Treating heartburn and GERD.
Article Type: Report
Subject: Heartburn (Care and treatment)
Heartburn (Research)
Gastroesophageal reflux (Care and treatment)
Gastroesophageal reflux (Research)
Nonsteroidal anti-inflammatory drugs (Usage)
Nonsteroidal anti-inflammatory drugs (Health aspects)
Author: Klotter, Jule
Pub Date: 10/01/2009
Publication: Name: Townsend Letter Publisher: The Townsend Letter Group Audience: General; Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2009 The Townsend Letter Group ISSN: 1940-5464
Issue: Date: Oct, 2009 Source Issue: 315
Topic: Event Code: 310 Science & research
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 211561644
Full Text: When the lower esophageal sphincter (LES) that separates the esophagus and the stomach fails to close properly, the stomach contents--a mix of food, enzymes, bile, and acid--backwash into the esophagus, often producing the sour taste and discomfort or outright pain of heartburn. The stomach was designed to withstand this corrosive mixture; the esophagus was not. Chronic heartburn, known as gastro-esophageal reflux disease (GERD), has been associated with an increased risk of esophageal cancer.

A number of behaviors and foods contribute to heartburn. Stress, particularly while eating, is one. Overeating and eating too quickly also promote reflux (backwash). In addition, certain foods and drinks--chocolate; tomatoes; raw onions; garlic; black pepper; vinegar; peppermint; fatty or spicy foods, and caffeinated, carbonated, or alcoholic beverages--relax the sphincter muscle, making reflux more likely. This muscle also loosens when people smoke or take some common medications (e.g., aspirin, non-steroidal anti-inflammatory drugs, and some antibiotics). Some asthma medications also cause GERD symptoms. Another behavior that contributes to reflux is lying down after a meal. People with GERD should raise the heads of their beds about 6 to 8 inches to encourage stomach contents to move down the GI tract instead of flowing back up into the esophagus. In some cases, GERD symptoms are caused by hiatal hernia (protrusion of part of the stomach up through the diaphragm).

Antacids, which neutralize stomach acid, and proton pump inhibitors (PPIs), which "turn off" the stomach's acid production, are the usual treatment for heartburn and GERD. While these medicines may relieve symptoms, reducing acid actually causes more problems. First, stomach acid is vital for effective digestion; without it, food will not be broken down into nutrients efficiently. Second, stomach acid contributes to effective closure of the LES muscle. Jonathan Wright, MD, explains in his book Why Stomach Acid is Good for Your (2001): "'When sufficient stomach acid is sensed, the LES will close. However, in conditions where there is a lack of stomach acid, the sphincter remains open, allowing stomach contents, including acid, to flow back through the opening, potentially creating a sense of irritation and discomfort. Adequate stomach acid production is an essential criterion for the [LES] to function properly and prevent the back flow of stomach contents.'" Third, pain caused by acid may diminish, but esophageal damage due to reflux of digestive enzymes, bile, and foods can still occur. Simply reducing the pain does not prevent esophageal damage.

Hart M. Heartburn, GERD and you: what you need to know to soothe the burn. Essential HEALTH. 4(1):8-10.

Martin R. Natural relief from heartburn. Life Extension. September 2006;23-26.

briefed by Jule Klotter

jule@townsendletter.com
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