Acid Indigestion and Gastro-Esophageal Reflux Disease

Alan Smith, Gastroenterologist
Wenatchee Valley Clinic, Wenatchee, Washington

Acid indigestion and gastroesophageal reflux disease (GERD) are very common. In the US, nearly 20-40% of the population experiences heartburn monthly. We can separate gastritis and ulcer disease from GERD by their respective manifestations, GERD being a more common problem.

Peptic ulcer disease, including duodenal or gastric ulcers and severe gastritis, has been linked to the bacteria Helicobacter pylori. Other risk factors include smoking, excessive alcohol use, and regular use of aspirin or other anti- inflammatory medications (“NSAIDs”) such as ibuprofen and naproxen. Ulcers usually cause dull pain in the upper abdomen which can feel like a gnawing ache or ‘hunger pain” to many patients. Ulcers can also cause bleeding which results in black tarry stools and is often a life- threatening emergency. Other abdominal problems can mimic ulcer symptoms; your physician may recommend an upper endoscopy or other imaging tests to sort out these possibilities. Helicobacter pylon can be tested for in several ways, endoscopy being the most accurate. Treatment of ulcer disease includes cessation of contributing risk behaviors, acid-reducing medications (there are several choices), and, if Helicobacter pylon seems to be the cause, antibiotics plus acid re­ducers are prescribed.

GERD covers a wide spectrum — from mild, occasional heartburn to severe inflammation in the esophagus with ulcerations and even stricture formation. Chronic severe reflux can result in so- called “Barrett’s Esophagus” which can predispose patients to esophageal cancer. Reflux is caused by gastric contents (mainly acid) regurgitating back up into the esophagus. ‘Heartburn” is the resulting symptom — a dull, burning substernal pain which is difficult to distinguish from angina (heart pain) based on the character of the pain alone. A key feature of angina is its tendency to occur with exertion, such as walking up stains on a hill, and its relief with rest. You should see your physician immediately if any pain suggestive of angina develops, especially if you fall into a high-risk group for heart disease.

GERD has been linked to respiratory problems including cough, asthma-like symptoms, and even more serious chronic lung disease. Patients with severe night­time symptoms seem to have more pro­longed acid exposure to the lining of the esophagus; hence the link to more serious complications. Since GERD is so com­mon, when should patients seek medical attention? Several symptoms should prompt heartburn sufferers to see their physician. These would include long­standing reflux (especially >5 years), diffi­culty swallowing, nighttime respiratory symptoms, weight loss, or any sign of GI bleeding. The evaluation of GERD might include upper GI endoscopy, UGI X-nays, and even attempts to quantify the severity of acid-reflux using an acid sensing probe placed through the nose into the lower esophagus.

There are many strategies for treat­ment of GERD. The mainstays of such programs are acid-reducing medications. H2- blockers such as Cimetidine and Raniti­dine are often used. The newer and more powerful Proton-Pump Inhibitors (PPls) include Omeprazole, Lansopnazole, Pantoprazole, and others, and are the most powerful and effective medications available for acid suppression. Other treat­ments for GERD include weight reduc­tion when appropriate, avoiding caffeine, alcohol, chocolate, & foods which seem to worsen symptoms. Avoiding a large evening meal and eating several hours before bedtime can be helpful. Elevation of the head of the bed 4-6” can also help reduce nighttime reflux. For some patients with severe symptoms and anatomy that greatly predisposes to reflux, surgery is a meaningful option.

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