What is heartburn is the most asked question asked by RefluxMD visitors.\u00a0 It, along with other acid reflux symptoms, is all too familiar to most of us. But did you know our tendency to pop a pill to feel better may be doing more harm than good? While medications help relieve symptoms, they do nothing to resolve the underlying cause of those symptoms: damage to the lower esophageal sphincter (LES). Read on to learn more about heartburn and why it\u2019s time to change how we treat it.<\/p>\n
It was only an hour ago that you finished that wonderful dinner \u2013 two helpings with wine followed by a delicious dessert \u2013 and now here you are sensing that all is not quite well. Pain has started to move up your chest and you know it\u2019s going to be a long night. Quickly you chew a few antacids and VOILA \u2013 feeling better. All is now well once again, or is it?<\/p>\n
That story is being written by millions of people every evening across America. In fact, one out of every three adults struggles with\u00a0heartburn<\/a>\u00a0and\u00a0regurgitation\u00a0<\/a>monthly, while more than 50 million suffer several times each week. Of course, we all know it\u2019s just a result of what we eat \u2013 right? WRONG! Since antacids \u201ccure\u201d the problem, it has to be excess acid in your stomach \u2013 right? WRONG AGAIN!<\/p>\n Those pains are a signal from your body that something is wrong \u2013 very wrong! An acidic stomach is normal and its necessary for the efficient digestion of food. So why are you getting those pains frequently? Simple, it is due to a small valve at the end of your esophagus called the\u00a0lower esophageal sphincter, or LES<\/a>. A healthy LES acts as a barrier keeping stomach contents where they belong, in the stomach.<\/p>\n For some, their LES gets damaged, and when it does, those acidic stomach contents can flow up, or reflux, into the esophagus, and that can be painful. This is acid reflux or gastroesophageal reflux disease (GERD). In fact, over 200,000 individuals visit emergency rooms each year believing they are having a heart attack, but quickly learn that their pain was from acid reflux.\u00a0 If you are asked the question,\u00a0what is heartburn, the simple and correct answer is a weak LES that allows stomach contents to reach the esophagus.<\/p>\n Unfortunately, for a segment of those with reflux disease, heartburn can progress to a precancerous condition called\u00a0Barrett\u2019s esophagus<\/a>, and in some cases, it can advance to\u00a0adenocarcinoma<\/a>, better known as esophageal cancer. In fact, the incidence of esophageal cancer is the fastest growing of all cancers in the US, outpacing melanomas, breast cancer, and prostate cancer.<\/p>\n Research published by the\u00a0Department of Gastroenterology, Landspitali University Hospital in Iceland<\/a>found that heartburn is a common and chronic condition that can negatively impact the quality of life, sleep, and daytime activities.\u00a0 2,000 Icelanders reported their heartburn symptoms over a ten year period.\u00a0 Researchers reported that\u00a0 43% reported heartburn in 1996 and 44.2% in 2006, with \u201ca strong relationship between those who experienced heartburn in both years.\u201d\u00a0 Researchers commented on some of the driving factors:<\/p>\n \u201cThe prevalence and natural history of heartburn are of importance as well as its association with functional dyspepsia and irritable bowel syndrome, and sociodemographic factors such as body mass index (BMI).\u00a0\u00a0Heartburn subjects with a BMI either lower or higher than normal weight were more likely to experience heartburn than subjects with normal weight.\u201d<\/p>\n Heartburn pain is a signal from your body that something is wrong \u2013 very wrong! An acidic stomach is normal and its necessary for the efficient digestion of food. So why are you getting those pains frequently? The answer is simple, it is due to a small valve at the end of your esophagus called the\u00a0lower esophageal sphincter, or LES<\/a>. A healthy LES acts as a barrier keeping stomach contents where they belong, in the stomach.<\/p>\n For some, their LES becomes weaker over time, and when it does, those acidic stomach contents can flow up, or reflux, into the esophagus, and that can be painful. This is acid reflux or gastroesophageal reflux disease (GERD). In fact, over 200,000 individuals visit emergency rooms each year believing they are having a heart attack, but quickly learn that their pain was from acid reflux.