November 27, 2012
Gastroesophageal reflux disease
Elaine is a 40-plus lady who writes Lifeline from Hagley Park Road in Kingston. Elaine says she has gained some weight recently on her stomach and has also been experiencing a "bitter" taste in her mouth, mild hoarseness and burning in her chest. Her heart often beats faster and she also has shortness of breath at times. She wonders if her weight gain has put a strain on her heart.
She saw a doctor recently who examined her and told her that she was experiencing acid reflux disease, a sort of stomach acid burn. However, Elaine is still concerned for her heart and wonders how stomach acid can cause her heart to beat fast and cause her to feel shortness of breath. She had a "stress ECG" done and this was normal.
Elaine has many symptoms which are associated with acid reflux or GERD (Gastro Esophageal Reflux Disease). Acid reflux is a condition in which the hHydrochloric acid found in the stomach which helps digest food eaten, leaks backwards from the stomach into the oesophagus through a leaking stomach valve.
The oesophagus is not built like the stomach to withstand the acid, so the individual experiences several symptoms related to this acid which rises up at times to the back of the throat and into the communal region where the upper airways and larynx are also located. This condition is worsened with weight gain as abdominal obesity tends to increase the back flow pressure from the stomach into the oesophagus.
Symptoms associated with acid reflux include:
Burning sensation behind the anterior chest wall (worse when lying down)
Bitter taste in the mouth
Hoarseness (as the acid inflames the vocal chords)
Wheezing as the acid rises up and affects the lungs
Shortness of breath (also because of the acid effect on the lung tissues)
Sensation as if something is "stuck" behind the breast bone"
There are several conditions which predispose to acid reflux. Drinking alcohol will increase stomach acid production and worsen the symptoms of GERD. Cigarette smoking does the same thing, so smokers are more liable to suffer with acid reflux. Also, smoking cuts the appetite and so smokers tend to eat irregularly, leaving the free acid to work on the intestinal tissues.
Obesity and pregnancy both increase the intra-abdominal pressure and facilitate the back flow of acid from the stomach up into the chest. GERD (acid reflux) is also made worse by several drugs and medications in common use.
All the non-Steroidal anti-inflammatory Analgesics (NSAIDS) will affect the stomach lining and worsen GERD. Several medications used to treat hypertension, asthma, car sickness, birth control pills, and some of the older anti-depressants can also worsen GERD.
Usually, if there is some doubt about the diagnosis of GERD, then several readily available tests can be recommended. The Barium swallow or barium meal contrast X ray procedures will often reveal GERD if this disorder is present. If still in doubt, the oesophagus and stomach and the sphincter (valve) area between the stomach and oesophagus can be directly examined by gastroscopy, where a flexible tube with a camera is used to traverse and examine all the upper intestinal tissues under direct observation by the gastroenterologist, (oesophagogastroduodenoscopy).
Treatment involves making lifestyle changes. Avoid foods which worsen the symptoms and have medication changed which worsen the symptoms of GERD. Avoid wearing tight clothing which increases intra-abdominal pressure and worsens GERD. Lose weight if overweight, stop smoking if that is a contributing factor.
In addition to the personal changes we can make there is medication in the form of H2 antagonists (eg Zantac, Cimetidine, etc) and the more modern and more potent Proton Pump inhibitors (eg Nexium, Omeprazole, Lansaprazole, etc). These medications all reduce the symptoms of GERD significantly.
At times a course of prescribed specific antibiotics may also need to be taken as there is some evidence that a bacterium, helicobacter pylori, is sometimes involved in the inflammatory process.
Surgery can be done if the reflux is significant and the valve leaks badly but, for the most part, surgery tends to be avoided. Some individuals will need to take the medication prescribed long term (months to years).
Elaine should review her condition with her health provider and request that the definitive tests be done to properly confirm (or rule out) her disorder.
Write to: Lifeline,
PO Box 1731