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Frequent Heartburn May Lead to Serious Complications

Munching on antacids can bring quick relief from heartburn, but someone who takes antacids with every meal may be masking a problem that could lead to serious health consequences.

A muscle called the lower esophageal sphincter is designed to prevent food from entering the esophagus from the stomach. When the muscle is weak or too relaxed, the digestive juices can come back up causing the burning sensation known as heartburn. More than 60 million American adults experience heartburn at least once a month, and about 25 million adults suffer from heartburn daily, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

People who have more than two episodes of heartburn per week may have gastroesophageal reflux disease (gastric reflux) and should be examined by a specialist for early damage to their esophagus, said S. David Li, M.D., a gastroenterologist who sees patients at Loyola University Medical Center in Maywood and Loyola's Family Health Center at Hickory Hills.

However, Li noted that some people with gastroesophageal reflux disease have symptoms other than heartburn, which may include hoarseness, a chronic cough, asthma attacks at night, tooth decay or chronic bad breath. Other warning signs that medical help is needed are heartburn symptoms that do not respond to an antacid, difficulty swallowing, mild heartburn symptoms ongoing for several years and unexplained weight loss.

Heartburn can be more than just inconvenient and uncomfortable. It can lead to serious complications if left untreated. Over time, acid in the esophagus can cause an ulcer, a tumor, fibrosis or scarring that tightens the esophagus (Barrett's esophagus), which often leads to cancer.  

A gastroenterologist examines patients to look for early signs of esophageal damage and identify patients who may be at risk for complications. With a small, lighted tube and a tiny video camera, called an endoscope, the physician can see any inflammation or irritation in the lining of the esophagus. The physician also may measure the acid levels in the esophagus through pH testing. Physicians at Loyola were among the first in the Chicago area to use a wireless pH probe that can be positioned comfortably in the patient's esophagus and worn there for 24 hours while it sends a signal about pH level to a device on the patient's belt.

"The first line of treatment for gastric reflux is avoiding food and beverages that aggravate the problem," said Khondker Islam, M.D., a gastroenterologist who sees patients at Loyola University Medical Center in Maywood and at Loyola's Family Health Center in Hickory Hills. Patients may find relief by eliminating foods that cause reflux or make it more painful, such as coffee, alcohol, chocolate, fried and fatty foods, and acidic foods. It also is helpful to eat smaller meals, wait several hours after eating before going to bed, and elevate the head of the bed on blocks so gravity will help keep stomach contents from moving back into the esophagus.

The next level of treatment would include medications, such as H2 receptor blockers or proton pump inhibitors that help reduce stomach acid. In some cases, surgery may be needed to correct the cause or complications from gastric reflux.

Islam noted that gastric reflux feels like chest pain to some people, but they should never assume chest pain is gastric reflux. Anyone experiencing chest pain, especially if it is associated with physical activity, should go to the nearest hospital emergency department.

Tell your primary care physician about your symptoms to determine if you should see a gastroenterologist.

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