Q: What is heartburn?
A: Heartburn is often described as a feeling of burning discomfort, localized behind the breastbone, which moves up toward the neck and throat. Some people even experience the bitter or sour taste of acid in the back of the throat. These symptoms of heartburn can last for several hours and often worsen after eating food. All of us may have occasional heartburn.
Q: What causes heartburn?
A: The lining of the esophagus is not used to being in contact with stomach acid, digestive enzymes and other stomach contents. These stomach juices are usually kept from flowing back into the esophagus by a muscular valve at the lower end of the esophagus called the lower esophageal sphincter (LES). If the LES relaxes too often or for prolonged periods, these stomach juices tend to flow backwards into the esophagus. This brings on the symptoms of heartburn.
Q: How is it treated?
A: Most infrequent heartburn can be treated with lifestyle modifications and proper use of over the counter medications such as antacids. Lifestyle modifications include avoiding foods and beverages that may lead to heartburn symptoms (e.g., tomato products, chocolate, peppermint, coffee, alcohol, citrus fruits and juices, etc.), smoking cessation, weight reduction if overweight, wearing looser fitting clothing and avoiding eating right before bedtime. Over the counter medications include antacids and two classes of acid blocking medications known as H2 blockers and proton pump inhibitors (PPI). However, if you require the use of these medications frequently (more than twice a week) then you may have gastroesophageal reflux disease (GERD) for which you should consult with your physician.
Q: Is heartburn another name for GERD?
A: Heartburn is the most common symptom of GERD which occurs in everyone and may produce symptoms of heartburn at times. Frequent heartburn (two or more times a week) may be associated with a more severe problem known as GERD. If left untreated GERD may lead to complications such as esophageal stricture (narrowing of the esophagus leading to food sticking), weight loss, bleeding and a precancerous condition known as Barrett's esophagus.
Q: How is GERD treated?
A: Like heartburn, the treatment of GERD also begins with lifestyle modifications. However, most patients with GERD will require prescription medications including PPI. If symptoms are not controlled on these medications, the physician may increase the dose of the medications or use others including medications for strengthening the lower esophageal sphincter or for increasing the clearance of acid from the stomach. If there are any concerning symptoms, the physician may also perform an upper endoscopy which involves visualization of the lining of the esophagus and the stomach by passing a small flexible tube with a camera through the mouth. This test requires sedation and is done at a hospital or office endoscopy center. After performing the test, the physician will be able to determine if there is any inflammation of the lining of the esophagus, including Barrett's esophagus.
Q: What is Barrett's esophagus? What causes it? How is it treated?
A: Barrett's esophagus is a precancerous condition of the esophagus which is caused by long standing exposure of the lining of the esophagus to stomach juices. It occurs most commonly in people with frequent and persistent symptoms of heartburn or GERD but may also occur in the absence of these symptoms. The reason Barrett's esophagus is important is because people who have it have a small increased risk of developing cancer of the esophagus.
The diagnosis of Barrett's esophagus is made by performing an upper endoscopy during which multiple biopsies are taken if the physician suspects it. Once confirmation is obtained, the treatment for Barrett's esophagus involves the treatment of the symptoms of GERD. Depending on what the biopsies show, the treatment plan may include continued or increased medications, repeated endoscopies and/or treatment provided during endoscopy. If there is evidence of cancer, your physician will refer you for treatment by an oncologist and a surgeon who specializes in surgeries of the esophagus.
Q: What can be done to prevent developing these conditions?
A: Prevention of progression of infrequent heartburn to GERD to Barrett's esophagus involves lifestyle modifications and prompt evaluation by a gastroenterologist if the symptoms of heartburn have been long standing, are occurring more frequently, are not controlled by over the counter medications or if there are any other concerning symptoms such as weight loss, food sticking or bleeding.
Dr. Ayaz Matin is a board-certified gastroenterologist specializing in diseases of the digestive system with the St. Luke's Health Network.