What is heartburn is the most asked question asked by RefluxMD visitors. It, along with other acid reflux symptoms, is all too familiar to most of us. But did you know our tendency to pop a pill to feel better may be doing more harm than good? While medications help relieve symptoms, they do nothing to resolve the underlying cause of those symptoms: damage to the lower esophageal sphincter (LES). Read on to learn more about heartburn and why it’s time to change how we treat it.
Heartburn and Acid Reflux Problems: A familiar scenario
It was only an hour ago that you finished that wonderful dinner – two helpings with wine followed by a delicious dessert – and now here you are sensing that all is not quite well. Pain has started to move up your chest and you know it’s going to be a long night. Quickly you chew a few antacids and VOILA – feeling better. All is now well once again, or is it?
That story is being written by millions of people every evening across America. In fact, one out of every three adults struggles with heartburn and regurgitation monthly, while more than 50 million suffer several times each week. Of course, we all know it’s just a result of what we eat – right? WRONG! Since antacids “cure” the problem, it has to be excess acid in your stomach – right? WRONG AGAIN!
What is heartburn?
Those pains are a signal from your body that something is wrong – very wrong! An acidic stomach is normal and its necessary for the efficient digestion of food. So why are you getting those pains frequently? Simple, it is due to a small valve at the end of your esophagus called the lower esophageal sphincter, or LES. A healthy LES acts as a barrier keeping stomach contents where they belong, in the stomach.
For some, their LES gets damaged, and when it does, those acidic stomach contents can flow up, or reflux, into the esophagus, and that can be painful. This is acid reflux or gastroesophageal reflux disease (GERD). In fact, over 200,000 individuals visit emergency rooms each year believing they are having a heart attack, but quickly learn that their pain was from acid reflux. If you are asked the question, what is heartburn, the simple and correct answer is a weak LES that allows stomach contents to reach the esophagus.
Unfortunately, for a segment of those with reflux disease, heartburn can progress to a precancerous condition called Barrett’s esophagus, and in some cases, it can advance to adenocarcinoma, better known as esophageal cancer. In fact, the incidence of esophageal cancer is the fastest growing of all cancers in the US, outpacing melanomas, breast cancer, and prostate cancer.
Research published by the Department of Gastroenterology, Landspitali University Hospital in Icelandfound that heartburn is a common and chronic condition that can negatively impact the quality of life, sleep, and daytime activities. 2,000 Icelanders reported their heartburn symptoms over a ten year period. Researchers reported that 43% reported heartburn in 1996 and 44.2% in 2006, with “a strong relationship between those who experienced heartburn in both years.” Researchers commented on some of the driving factors:
“The prevalence and natural history of heartburn are of importance as well as its association with functional dyspepsia and irritable bowel syndrome, and sociodemographic factors such as body mass index (BMI). Heartburn subjects with a BMI either lower or higher than normal weight were more likely to experience heartburn than subjects with normal weight.”
The source of that discomfort
Heartburn pain is a signal from your body that something is wrong – very wrong! An acidic stomach is normal and its necessary for the efficient digestion of food. So why are you getting those pains frequently? The answer is simple, it is due to a small valve at the end of your esophagus called the lower esophageal sphincter, or LES. A healthy LES acts as a barrier keeping stomach contents where they belong, in the stomach.
For some, their LES becomes weaker over time, and when it does, those acidic stomach contents can flow up, or reflux, into the esophagus, and that can be painful. This is acid reflux or gastroesophageal reflux disease (GERD). In fact, over 200,000 individuals visit emergency rooms each year believing they are having a heart attack, but quickly learn that their pain was from acid reflux.
Unfortunately, for a segment of those with reflux disease, heartburn can progress to a precancerous condition called Barrett’s esophagus, and in some cases, it can advance to adenocarcinoma, better known as esophageal cancer. In fact, the incidence of esophageal cancer is the fastest growing of all cancers in the US, outpacing melanomas, breast cancer, and prostate cancer. It is also one of the more deadly cancers with a very low 5-year survival rate.
