Heartburn: It’s Not a Cardiac Issue
Some people periodically experience a burning sensation inside their chest cavities. Most people call this “heartburn.” Over 50% of Americans experience heartburn at least once in their lives.
Before I launch into my discussion about heartburn, I want to make sure that everyone knows the condition has nothing to do with the heart. “Heartburn” is actually acid reflux or gastroesophageal reflux disease (GERD). GERD is a condition in which the esophagus becomes irritated or inflamed because of acid backing up from the stomach.*
The scientific explanation for what happens is this: Your esophagus has muscles called esophageal sphincters that constrict when you’re not eating to prevent stomach acid from backing up. When these muscles relax or malfunction, stomach acid can flow into the esophagus and damage the esophageal lining, creating a burning sensation.
Medically, the GERD usually isn’t the main problem; it’s usually just a symptom of another condition.
There are three main types of reflux. The first type is what I call “functional reflux,” which is reflux that is not caused by a disease (a.k.a. GER without disease). People who have functional reflux usually have a strong reaction to certain foods – usually coffee, chocolate, ice cream, or oily fried foods because these foods stimulate stomach acid production.
Others experience functional reflux because of lifestyle tendencies. Stress increases acid production. Eating immediately before you sleep can also cause reflux because eating relaxes the esophageal sphincters, and lying down allows gravity to pull stomach acid into your esophagus. Smoking also relaxes the esophageal sphincters.
Obesity can also lead to functional reflux because the excess weight in the body cavity puts pressure on the stomach. This pressure could squeeze stomach acid back up the esophagus.
Aside from functional reflux, people can experience “heartburn” if they have stomach diseases. In China, 70% to 80% of people who experience GERD also have peptic ulcers. Once the peptic ulcers have been cured, the GERD also disappears.
Another potential cause of reflux is a hiatus hernia. A hiatus hernia occurs when the esophagus becomes detached from the diaphragm and part of the stomach gets pushed into the diaphragm or chest cavity. When this occurs, the stomach usually cannot settle back to where it should be.
Esophageal sphincters are often helped by the muscles in the diaphragm to close off the esophagus. If part of the stomach has been pushed into the diaphragm, the esophagus will not close off completely. It’s this trait of hiatus hernias that can cause reflux.
The last type of reflux is called “silent reflux,” which is difficult to diagnose because of its atypical symptoms. People who experience silent reflux usually have a dry cough that occurs mostly at night.
In people with silent reflux, a small amount of stomach acid backs up into the esophagus and is breathed into the airway, thus irritating the passageway to the lungs.
People who experience silent reflux usually end up seeing Ear, Nose and Throat (ENT) doctors for more help but can feel frustrated when there doesn’t seem to be anything wrong.
What’s the big deal?
Many people will experience reflux at some time in their lives. However, it’s never a good idea to ignore medical problems. For people with mild persistent reflux, over-the-counter antacids can help with the symptoms.
However, if you experience serious persistent reflux, it might be time to see a doctor. If you ignore the symptoms too long, a few things could happen:
- Scarring – Your esophagus becomes so irritated that it begins to form scar tissue. This scar tissue could accumulate and start to block off your esophagus. This condition requires dilation treatment or surgery.
- Esophagitis – Your esophagus could become inflamed. Esophagitis normally requires a six-week treatment coupled with medicine that inhibits acid production in your stomach.
- Barrett’s esophagus – This is a condition in which the esophageal lining is worn away by stomach acid, and the stomach lining begins to creep up into the esophagus. This is a serious condition that requires long-term management and periodic monitoring by endoscopy.
- And, of course, long-term neglect of any part of our bodies could potentially result in cancer. About 2% of Barrett’s esophagus cases end up as cancer.
I would recommend a consultation for people who fit any of the following descriptions:
- You’re over 45 and are experiencing persistent GERD for the first time.
- You’ve been taking reflux medicine every day for two weeks and have not responded.
- You’ve been taking reflux medicine for days on end and have responded. However, symptoms come back full force immediately after you stop taking the medicine.
In the end, it’s always better to prevent disease than to cure it. If you have a pre-existing condition that you think may be caused by irregularities in your stomach or digestive system, I encourage you to get it checked out. If you find that your lifestyle puts you at risk for GERD, make changes to how you live. Lifestyle changes could have long-lasting health benefits. It’s never too late to start.