Departments
Health Matters
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Week of 8 January 1999 |
Vol. II, No. 18 |
Health Matters
Heartburn: relief for acid reflux
My husband often complains of heartburn. What exactly is heartburn, and is it serious?
The heartburn your husband suffers from is actually a symptom of gastroesophogeal reflux disease, more commonly known as acid reflux. Reflux occurs when the lower esophageal sphincter -- the valve between the esophagus and the stomach -- relaxes, allowing acidified contents of the stomach to flow back into the esophagus. Because it is not equipped to handle acid, the lining of the esophagus becomes inflamed and damaged.
"Basically, heartburn is caused by acid getting where it doesn't belong," says Michael Wolfe, M.D., chief of the Section of Gastroenterology at Boston Medical Center and professor of medicine at Boston University School of Medicine.
The inflammation produces a painful burning sensation in the throat, just below the breastbone. The pain often rises in the chest and may radiate to the throat and neck and is sometimes accompanied by a hot, sour liquid in the back of the throat, called waterbrash. Heartburn is more likely to occur after meals and when lying down or bending over, says Wolfe, coauthor of Heartburn: Extinguishing the Fire Inside (W. W. Norton Co., 1997).
Certain foods, he says, can universally cause heartburn: caffeinated and decaffeinated soft drinks and coffee -- in fact, he says, decaffeinated coffee may cause more reflux than caffeinated beverages. Other substances that trigger reflux include peppermint (because it causes the sphincter valve to relax), chocolate, fatty foods, alcohol, nicotine, and cigarette smoke. Nonuniversal causes (those that don't cause heartburn in everyone) include spicy foods, and because of their acidic content, citrus fruits and tomatoes. Being overweight can also lead to heartburn.
Some people get reflux "no matter what. It's the unluck of the draw," says Wolfe, who has conducted research on the effectiveness of combining antacids and H2 blockers, two common medications used to treat heartburn.
Treatments for heartburn depend on the severity of the condition, according to Wolfe. Most of the initial treatments are lifestyle changes, including avoiding foods that cause reflux, losing weight, quitting smoking, and moderating alcohol use. In addition, he says, raising your bed on an incline or using a firm foam wedge to raise your chest and head can greatly reduce episodes of heartburn at bedtime. He adds that the motion of chewing gum raises the level of saliva and bicarbonate -- a naturally occurring antacid within the saliva -- in the digestive system.
If lifestyle modifications don't work, you can try antacids, which have been proven effective in treating heartburn. "Antacids have been around for ages," says Wolfe. "The Greeks prescribed the use of coral powder, a natural antacid, to treat heartburn and other digestive disorders."
Over-the-counter antacids provide quick relief for mild heartburn, but usually don't last for more than an hour. Low-dose H2 blockers, which decrease the flow of stomach acid and aid in the healing process of mild-to-moderate irritation of the esophagus, are systemic drugs that take up to an hour to work and are best used when one is expecting an episode of heartburn.
"The problem with antacids is that while they work quickly, they don't last long. On the other hand, H2 blockers take a while to begin working, but provide relief for a longer period of time," says Wolfe. "Combining these medications gives you both components for faster, longer relief. As one wears off, the other kicks in, giving heartburn sufferers more sustained relief."
In addition to heartburn, acid reflux can cause other medical problems, including esophageal ulcers, scarring of the esophagus, acid laryngitis, from which President Clinton suffers, and dental erosion.
More severe reflux and the associated problems of asthma and hoarseness are best treated with drugs like Prilosec and Prevacid, which reduce gastric acid secretions. If all other treatments fail, he says, surgery can be performed to strengthen the lower esophageal sphincter.
"Health Matters" is written in cooperation with staff members of Boston Medical Center. For more information on heartburn or other health matters, call 638-6767.