Doctors at Johns Hopkins Medicine noted the following risk factors for complications from heartburn:
- Five years or more of reflux symptoms
- GERD symptoms from a young age
- History of smoking
They recommend anyone with GERD symptoms and any of these risk factors schedule an evaluation with a GERD expert.
Are medications the best treatment option?
After answering the question, “what is heartburn”, the next question is what can I do about it? Unfortunately, when adults experience pain, most Americans do what most Americans always do — pop a pill. The drug industry sells over $14 billion in medications to “cure” heartburn.
No longer satisfied with doctors recommending their drugs, most pharmaceutical manufacturers now promote directly to the consumer. Everyone that watches television has seen Larry the Cable guy promoting the “purple pill”. That medication is one of the most popular drugs in a class called proton pump inhibitors (PPIs) that work by reducing the amount of acid produced within the stomach.
But do PPIs work? Do they cure the disease? PPIs have proven to relieve symptoms for about 40% of all adults, and reduce symptoms for another 30%., For several medical conditions, they are highly valuable for short to mid-term use. However, they do not cure gastroesophageal reflux disease since they cannot strengthen or repair the LES. Thus, they only mask the symptoms of the disease. As a result, the disease continues, – and may very well progress.
More importantly, there are many negative health effects associated with daily, long-term use of PPIs. In our article titled Are long-term PPIs the right choice for treating acid reflux? RefluxMD highlights seventeen serious health risks. In addition, an article published in the New England Journal of Medicine, researchers found an increased risk of death due to PPI use vs. H2 blockers or other antireflux treatments.
Dr. David Kleiman with the Department of Surgery at New York Presbyterian Hospital and Weill Cornell Medical College presented a research study documenting that 32% of PPI use beyond the initial 8-week trial was unnecessary since there was no evidence of reflux disease with those individuals. According to Dr. Kleiman, “PPIs continue to be misused and overused in a large percent of our population.” With billions being spent on those medications, that is more than a small problem.
Dr. Tom DeMeester, Senior Medical Advisor to RefluxMD has followed the research on PPIs for many years and he, too, agrees that today’s status quo treatment is not only ineffective but may also be harmful. “Daily PPI use has several potentially harmful side effects including an increase in the risk of diarrhea from bacterial infections, an increase in hip fractures, an increase in the risk of contracting pneumonia and an increase in muscle spasms, tremors, and irregular heartbeats,” Dr. DeMeester said.
He also noted that these drugs may have the opposite impact than what was expected: “A study by Dr. Blair Jobe at the University of Pittsburg found that those taking PPIs daily and reporting no traditional heartburn symptoms were over 60% more likely to advance to Barrett’s Esophagus or adenocarcinoma. We really have to look long and hard at the use of PPIs”.
H2 blockers and antacids do not have the same health risks as PPIs, but they may not be as effective. However, before you decide to use PPIs daily as a maintenance medication, be sure you know the risks and all the other alternative treatment options.
It’s time to treat the disease, not just the symptoms
Isn’t it time that we start to listen to the messages of our body and begin to do the right thing? Heartburn is serious, and over the long term it can reduce the quality of your life, or worse, it can result in a potentially deadly disease. It is time to stop treating the symptoms and start treating the disease.
So what is the best treatment for heartburn? That question should be easy to answer. But it isn’t. That’s because reflux disease has several stages, and each stage has its own answers to that question. Because reflux disease is a progressive chronic condition, it is very important to not only know your stage but the signals that you are moving into the next stage. GERD does not improve, nor can the LES return to its previous healthier state without a surgical procedure. The most important factor in managing reflux disease is to stop any further progression.
Stage 1 – Intermittent and Controllable Symptoms
Typically during this stage symptoms are only intermittent and they can be managed using antacids or H2 blockers, both sold at any pharmacy without a prescription. But this is the critical time for most GERD suffers to take an active role in managing the progression of their disease. Lifestyle is the most important action that can be taken. Diet, portion size, food choices, BMI (weight), alcohol consumption, smoking, and the hour when dinner is served are all important to stop the progression and address the symptoms of an acid reflux problem.
