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When What Goes Down, Comes Up 

Symptoms of acid reflux disease could be a sign of more serious problems

Acid reflux can be painful and uncomfortable and instantly make you regret eating an extra slice of pizza. Heartburn, a burning sensation in your chest, is the most common symptom and just about everyone experiences it at one time or another. Occasional acid reflux is to be expected, and in most cases, it can be easily treated with an over-the counter medication like an antacid. However, acid reflux disease, also known as GERD (Gastro Esophageal Reflux Disease), can interfere with your lifestyle, disrupt your sleep, and even cause lasting damage.

The muscle between the lower esophagus and the stomach, called the esophageal sphincter, opens to move food out of the esophagus and into the stomach and closes once the food has passed. Acid reflux occurs when that muscle relaxes at the wrong times, allowing food and acids from the stomach to come back up. Acid reflux can be diagnosed as GERD when the problem becomes chronic, happening two or more times a week.

Heartburn is the most common symptom of GERD, and in fact, pain from heartburn can be so severe that it is often mistaken for a heart attack. Other symptoms may include a persistent dry cough, chest pain, and esophageal spasms. Typically, GERD is diagnosed by your physician through a review of your medical history. If you've been experiencing symptoms of acid reflux for more than two weeks and over-the-counter medications are not bringing you relief, or if you've had GERD for some time but your symptoms are worsening, it's time to see a physician.

Gastroenterologist with East Jefferson General Hospital Dr. George Catinis warns, "It's important to rule out red flag symptoms such as difficulty swallowing, vomiting, weight loss or anemia. We also consider the duration of symptoms, whether they are new or old and if they are worsening in character. These could indicate complications from GERD such as esophagitis which is an inflammation of the lining of the esophagus, Barrett's esophagus--when the lining of the esophagus has become premalignant--or esophageal cancer." If your symptoms don't respond to medications or lifestyle change or if you are exhibiting red flag symptoms, your physician may perform an endoscopy to rule out or confirm a more serious issue.

Although esophageal cancer is not common in the United States, it does happen. "I recently had a patient who had heartburn off and on for years. His symptoms began to worsen, and he had difficulty swallowing, so we did an endoscopy and unfortunately, found that he had cancer," recalls Catinis.

In the absence of red flag symptoms, most patients can find relief through over-the-counter medications and lifestyle change. There are three kinds of medications used to treat GERD. Antacids, like Rolaids neutralize the acid in the stomach. H-2-receptor blockers, (Tagamet HB, Pepcid AC and Zantac, for example) reduce acid production. Although these don't act as quickly as antacids, they can provide longer relief, so they are often taken together. The antacids stop symptoms long enough for the H-2 receptor blockers to start working. Proton pump inhibitors, like Prevacid or Prilosec block acid production, allowing time for damaged esophageal tissue to heal. All three types of medications are available in stronger, prescription forms.

In addition to medication, there are some lifestyle changes that can lessen the painful effects of the disease and suppress flare-ups. Weight loss is one of the best ways to ease the discomfort of reflux and usually a loss of five to 10 pounds is enough to make a difference. Catinis explains, "Your stomach is a cavity in the abdomen which distends like a balloon when you eat. Excess weight can put pressure on that cavity, leaving less room to expand, causing reflux."

Avoiding certain foods can also help. Caffeine products like coffee and chocolate can relax the esophageal sphincter, making acid reflux symptoms worse. Mint products have the same effect. Hot sauce and citrus fruits can increase the acidity in the stomach, also contributing to reflux.

If you are a smoker suffering from GERD, Catinis suggests quitting. He says, "Smoking interferes with the esophageal membranes. It accentuates the injury end result of damage to the esophageal mucosa that has been exposed to the acid reflux."

Most importantly, if lifestyle, diet change and over-the-counter medicines don't provide relief within two weeks, see your doctor. "Don't ignore your symptoms," says Catinis. "You can't always blame it on the hot sauce. Prolonged or worsening symptoms could be an indication of bigger problems."


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