August 7, 2003
Several options for treatment of acid reflux
TV comedy fans may have fond memories of the old “Sanford & Son” series. Crusty father Fred Sanford would clutch his chest and shout towards heaven, “I’m coming, Elizabeth!” whenever his independent-minded son came up with yet another idea for improving their junkyard home. It could be that Fred wasn’t faking heart attacks, particularly after large, fatty meals. Dr. Michael Saunders, associate director of endoscopy at UW Medical Center, says acid reflux disease can cause chest pain, too.
“Whenever a patient arrives with chest pain, we have to exclude the possibility of a cardiac event,” Saunders says. “Once we’ve done that, the most common cause of a non-cardiac chest pain would be the esophagus. Most likely it’s related to acid reflux.”
Acid reflux occurs when the stomach’s contents travel back up the esophagus, typically causing heartburn and regurgitation. In some cases, patients report a chronic cough, chest pain or sore throat, as well as other symptoms. Reflux can occur rarely, once a month or every night, depending on the severity of the problem. Saunders says up to 25 percent of the adult population may have reflux problems.
The root of the reflux problem is a muscle at the base of the esophagus that regulates the admission of food to the stomach.
“Normally the lower esophageal sphincter muscle should only relax in response to swallowing,” Saunders says. “Relaxation of this muscle in the absence of swallowing is the main trigger for garden-variety reflux. Anatomic abnormalities like hiatal hernia, when part of the stomach herniates through the diaphragm into the chest cavity, can cause severe reflux as well.”
The most common trigger for acid reflux is a large, fatty meal. The risk factors for reflux are obesity, a family history of reflux and excessive alcohol intake — above 7 to 10 drinks a week.
Treatment of reflux depends on the severity. If you end up at the emergency room due to chest pain, once heart problems are ruled out you may be given a prescription for antacids. Medication can control the symptoms and disease in the majority of patients. More severe cases may require surgery or endoscopic treatment to re-enforce the lower esophageal sphincter muscle. Newer endoscopic treatments are being investigated as a less invasive option.
The damage that acid reflux can do to the esophagus is no laughing matter and can result in a relatively rare complication called Barrett’s esophagus, a change in the lining of the esophagus that requires careful tracking by a physician. This condition can, in a small number of cases, lead to esophageal concer.
Saunders says that reflux patients can ease their symptoms and help prevent complications by making some lifestyle changes, like avoiding smoking and excessive caffeinated and alcoholic beverages.
“Eating smaller meals and dealing with reversible factors like obesity can often make a big difference,” Saunders says. “Raising the head of the bed can also help reduce night-time symptoms, along with avoiding eating within two hours of bed time.”
Acid reflux, despite new medications and the use of less invasive endoscopic surgical techniques, isn’t about to go away.
“We’re seeing a lot more acid reflux, with more severe symptoms, in younger and and younger patients. I think it’s related to the rising prevalence of obesity, which has quadrupled in the past few decades,” Saunders says.
Saunders warns that acid reflux is a chronic condition that often needs life-long treatment, much like high blood pressure.