Stage 2 – Daily Use of Medications
When the frequency of the symptoms, the severity of the symptoms, or both, become too much to bear, many people choose to use H2 blockers or PPIs on a daily basis, sometimes twice a day. Some are doing so under the observation of a physician, while others simply self-diagnose and self-medicate by making a trip to the pharmacy or warehouse store.
However, as we discussed above, the long-term daily use of PPIs as the solution to an acid reflux problem has some risk. All of the diet and lifestyle choices are critical at this point since you must stop your disease from progressing to stage 3.
Elevation therapy at night is also recommended since keeping stomach contents in the stomach during sleep can slow the progression, as well. As long as you can manage your symptoms to your satisfaction, you are considered Stage 2. However, when you cannot control those symptoms, your disease has progressed to Stage 3.
Stage 3 – Unable to Control Symptoms to Your Satisfaction
Unfortunately, this is where many sufferers discover RefluxMD – and at this point, the options are becoming limited. It is important to work closely with a reflux disease expert, someone we refer to as a GERD expert. It is at this point that every Stage 3 sufferer should receive honest advice about his or her surgical options.
Surgery is the really the only way to restore a damaged lower esophageal sphincter, of which there are several options, including a traditional Nissen fundoplication and the LINX Reflux Management System surgery. LINX is a relatively new procedure and requires testing to determine if an individual is a candidate for it.
Elevation therapy, diet, and lifestyle choice should be tried to manage symptoms, but they may not have much impact. Typically medications are required for those in GERD Stage 3 where the acid reflux problem must be addressed.
Stage 4 – Barrett’s Esophagus
This is a consequence of longstanding GERD and can be somewhat frightening since Barrett’s esophagus is a pre-cancerous condition. This requires careful monitoring by a specialist. Most options are limited at this point and medications are almost mandatory.
Since esophageal cancer is the fastest growing cancer in the US today, Stage 4 should be avoided at all cost since the basic acid reflux problem has now evolved to a serious condition with dangerous consequences if further disease progression continues.
So what should YOU do if you have an acid reflux problem?
As noted above, first determine your stage of reflux disease, and then determine what options are available to you. The necessity of scheduling a physician visit – and what type of physician – will be determined by your GERD Stage.
Second, be active in managing your disease, regardless of its stage. This is no time to be lazy or to ignore your symptoms. GERD never reverses itself and this disease is progressive. Since it can materially impact the quality of your life and potentially threaten your life, you must be serious about managing this disease.
Consider your controllable options:
- Diet, food choices, portion size, and eating times.
- Smoking and alcohol consumption – reduce or eliminate.
- BMI, as discussed above in the Iceland study and the Johns Hopkins article, is a direct contributor to heartburn.
- Medications, the least powerful at the lowest dose to manage your symptoms.
- Modify your sleep position to avoid nighttime symptoms and progression.
- Experiment with different natural home remedies.
- Finally, use all of the tools available at your disposal, including the Internet, your local gym, dieticians, fellow GERD sufferers, doctors, nurses, and family members.
You are not alone and you can succeed if you are determined and supported. However, most people need help to find a path to relief and long-term health, so let RefluxMD be your partners in this journey. You are the reason we are here.
Medical resources used for this article
- Natural history of heartburn: A 10-year population-based study; by Linda Bjork Olafsdottir MSc Pharm, Hallgrimur Gudjonsson MD. et al; National Institute of Health; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3040336/
- Heartburn’s Hidden Cancer Risk, by doctors at Johns Hopkins Hospital, including Marcia “Mimi” Canto, M.D., M.H.S., and Richard Battafarano, M.D., Ph.D., Johns Hopkins Medicine, https://www.hopkinsmedicine.org/health/healthy_aging/healthy_body/heartburn-hidden-cancer-risk
- Study Finds Increased Mortality Risk with PPI Use, by Kelly Young and reviewed by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM, New England Journal of Medicine, https://www.jwatch.org/fw113056/2017/07/05/study-finds-increased-mortality-risk-with-ppi-use
This Article is Written and/or Reviewed by RefluxMD Medical Authors Team and Reviewers