Dr. Swiner’s Medical Note of the Month, July 2010 (II)-Got GERD?

Ask Dr. SwinerAcid reflux

Published Wednesday, July 21, 2010 7:00 amby Nicole Price Swiner, Columnist

A patient of mine recently asked me to address heartburn, so here goes.

GERD, or gastro-esophageal reflux disease, is a condition that can vary from mild to severe. Heartburn describes the classic presentation of this disorder that can literally feel like burning from the pit of one’s stomach through the esophagus and central chest up to the level of the throat.

Some complain of chest pain that even mimics that of a heart attack if severe enough. Burping, belching and bloating, particularly after eating or when sleeping, can be disruptive. Awakening with a sour taste in the mouth or an unexplained chronic cough can also be caused by acid reflux.

So, what causes an increased production of acid in the belly? We all have proton pumps and H2 receptors in our stomachs that manage the balance and acid and base from our foods for digestion. When food enters the stomach from the esophagus, a certain amount of acid is released to help break it down into proteins and amino acids for our bodies to use for energy.

Some foods, drinks, alcohol or chocolate can be associated with too much acid production. Interestingly, emotional stress can lead to an increased production of acid from proton pumps and H2 receptors in our stomachs. If acidity is prominent, a burning sensation can be felt and pain can extend from the stomach (in the center and to the left of the middle of the stomach) all the way up to the esophagus and throat. Caffeinated beverages like soda, tea and coffee, and spicy ingredients and citrus can make this worse. If left for too long, ulcers, or an eating away of the lining of the stomach, can develop and even worsen to the point of bleeding.

Medicines used to treat GERD can be grouped into three types: those we use at the time of acute pain such as Tums or Maalox; one group that affects proton pumps – Nexium or Prilosec; and those affecting H2 receptors – Zantac or Pepcid.

My rule is that if a patient complains of reflux symptoms requiring Tums more than two to three times a week, he or she likely needs preventive medicine from one of the other two groups. Most of these medicines now are available over the counter without a prescription and in generic form: Zantac is Ranitidine, Prilosec is Omeprazole and Pepcid is Famotidine. However, the best treatment is always prevention.

I’m a coffee lover myself, but I try to limit my intake to one serving of caffeine a day, including sodas. If you’re like me and can’t give up coffee, tea or soda totally, switch to decaffeinated brands. Also, tomato sauce, hot sauce, salsa and chocolate are not your friends if GERD is your problem. Orange juice and peppermints can be culprits for flares too, which we all may ingest on a regular basis.

A huge piece of advice is to quit smoking – completely. Cutting back won’t cut it. Weight loss, because of less pressure on the esophagus and stomach giving more room for digestion, also helps.

C. Nicole Price Swiner, MD, works for the Durham Family Practice in Durham. Contact her at 220-9800.

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