Get That Heartburn Checked - It could save your life!

That annoying burning in your chest or acidic taste in your mouth after a big meal or a few too many cocktails is normal. However, if you are experiencing heartburn regularly, having trouble sleeping because of acid reflux at night, noticing food getting stuck in the mid chest, clearing your throat uncontrollably, or getting chest pain that the cardiologist says is not a heart problem, you may have a condition called gastroesophageal reflux disease (GERD).

Gastroesophageal reflux disease is so common that some gastroenterology societies are starting to recommend we screen patients for symptoms that suggest a problem might exist. The reason to have a gastroenterologist evaluate you for reflux is to make sure none of the serious complications of this disease are present and to find out why you have the condition in the first place.

The most feared complication of GERD is esophageal cancer. One of my favorite singers, Eddie Money, recently passed away from this disease. The problem with esophageal adenocarcinoma, which is strongly associated with prolonged heartburn, is that it is very aggressive and effective treatments are not available yet.

Can esophageal cancer be prevented? There is a condition associated with GERD that is a precursor to esophageal cancer that can be readily identified during an upper endoscopy performed by an expert gastroenterologist. An upper endoscopy is a very simple procedure, done under sedation so there is no discomfort or choking, during which the lining of the esophagus, stomach, and duodenum are examined. The condition we are looking for in patients with GERD is called Barrett's esophagus, after the physician who first described it years ago.

I tell my patients to imagine their living room walls have a soothing shade of pink paint while their bedrooms have a nice covering of beige. The living room is the stomach and the bedroom is the esophagus. Now imagine you wake up one morning to find that half the walls in the bedroom now have the pink shade of living room paint, this is Barrett's esophagus. The lining cells of the stomach start to creep up and replace the lining of the esophagus. By itself, this process causes no harm. The problem is that once Barrett's esophagus occurs, the patient has more than a 100 fold increased risk of developing esophageal cancer compared to people without this condition.

I then tell my patients to imagine a big frisbee between their chests and abdomen. Below the frisbee is the stomach, about the size of a nerf football. The esophagus travels through a hole in the middle of the frisbee and the stomach is kept in place if that hole stays strong. If the hole weakens over time, the stomach can slip through it above the frisbee into the chest. This process causes the most common reason people have GERD - the hiatal hernia. Most hiatal hernias are quite small, about the size of a tangerine, but some hernias can be very large, closer to a grapefruit. Large hiatal hernias need medical attention since they can cause a variety of conditions including iron deficiency anemia, chest pain, coughing, irritation of the heart, pneumonia, and sometimes may necessitate emergency surgery.

My patients have serious concerns about how to treat their reflux symptoms. They come to the office very worried about using medications called proton pump inhibitors after hearing about possible connections to kidney damage, heart attack, stroke, dementia, bone fractures, and intestinal infections. I always advise that untreated GERD can be catastrophic, resulting in obstruction of the esophagus from scar tissue called strictures. This can also include intestinal bleeding from esophageal ulcers, Barrett's esophagus leading to esophageal cancer, aspiration at night from secretions accumulating in the hiatal hernia, and terrible issues with voice changes, sinusitis, ear pain, and throat clearing from worsening reflux. I also show my patients a recent study of 17,000 patients that demonstrated excellent safety with properly prescribed proton pump inhibitors.  

Every day I help patients manage the risks and benefits of treatments for many digestive conditions. Gastroesophageal reflux is no different. It can be a serious, sometimes life threatening condition if left untreated and unmonitored. Go see a gastroenterologist about your heartburn...it can save your life!