Sept. 28--Heartburn is a hot topic.
Tune in to television and lay off the DVR's fast-forward button during the
commercial breaks. We're talking heartburn and acid reflux problems, which are
on the rise.
"The problem is half the people in this country experience reflux. It's very
common and a lot of that may have to do with obesity," said Dr. Michael
Sternthal, medical director of the Endoscopy Center at Baptist Hospital in Coral
Springs. "People are gaining weight and that's certainly a big risk factor. Some
of that is due to more awareness. We used to have the old [Pepto Bismol]
commercial -- 'plop-plop, fizz-fizz' -- now we are inundated with the [Nexium]
'purple pill' and you go to the drug store and see lines of pill bottles."
Some of the reflux can be relatively harmless. Most everybody can relate to that
roiling, boiling sensation that bubbles up from the stomach to the throat after
a big or spicy meal. Often, the symptoms are traceable to that second helping of
nachos and are not regular occurrences.
Changes in diet and exercise to control weight gain, avoiding alcohol and
smoking, and listening to mom's admonishment -- "Don't lie down after dinner!"
-- can quench the fire. When that doesn't work, over-the-counter medications,
primarily proton pump inhibitors (PPI) like Prevacid and Prilosec that block
acid production, can alleviate the symptoms.
But gastroesophageal reflux disease, or GERD, can be more serious. GERD, which
affects an estimated 25 percent of the U.S. population , or about 50 million
Americans, can make swallowing difficult and lead to chronic throat and chest
pain. Left untreated, GERD eats away at the lining of the esophagus, a 10-inch
tube with which we swallow food and drink, and renders the esophageal sphincter
flap, which keeps stomach acid, bile and other contents, out of the throat,
relatively ineffective. Cancer of the esophagus can result, though it is not as
prevalent as colon cancer, which is the second-leading cause of cancer death
behind lung cancer.
"The alarms are if you are losing weight, food is getting stuck when you
swallow, or you vomit blood or have a dark stool then you should see your
doctor," Sternthal said.
Obesity can increase pressure in the abdominal area and push the stomach into
the chest, known as a hiatal hernia, which leads to a higher chance of acid
spilling into the esophagus, said Dr. Baharak Moshiree, an associate professor
of medicine and director of motility at the University of Miami Miller School of
Raising the head of the bed by six to eight inches with a block, not just
pillows, and not eating late at night or within three hours of bedtime can
alleviate symptoms or reduce the risk of reflux.
"Acid reflux-inducing foods like Hispanics love, cafe con leche, because of the
caffeine which is hard to tell patients to avoid, causes inflammation of the
stomach and causes impairment of the muscles in the lower esophageal sphincter,"
Moshiree said. "Caffeine weakens the muscles which predisposes us to more
reflux. Same with chocolate and alcohol. Peppermint, fatty and fried foods does
the same thing. Smoking neutralizes the saliva in our mouth and saliva can
neutralize acid so this can cause more symptoms.''
Chewing gum, Moshiree said, can be helpful because it stimulates saliva
Barrett syndrome is a more serious complication of prolonged acid reflux,
lasting 10 or more years. The lining of the esophagus, worn by acid, changes to
a tissue similar to the intestinal lining. The process is referred to as
intestinal metaplasia. Individuals with Barrett's esophagus are at increased
risk for a rare type of cancer called esophageal adenocarcinoma. A preventative
procedure, radial frequency ablation, scoops out damaged tissue from the
esophagus and can help avert or treat Barrett's.
Once diagnosed with Barrett's, which affects about 10 percent of adults with
reflux, according to Dr. Barry Migicovsky, a gastroenterologist with Memorial
Regional Hospital, an individual will usually undergo surgery to remove the
abnormal cells and then is put on meds indefinitely.
Vanessa Gonzalez, 36, a reflux patient of Moshiree, never figured she could have
GERD despite a persistent cough that lasted for five months at a time.
"I never felt any heartburn or symptoms that would tell you you have acid
reflux," she said. A gastroenterologist who examined Gonzalez, who works as an
administrator in the cardiology department at the University of Miami, suggested
her problem sounded like GERD.
"I said, 'Oh, you must be out of your mind.' Just because I had this cough I
thought everyone was crazy telling me I had GERD. But then a few months ago I
got this really bad, crushing pain in my chest. I didn't have the cough but had
this pain and got scared. Every time I'd lean forward or lay down it was really
painful and the first thing you think is you are having a heart attack. I
finally went to Dr. Moshiree and she did an endoscopy and the results came back
that I had symptoms of GERD."
Gonzalez was put on Zantac, a histamine blocker, and said she hasn't had
"My whole experience triggered my husband to go see her as well. He gets a lot
of heartburn and had similar symptoms but he has reflux, not GERD. He eats a lot
of spicy foods.''
Richard Kearns, a patient of Migicovsky's at Memorial and a former CEO of Spice
World, a major supplier of garlic to the nation's supermarkets, had Barrett's.
"Being a layman, I thought it was heartburn. There was a time if I ate too close
to bedtime, which I would do a lot when going out with colleagues and having a
glass or two of wine, I felt like someone put a blowtorch in my esophagus. I
realized this was not normal," he said from his home in Deerfield Beach.
Kearns underwent the ablation procedure about 2-1/2 years ago. "There was some
pain involved, nothing I couldn't live with. I didn't love the soft diet for a
week afterward," he said, chuckling.
Last week an endoscopy revealed his system was clear. "I'm feeling pretty darned
Screenings can detect esophageal problems before they become too serious or lead
High resolution esophageal and three-dimensional anorectal manometry uses color
topography to measure the areas of the esophagus as they contract. Probes
measure the acidity in the esophagus and how often a patient has reflux
episodes. For this test, a patient wears a catheter for 24 hours and is assessed
by the doctor after returning the following day.
A Bravo sensor capsule, lowered into the esophagus through the mouth where it
can attach to the esophagus wall, transmits radio frequency to a computer for a
doctor's analysis. This test is popular with younger patients and the capsule is
excreted via the GI tract in about 48 hours.
When reflux or GERD is diagnosed, proton pump inhibitors like Nexium are
effective but long term use can increase chances for osteoporosis because the
meds can interfere with the absorption of calcium and vitamin B12. Rather, it's
better to change your diet and lifestyle, doctors say.
If one has Barrett's and treatments like ablation do not work, or if there is
cancer and it isn't caught early enough, the best option is surgery, said Dr.
Mark Block, chief of the division of thoracic surgery at Memorial Healthcare
System in Broward.
One type of surgery, done through laparoscopy, sews the upper part of the
stomach around the lower part of the esophagus to shore up the sphincter muscle.
Robotic, three-dimensional visualization, or video-assisted thoracic surgery, is
minimally invasive and makes little incisions.
"This can make a big difference in recovery time and the complication rate after
surgery," Block said. "In the last year or so I've done probably half a dozen,
and the recovery is much better than the traditional open approach."
The most common complication of the surgery is pneumonia and breathing problems.
Patients are kept in the hospital for a minimum of a week and drink liquids
during the healing process.
"Most can come back to the same sort of diet before they became ill but they
have to eat smaller meals more regularly because they don't have a functioning
esophagus so they have to be careful not to lay down after they eat," Block
said. "If you catch these cancers early, the operation is curative."
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