<\/p>\n Unfortunately, for a segment of those with reflux disease, heartburn can progress to a precancerous condition called\u00a0Barrett\u2019s esophagus<\/a>, and in some cases, it can advance to\u00a0adenocarcinoma<\/a>, better known as esophageal cancer. In fact, the incidence of esophageal cancer is the fastest growing of all cancers in the US, outpacing melanomas, breast cancer, and prostate cancer. It is also one of the more deadly cancers with a very low 5-year survival rate.<\/p>\n Doctors at Johns Hopkins Medicine<\/a>\u00a0noted the following risk factors for complications from heartburn:<\/p>\n They recommend anyone with GERD symptoms and any of these risk factors schedule an evaluation with a GERD expert.<\/p>\n After answering the question, \u201cwhat is heartburn\u201d, the next question is what can I do about it?\u00a0 Unfortunately, when adults experience pain, most Americans do what most Americans always do \u2014 pop a pill. The drug industry sells over $14 billion in medications to \u201ccure\u201d heartburn.<\/p>\n No longer satisfied with doctors recommending their drugs, most pharmaceutical manufacturers now promote directly to the consumer. Everyone that watches television has seen Larry the Cable guy promoting the \u201cpurple pill\u201d. That medication is one of the most popular drugs in a class called\u00a0proton pump inhibitors (PPIs)<\/a>\u00a0that work by reducing the amount of acid produced within the stomach.<\/p>\n But do PPIs work? Do they cure the disease? PPIs have proven to relieve symptoms for about 40% of all adults, and reduce symptoms for another 30%.,\u00a0 For several medical conditions, they are highly valuable for short to mid-term use. However, they do not cure gastroesophageal reflux disease since they cannot strengthen or repair the LES. Thus, they only mask the symptoms of the disease. As a result, the disease continues, \u2013 and may very well progress.<\/p>\n More importantly, there are many negative health effects associated with daily, long-term use of PPIs.\u00a0 In our article titled\u00a0Are long-term PPIs the right choice for treating acid reflux?<\/a>\u00a0RefluxMD highlights seventeen serious health risks.\u00a0 In addition, an article published in the\u00a0New England Journal of Medicine<\/a>, researchers found an increased risk of death due to PPI use vs. H2 blockers or other antireflux treatments.<\/p>\n Dr. David Kleiman with the Department of Surgery at New York Presbyterian Hospital and Weill Cornell Medical College presented a research study documenting that 32% of PPI use beyond the initial 8-week trial was unnecessary since there was no evidence of reflux disease with those individuals. According to Dr. Kleiman, \u201cPPIs continue to be misused and overused in a large percent of our population.\u201d With billions being spent on those medications, that is more than a small problem.<\/p>\n Dr. Tom DeMeester<\/a>, Senior Medical Advisor to RefluxMD has followed the research on PPIs for many years and he, too, agrees that today\u2019s status quo treatment is not only ineffective but may also be harmful. \u201cDaily PPI use has several potentially harmful side effects including an increase in the risk of diarrhea from bacterial infections, an increase in hip fractures, an increase in the risk of contracting pneumonia and an increase in muscle spasms, tremors, and irregular heartbeats,\u201d Dr. DeMeester said.<\/p>\n He also noted that these drugs may have the opposite impact than what was expected: \u201cA study by Dr. Blair Jobe at the University of Pittsburg found that those taking PPIs daily and reporting no traditional heartburn symptoms were over 60% more likely to advance to Barrett\u2019s Esophagus or adenocarcinoma. We really have to look long and hard at the use of PPIs\u201d.<\/p>\n H2 blockers and antacids do not have the same health risks as PPIs, but they may not be as effective.\u00a0 However, before you decide to use PPIs daily as a maintenance medication, be sure you know the risks and all the other alternative treatment options.<\/p>\n Isn\u2019t it time that we start to listen to the messages of our body and begin to do the right thing? Heartburn is serious, and over the long term it can reduce the quality of your life, or worse, it can result in a potentially deadly disease. It is time to stop treating the symptoms and start treating the disease.<\/p>\n So what is the best treatment for heartburn?\u00a0 That question should be easy to answer. But it isn\u2019t. That\u2019s because reflux disease has several stages, and each stage has its own answers to that question. Because reflux disease is a progressive chronic condition, it is very important to not only know your stage but the signals that you are moving into the next stage. GERD does not improve, nor can the LES return to its previous healthier state without a surgical procedure. The most important factor in managing reflux disease is to stop any further progression.