Acid Reflux: Why You Should Not Ignore It
Acid reflux can be called various terms from indigestion to heartburn to sour stomach. It is one of the most common gastrointestinal symptoms people experience, and it has a high prevalence in the Indian population. In fact, one study1 estimated that up to 20% of the Indian population experiences heartburn symptoms per year. When signs and symptoms of heartburn occur at least twice each week, interfere with daily life, or when your doctor can see damage to the esophagus, you may be diagnosed with gastroesophageal reflux disease (GERD).
Symptoms of GERD can include a burning sensation in the chest, sour taste, fullness in the throat, hoarseness, or just a dry cough. Certain symptoms, such as trouble swallowing, weight loss, nausea and vomiting, or dark stools are considered “alarm symptoms.” These specific symptoms should prompt an evaluation by a physician immediately. There are known risk factors of GERD, many of which are commonly encountered in the Indian population. These include obesity (especially abdominal girth), diabetes, tobacco (smoked or chewed), alcohol, caffeine, spicy foods, and pregnancy.
Although a simple history can lead to a diagnosis of GERD, in most cases, there are a few tests that can help with diagnosis and complete evaluation. One commonly used test is a direct evaluation of the upper GI tract through a modified camera, or scope, called an esophagogastroduodenoscopy (EGD). This is a very safe and useful test that is performed under sedation by a gastroenterologist to ensure that patients are comfortable.
Once a diagnosis and severity of GERD is made, many people can manage the symptoms with lifestyle changes. These include
• Weight loss. Even a few pounds can resolve symptoms.
• Avoid tight fitting clothing.
• Limit or avoid trigger foods, such as caffeine, alcohol, tobacco, spicy foods, and juices. Avoid carbonated beverages and fatty foods.
• Avoid late evening meals. Eat dinner at least 3 hours before bedtime.
• Take walks of 20-30 minutes after meals, especially dinner.
• Quit smoking.
• Elevate the head of your bed by 4-5 inches. Telephone books or risers work better than pillows.
If the above lifestyle modifications do not eliminate GERD symptoms, some patients may require over-the-counter medications such as omeprazole (Prilosec) or esomeprazole (Nexium). These medications work best if they are taken 30 minutes before a meal, typically breakfast. A small percentage of people with GERD may need stronger prescription medications, or even surgery, to reduce symptoms.
Many people feel GERD is a benign condition that does not have long-term effects. Although this is the case for most, some patients can develop difficulty swallowing from esophageal narrowing; gastrointestinal bleeding; or even esophageal cancer. In fact, the rate of esophageal cancer has been rapidly rising in the U.S., and most experts believe this is due to longstanding GERD. For this reason, patients who experience “alarm symptoms,” new onset symptoms after the age of 50, or longstanding symptoms should seek the help of their primary physician or a gastroenterologist for further evaluation.
1) Epidemiology and symptom profile of gastroesophageal reflux in the Indian population: report of the Indian Society of Gastroenterology Task Force. Indian J Gastroenterol. 2011 May;30(3):118-27.
[Neal Patel, M.D., completed his residency and fellowship at the Mayo Clinic, and is a specialist with Atlanta Gastroenterology Associates (AGA). He is an expert in colon cancer screening and treats every type of digestive disorder.]
[Gulshan Harjee, M.D., is a board certified internist in private practice with an emphasis on prevention. Please email your health and medical questions for consideration in this column to: firstname.lastname@example.org. The material in this column is of a general nature, and must not be construed as specific medical advice. This column rotates monthly along with the Fitness Lifestyle column by Aarti Patel.]
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