and/or adenocarcinoma of the esophagus

Do not delay an endoscopy if you have any of the “alarm symptoms” of esophageal cancer, including unexplained weight loss, difficulty swallowing, persistent vomiting, loss of appetite, new onset of heartburn after age 60, or signs of bleeding (in vomitus or stool).

If your doctor orders medication and heartburn persists, it may be bile reflux, which is more common after you’ve had your gall bladder removed.

Also, do you snore? If so, get a study to check for sleep apnea. Reflux of fluid while you’re sleeping can cause you to cough and interrupt your sleep. In reverse, episodes of apnea (when you stop breathing) can promote reflux. They often have a reciprocal effect.

The most important step is to reduce and minimize acid reflux. Effective ways to do this:

• maintain a healthy weight
• don’t smoke
• limit alcohol consumption
• eat smaller meals, and wait a few hours before going to bed
• avoid late-night snacking
• sleep with your head slightly elevated. Nighttime GERD is more damaging because the esophagus is also “sleeping” and doesn’t promptly push acid down. Don’t sleep on extra pillows because it can bend your neck and/or bend you at the waist, which can aggravate reflux. Instead, put a wedge under the mattress near your head or put blocks under the legs at the top of the bed.

Listen to the entire show on our website:

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