<\/p>\n Typically during this stage symptoms are only intermittent and they can be managed using antacids or H2 blockers, both sold at any pharmacy without a prescription. But this is the critical time for most GERD suffers to take an active role in managing the progression of their disease.\u00a0Lifestyle<\/a>\u00a0is the most important action that can be taken. Diet, portion size, food choices, BMI (weight),\u00a0alcohol consumption<\/a>, smoking, and the hour when dinner is served are all important to stop the progression and address the symptoms of an acid reflux problem.<\/p>\n When the frequency of the symptoms, the severity of the symptoms, or both, become too much to bear, many people choose to use H2 blockers or PPIs on a daily basis, sometimes twice a day. Some are doing so under the observation of a physician, while others simply self-diagnose and self-medicate by making a trip to the pharmacy or warehouse store.<\/p>\n However, as we discussed above, the long-term daily use of PPIs as the solution to an acid reflux problem has some risk. All of the diet and lifestyle choices are critical at this point since you must stop your disease from progressing to stage 3.<\/p>\n Elevation therapy<\/a>\u00a0at night is also recommended since keeping stomach contents in the stomach during sleep can slow the progression, as well. As long as you can manage your symptoms to your satisfaction, you are considered Stage 2. However, when you cannot control those symptoms, your disease has progressed to Stage 3.<\/p>\n Unfortunately, this is where many sufferers discover RefluxMD \u2013 and at this point, the options are becoming limited. It is important to work closely with a reflux disease expert, someone we refer to as a\u00a0GERD expert<\/a>. It is at this point that every Stage 3 sufferer should receive honest advice about his or her surgical options.<\/p>\n Surgery<\/a>\u00a0is the really the only way to restore a damaged lower esophageal sphincter, of which there are several options, including a traditional Nissen fundoplication and the LINX Reflux Management System surgery. LINX is a relatively new procedure and requires testing to determine if an individual is a candidate for it.<\/p>\n Elevation therapy, diet, and lifestyle choice should be tried to manage symptoms, but they may not have much impact. Typically medications are required for those in GERD Stage 3 where the acid reflux problem must be addressed.<\/p>\n This is a consequence of longstanding GERD and can be somewhat frightening since\u00a0Barrett\u2019s esophagus<\/a>\u00a0is a pre-cancerous condition. This requires careful monitoring by a specialist. Most options are limited at this point and medications are almost mandatory.<\/p>\n Since esophageal cancer is the fastest growing cancer in the US today, Stage 4 should be avoided at all cost since the basic acid reflux problem has now evolved to a serious condition with dangerous consequences if further disease progression continues.<\/p>\n As noted above, first\u00a0determine your stage of reflux disease<\/a>, and then determine what options are available to you. The necessity of scheduling a physician visit \u2013 and what type of physician \u2013 will be determined by your GERD Stage.<\/p>\n Second, be active in managing your disease, regardless of its stage. This is no time to be lazy or to ignore your symptoms. GERD never reverses itself and this disease is progressive. Since it can materially impact the quality of your life and potentially threaten your life, you must be serious about managing this disease.<\/p>\n Consider your controllable options:<\/p>\n You are not alone and you can succeed if you are determined and supported. However, most people need help to find a path to relief and long-term health, so let RefluxMD be your partners in this journey. You are the reason we are here.<\/p>\nWhat is heartburn?<\/h2>\n
The source of that discomfort<\/h2>\n
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Are medications the best treatment option?<\/h2>\n
It\u2019s time to treat the disease, not just the symptoms<\/h3>\n
Stage 1 \u2013 Intermittent and Controllable Symptoms<\/h3>\n
Stage 2 \u2013 Daily Use of Medications<\/h3>\n
Stage 3 \u2013 Unable to Control Symptoms to Your Satisfaction<\/h3>\n
Stage 4 \u2013 Barrett\u2019s Esophagus<\/h3>\n
So what should YOU do if you have an acid reflux problem?<\/h2>\n
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Medical resources used for this article<\/h3>\n
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