Heartburn, Reflux, Gerd: Are You Suffering?
It has recently been estimated that upwards of 40% of the US population suffers from some degree of esophageal reflux, with roughly 20% complaining of weekly episodes of heartburn and 10% struggling with daily symptoms. The process of esophageal reflux occurs when there is a backward flow of acid, bile and other stomach contents trying to move in a reverse direction from the stomach back into the esophagus. There are a variety of reasons why someone may experience this phenomenon of reflux that range from overeating, consumption of foods or beverages (such as coffee or cola beverages) that allow for relaxation of the esophageal sphincter, peptic or duodenal ulcers, the use of anti-inflammatory medications (even a baby aspirin) or perhaps the presence of a hiatal hernia.
The most obvious symptom of esophageal reflux is known as heartburn. This tends to occur after the eating of food and can last anywhere from just a few minutes to several hours. Many people describe this as a burning sensation felt in the pit of the stomach or just below the sternum and working its way up into the chest or throat. When the esophagus becomes inflamed, symptoms may be described as a sharp or stabbing pain felt in the center of the chest. These symptoms are often mistaken for a heart attack and can prompt many to seek assistance from the local emergency room.
GERD (gastroesophageal reflux disease) often results in a chronic irritation from the acid-bile refluxing into the esophagus. If left unchecked it may cause normal cells to be replaced by precancerous cells. Known as Barrett’s esophagitis, this condition is typically identified throughout he use of a specialized examination known as an endoscopy and performed while under anesthesia by a GI specialist.
There are many medical approaches to treating these common digestive disorders that range from the use of antacids such as Tums, Rolaids, Maalox, or Histamine blocking (H2) medications such as Tagament, Pepcid, and Zantac. In fact, this condition has grown so common that many of these products that were once only available by prescription are now readily available over-the-counter. If these basic approaches to symptom relief fail to work, then proton-pump inhibitor drugs such as Nexium, Prevacid, or Prilosec are often recommended.
Use of these medications does have its shortcomings and long-term use can and will block stomach acid production from occurring in the stomach. Stomach acid, however, is not our enemy. Our body needs this acid for many reasons — one of which is to break down proteins for digestion. Failure to do this can lead to all sorts of problems that include intestinal permeability, anemia, fatigue, increased allergy disorders, bacterial and yeast overgrowth and irritable bowel just to name a few. In the stomach, one important function of the acidity is to initiate the conversion of pepsinogen to pepsin (an enzyme needed to allow us to digest protein). Without proper enzyme production, the body has a difficult time digesting food, often resulting in a variety of chronic disorders referred to as functional disorders of the body. Failure to correct these basic functional issues can and will lead to additional health concerns and quite possibly disease.
Are antacid medications always the answer?
No, certainly not in my practice they aren’t. First, the esophageal sphincter is designed to close shut and prevent the refluxing of foods as acid is formed in the stomach. If stomach acids fails to be adequately present (as a result of antacid use) then improper close of the esophageal sphincter may occur. This low level of acid can allow reflux to occur back up into the esophagus and may result in worsening symptoms of the very condition being treated. In fact, since we are on the topic of heartburn and reflux, it is probably a good time to mention that slow stomach acid (achlorhydria) is a common ailment found in approximately 50% of Americans over the age of 60. Lack of stomach acid triggers a chain reaction of digestive disorders, including malabsorption of nutrients and symptoms often associated with Fibromyalgia and Chronic Fatigue Syndrome. Foods that are incompletely digested become toxic to our body and are then subsequently absorbed into the bloodstream, often leading to issues involving food allergies, inflammation and a host of pain related disorders and numerous autoimmune related conditions.
It should be remembered that the stomach needs an acid environment in order to activate the enzyme pepsinogen into pepsin. No acid equates to no pepsin, which is needed for the digestion of protein. Of course protein is needed for growth and development, the formation of hormones, enzymes and antibodies. Deficiency of protein is often recognized by fatigue, loss of appetite and edema. Additionally, no protein digestion will translate into a lack of amino acids. A lack of amino acids means a lack of brain neurotransmitters, leading to symptoms commonly associated with mood disorders, depression, and anxiety. I can only hope that you see where I am going with all of this — where one problem ends up creating another and another and thus the long-term list of symptoms begins to develop.
What are the answers then? This is actually a difficult question because there are many things that need to be investigated when a patient is struggling with heartburn / reflux issues. It is often wise to start by addressing the basics — beginning with the diet. Taking note of foods that cause issues and avoiding them may lend big clues in what type of food you could be having the most trouble digesting. In addition, it is imperative that the integrity of the protective stomach lining be evaluated. Many individuals lack adequate amounts of mucous designed to coat and protect the stomach. Any deficiency in mucous may be the result of high levels of emotional stress or the use of medications such as mucinex or a host of cough suppressant medication that work to suppress mucus. This thinning of mucous in a sinus or respiratory region of the body may help some to alleviate cold symptoms but tends to hasten digestive issues. Without adequate mucous to protect the stomach lining, it becomes very easy for stomach irritation to occur in the presence of stomach acid resulting in yet another common source of heartburn and reflux type symptoms.
The bottom line is that digestive issues are very complicated and should not be treated on your own. Consult a professional for serious symptoms or concerns about your health. When all else fails and your health begins to falter, focus your thoughts and look to the basics. In most cases, you will find that you are doing something that contributes heavily to your current issues. Perhaps some simple adjustments in diet as well as improved digestion will solve many of the basic issues so common today.