From Memorial Day through Labor Day, grill-loving Americans consume more than 7 billion hot dogs, 50% more than any other time of year. Unfortunately, these barbecue favorites — along with burgers and sausages — are high fat foods, notorious for causing heartburn.
According to the American College of Gastroenterology, over 60 million Americans experience heartburn once a month. Typically described as a painful burning in the middle of the chest, heartburn is a symptom of acid reflux — the backflow of stomach contents into the esophagus. It can be accompanied by a sour taste in the mouth, burping, or nausea. Those who suffer from heartburn more than twice weekly are at risk for gastroesophageal reflux disease (GERD), a chronic condition afflicting 20% of all Americans that is also linked to esophageal cancer and ulcers.
The stomach lining is coated with a thick layer of mucus that serves as a barrier against the corrosive effect of hydrochloric acid, crucial for digestion. But the esophagus has no such protection, and so is easily damaged by chronic acid reflux. A muscular valve (or sphincter) at the base of the esophagus keeps stomach contents where they belong, but increased abdominal pressure from overeating or lying down right after a meal can force the valve open, allowing gastric material into the esophagus.
Nicotine and acidic foods or drinks may also trigger reflux too by relaxing the sphincter. Some common offenders include tomato sauce, chocolate, sugary or fatty foods, coffee, and alcohol.
GERD can inflame the esophagus all the way up to the throat and sinuses, causing pain, hoarseness, and nasal congestion. Stomach acid can be aspirated, too, resulting in asthma-like symptoms such as wheezing, coughing, and shortness of breath.
Certain factors may increase the risk of developing GERD by weakening the esophageal sphincter: autoimmune diseases (like rheumatoid arthritis), obesity, hiatal hernia (where the stomach bulges above the diaphragm), family history, and some prescription medications (anti-hypertensives like amlodipine or diltiazem; tranquilizers like diazepam and alprazolam;, and nonsteroidal anti-inflammatories like ibuprofen or naproxen).
If you have heartburn more than twice weekly, see your primary care provider. You may be referred to a gastroenterologist for an upper endoscopy, in which a flexible fiberoptic scope is inserted through the mouth to examine the esophagus, stomach, and upper small intestine.
Mild cases of GERD may respond to lifestyle changes such as weight reduction, smaller meals, and avoidance of food triggers. Eating no later than three hours before bedtime and elevating the head of the bed while sleeping can also help. Antacids like Tums or Rolaids may relieve heartburn symptoms. Liquid antacids like Mylanta or Gaviscon coat the esophagus and neutralize stomach acid.
Moderate to severe GERD is treated with acid-reducing prescription medications to promote esophageal healing and ease symptoms. The cornerstone of therapy is proton pump inhibitors (PPIs) such as omeprazole and pantoprazole, enzyme-blockers that decrease stomach acid secretion. Histamine receptor antagonists — famotidine or cimetidine — are less effective acid-reducers, reserved as add-on medication for resistant GERD, and occasionally for recurrent symptoms. Surgery (to tighten the esophageal sphincter) is an option if medical therapy fails.
The majority of GERD sufferers require only eight weeks of treatment with PPIs — yet research has shown that up to 70% of Americans take them for years. Not only do patients continue to consume over-the-counter PPIs, but also healthcare providers overprescribe them out of concern that symptoms will persist. PPIs must be tapered slowly over several weeks; recurrent acid reflux may necessitate an endoscopy to determine if further treatment is needed.
Long-term use of OTC or prescription PPIs can cause serious health problems. Chronic stomach acid reduction can interfere with absorption of critical nutrients like calcium, increasing the risk of osteoporosis; malabsorption of magnesium and B12 may impact brain and heart health. PPIs can weaken the immune system by promoting an abnormal bacterial overgrowth in the gut; they can also interfere with medications like warfarin (a blood thinner) and citalopram (an antidepressant).
If you experience acid reflux, stand up, loosen your belt or change into nonbinding clothes, and take small sips of water to wash down the stomach contents. Heartburn chest pain can mimic a heart attack; If antacids don’t help, or you have additional symptoms such as sweating, palpitations, or radiating pain, call 911.
Dr. Mary Jenkins, a contributor to the Herald and member of its board of directors, retired after nearly 40 years as a family practice physician in New York state.