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  • Heart Attack

    Heartburn symptoms are often mistaken for heart attack symptoms.

    If symptoms include:

    • chest pain or pressure that lasts for more than a few minutes.
    • pain spreading to the shoulders, neck or arms.
    • jaw pain or toothache.
    • lightheadedness, nausea, sweating or shortness of breath.

    Please call 911 immediately.


    Brett Kalmowitz, MD

    Gastroesophageal Reflux Disease (GERD)

    Heartburn is a common problem that affects most people at some point in their lives. In most cases, it can be managed with over-the-counter medications or lifestyle changes. For those who have gastroesophageal reflux disease (GERD), these remedies are merely temporary and further treatment, or even surgery, is required to reduce symptoms.

    What is GERD?

    GERD occurs when acidic stomach juices – or food and fluids – are passed back into your esophagus, the muscular tube that carries food and liquids from the mouth to the stomach. The flow back of these stomach juices, also called reflux, produces a variety of symptoms including heartburn, acid regurgitation, chest pain, hoarseness and chronic cough.

    “Heartburn, or acid indigestion, is the most common symptom of GERD,” says Brett Kalmowitz, MD, gastroenterologist at Rhode Island and The Miriam hospitals. “Heartburn is a burning chest pain that begins behind the breastbone and moves upward to the neck and throat. It can last as long as two hours and is often worse after meals. Lying down or bending over after a meal can also contribute to heartburn.”

    GERD is often the result of conditions that affect the lower esophageal sphincter (LES). The LES, a muscle located at the bottom of the esophagus, opens to let food into the stomach and closes to keep food in the stomach.

    staywell-gastroesophageal-refluxSuction, or negative pressure, in the stomach generally keeps the LES closed. When this muscle relaxes too often or too long, acid refluxes back into the esophagus and causes vomiting or heartburn.

    Untreated, GERD can result in numerous problems, including

    • Reflux esophagitis (inflammation)
    • Stricture (narrowing) of the esophagus resulting in difficulty swallowing (dysphagia)
    • Ulceration
    • Bleeding
    • Recurrent pneumonia
    • Hoarseness
    • Barrett's esophagus and esophageal cancer

    Diagnosis

    Diagnosis of GERD is done in a few different ways. An x-ray, with the help of a barium swallow, can evaluate the digestive organs for evidence of ulceration or abnormal blockages. An ulceration is an inflammation of an organ wall due to a lesion or breakdown of tissue.

    An endoscopy can also be used in diagnosis. This involves sending a small, flexible tube with a camera down the esophagus to examine the digestive tract.

    In another diagnostic procedure, a small tube is sent down the digestive tract to measure the amount of acid, or pH level, in the esophagus. The other end of the tube is connected to a monitor that monitors pH for a one-day or two-day period.

    The patient is asked to keep a diary during this period to help determine triggers of acid reflux.

    Barrett’s Esophagus

    Barrett’s esophagus is a condition in which the tissue lining of the esophagus is replaced by tissue that is similar to the intestinal lining. This process is called intestinal metaplasia. People with Barrett’s esophagus are at increased risk for esophageal cancer.

    For this condition, radiofrequency ablation is a treatment option for removing the affected tissue so the body can replace it with healthy normal esophageal tissue.

    While not a surgical procedure, radiofrequency ablation is done in a similar way as an endoscopy. A controlled amount of energy is delivered via catheter to the esophageal lining to remove the diseased tissue.

    A slightly heavier sedation is commonly used for this procedure because the procedure may take longer than a standard endoscopy.

    Treatment

    Treating GERD can be done surgically and non-surgically.

    Non-surgical methods may simply include eating smaller meals and wearing loose clothing. Avoiding triggers such as coffee, alcohol, cigarettes, tea and sodas may alleviate symptoms.

    Medications can be taken to target acid-producing cells in the stomach. Brand-name medications Zantac (rantidine), Tagamet (cimetidine) and Pepcid (famotidine) reduce symptoms by targeting histamine Type 2 receptors (H2 blockers).

    Prokinetic agents, also known as promotility drugs, are medications that increase the strength of esophageal contractions and the resting pressure at the lower esophageal sphincter. Essentially, prokinetic agents reinforce the LES, or the door between the stomach and the esophagus.

    Surgery may be necessary to correct GERD.

    “An effective procedure is fundoplication,” says Kalmowitz. “During this surgery, the surgeon wraps a part of the stomach called the fundus – the highest part of the stomach – around the esophagus to create a partial or complete ring. “

    Fundoplication is frequently performed laparoscopically. The major advantage to a laparoscopic approach is that small incisions result in less pain, reduced hospital stay and a faster recovery when compared to the open approach. While there are risks to any surgical procedure, this surgery has been performed successfully since the 1950s.

    Don’t Ignore the Symptoms

    Acid reflux can certainly be annoying, but it is also a telltale sign of a possibly serious condition.

    “If you often feel heartburn,” says Kalmowitz, ”or experience acid regurgitation, chest pain, hoarseness and chronic cough, please contact your primary care physician who can determine whether additional steps are necessary.”