Heartburn: A Common Problem
Jeffrey Michalak, DO, Gastroenterologist
Midlands Clinic, PC
Have you suffered from repeated bouts of heartburn and sour tasting fluid in your throat? These are classic symptoms of a common health problem called gastroesophageal reflux disease or GERD. This is a condition in which the esophagus becomes irritated because of acid flowing back from the stomach.
The esophagus is the tube connecting the throat to the stomach. When food is swallowed, it travels down the esophagus, past a sphincter that joins the esophagus to the stomach, and into the stomach. Smoking, caffeine, and alcohol all increase the level of acid in your stomach, which can make your symptoms worse. Eating certain foods or medicines can also add to the problem.
Symptoms of GERD
- A burning sensation in the chest (heartburn)
- A bitter or sour taste in the back of your mouth
- Pain in the lower chest/upper abdomen
- Chronic cough and hoarseness
- Worsening of the above symptoms when bending over or lying down flat
Causes of GERD
The exact cause of GERD is unknown. The following are contributing factors that may weaken the lower esophageal sphincter, resulting in reflux:
- Lifestyle: Use of alcohol or cigarettes, obesity, poor posture (slouching)
- Medications: Calcium channel blockers, theophylline (Tedral, Hydrophed, Marax, Bronchial, Quibron), nitrates, antihistamines
- Diet: Fatty and fried foods, chocolate, garlic and onions, drinks with caffeine, acidic foods such as citrus fruits and tomatoes, spicy foods, mint flavorings
- Eating habits: Eating large meals, eating quickly or soon before bedtime
- Other medical conditions: Hiatal hernia, pregnancy, diabetes, rapid weight gain
When to Seek Medical Care
Many people experience the signs and symptoms of GERD on occasion. When the signs and symptoms occur at least twice a week, or interfere with daily activities, it is time to call your doctor. It is advised to try and relieve GERD symptoms by changing habits, diet, and lifestyle, prior to consulting a health-care professional.
- Call your doctor when symptoms of GERD occur frequently, disrupt your sleep, interfere with work or other activities, or are not relieved by lifestyle change or over the counter medications.
- Inform your doctor of your lifestyle changes and if you are using over the counter medications so that it can assessed as to how well these changes are working for you.
If you have any of the following, go immediately to the emergency department:
- Severe chest pain or pressure, especially if it radiates to your arm, neck, or back
- Vomiting followed by severe chest pain
- Vomiting blood
- Dark, tarry stools
- Difficulty swallowing
- Shortness of breath
Your Medical Evaluation
The goals of treatment are reducing reflux, relieving symptoms, and preventing damage to the esophagus. This can be done a number of ways. The first thing your doctor will do is a thorough physical exam and request diagnostic tests. These tests may be performed by a gastroenterologist, or GI doctor. A gastroenterologist specializes in treating digestive problems. The following are tests that may be performed to identify what is causing your GERD discomfort:
- Barium Upper GI- a series of xrays to evaluate how your digestive tract works.
- Esophageal endoscopy- allows the doctor to see inside your esophagus through a tiny flexible tube.
- Esophageal manometry- measures the muscle tone in the sphincter between your esophagus and stomach as well as the muscle tone of the esophagus.
- pH monitoring- test that monitors the acid in your esophagus for 24-72 hours
- Ruling out gall bladder problems through ultrasound
Life After Treatment
GERD can often be managed through a combination of lifestyle changes, medication and sometimes surgery. Your doctor can help you find the option that is right for you. With the appropriate treatment, you can return to living a full and healthy life, eating the foods and doing the activities you enjoyed before your heartburn started.
Dr. Jeffrey Michalak, Gastroenterologist at Midlands Clinic, PC, sees patients for GERD and other digestive disorders. To make an appointment with Dr. Michalak, please call 605-217-5500.