Common heartburn may point to more serious conditions

This content is sponsored by MedStar Washington Hospital Center

Heartburn is everywhere: commercials for cures are on TV, antacids can be found in medicine cabinets around the country and long-term solutions are the focus of research.

Heartburn is very common — in fact, it’s estimated that about 20 percent of American adults have heartburn symptoms at least once a week, according to Dr. Mitesh Patelgastroenterologist at MedStar Washington Hospital Center.

While it may seem standard, heartburn should not be ignored because, in the long term, it could lead to serious health conditions.

Heartburn occurs in the esophagus, which transports food from the mouth to the stomach. The acid that breaks down food particles in the stomach can creep up into the esophagus, causing a burning sensation.

“When acid splashes up where it’s not supposed to be it can exert its influence and cause discomfort as well as damage to the lining,” Dr. Patel said. “For example, if you were to give me your hand and I dripped some acid onto your hand, you wouldn’t like it and it would burn. Well our esophagus sort of doesn’t like having acid go up there either.”

The splash-back process is called “acid reflux,” and it happens because the esophagus has a ring of muscles that open and close without our control. For most people, the ring of muscles relaxes five or six times an hour; it can happen as many as 20 times an hour for people with chronic acid reflux, Dr. Patel said.

“The esophagus is very much like our skin. So if you’ve ever had a bad sunburn — boy, that can be painful. And likewise, the little nerve endings that go into the esophagus are very delicate and sensitive and as that acid penetrates and gets to those nerve endings, that’s what signals the discomfort,” he said.

Heartburn can be triggered by certain foods. Most commonly it can happen after consuming caffeine, chocolate, citrus fruits, spicy meals and tomatoes.

There are several options to treat heartburn, Dr. Patel said. One common way is with antacids such as Tums or Rolaids. Also, there are pharmaceutical agents such as Zantac or Pepcid that reduce the amount of acid in the stomach, thus reducing some symptoms. Lastly, proton pump inhibitors block the enzymes that produce stomach acid.

There can be long-term consequences with some of the options, Dr. Patel acknowledged.

Proton pump inhibitors were considered to be a “wonder drug” when they first came to market, he said, but with longer-term use, there are certain populations who are at risk of mild complications and sometimes more severe issues. Complications include an increased risk of certain infections such as pneumonia or an infection of the colon; shifts in electrolytes leading to low magnesium; a reduction in the amount of bone density; possible kidney damage; and dementia later in life.

“We know that these medications help patients when they are used for the interval they are supposed to be,” Dr. Patel said. “But the long-term use with the small potential risk of these issues is forcing our hand to try to get patients off of them if we can.”

In some patients, acid reflux can lead to cancer, Dr. Patel said. The esophagus’ lining is delicate and “if it is repeatedly insulted by acid and other juices, then those cells can actually transform and that’s a process call metaplasia,” he said. This change, known as Barrett’s esophagus, can lead to cell mutations that can become cancerous.

Cases of esophageal cancer are rising at a time when many other cancers seem to be diminishing, Dr. Patel said. It’s a concerning trend he said may be due to the country’s obesity epidemic.

“It’s thought that having the extra weight especially around the truncal area around the waist is exerting pressure around the stomach. When that happens, it can actually make acid reflux worse, causing more reflux events leading to those changes in the cell lining and the progression toward mutation and cancer,” he said.

Patients who have suffered from heartburn for a longer period of time should consider seeing a specialist at MedStar Washington Hospital Center who can help diagnose them, Dr. Patel said. There could be “silent damage going on in the lining” that patients don’t even know about, he said.

“The longstanding harm of acid reflux causing damage to the lining whether through narrowing or cell change and potentially cancer — those are major reasons why patients should seek attention from a specialist.”

While there is no great cure for heartburn, there are some lifestyle changes that people can make to possibly minimize symptoms.

“Invariably we are going to eat and there will be certain meals and certain compounds in foods that make symptoms worse,” Dr. Patel said. “And so try to shift your diet and really make better diet choices to try to reduce those events.”

Read more from Dr. Patel on heartburn in a blog post and listen to his podcast.

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