Case Study
A doctor’s advice on heartburn
HEARTBURN IS A VERY COMMON SYMPTOM, affecting about 40 per cent of adults every month – even more so during the holiday season. It’s described as a burning sensation behind the sternum, or breastbone. The burning can radiate into the neck, throat or jaw. It is caused by the regurgitation of stomach acid into the esophagus.
A muscular ring (sphincter) separates the esophagus from the stomach. Normally this sphincter keeps stomach acid in the stomach. However, some sphincters allow acid to back up into the esophagus. This is called gastroesophageal reflux disease (GERD), and people feel it as heartburn. It can sometimes mimic the pain one has with a heart attack and so often causes people to come to the ER the first time they experience it. Age is not a specific risk factor for GERD, but a number of things that become more common with age are risk factors, including obesity, diabetes and several medications. Older people are more likely to be concerned that their chest discomfort is heart-related (and rightly so), and so are more likely to present to the ER with these symptoms.
In addition to heartburn, GERD can cause other symptoms, including a bitter acidic taste in one’s mouth, a hoarse voice, sore throat, dry cough, extra saliva (a.k.a. water brash) and difficulty swallowing.
GERD is often made worse by large meals and by lying flat after eating. Since many people do these things during the holidays, more people experience heartburn at this time. And some foods are known to promote GERD in people who are prone to it, such as caffeinated products, citrus fruits, tomatoes, garlic, onions, chocolate, fried foods, spicy foods and alcohol, especially in excess. At least one study suggests that eating too quickly can cause reflux.
Certain medications are associated with causing GERD, including nonsteroidal anti-inflammatory drugs (NSAIDs), calcium channel blockers (often used for high blood pressure), certain asthma and allergy medications, certain bone density medications, sedatives, painkillers, antibiotics, potassium and iron pills.
If you have heartburn or other symptoms, which may indicate GERD, then visit your doctor (if you have unexplained, persistent chest discomfort, then go to the ER). Your doctor will investigate your symptoms. You may also be tested for a bacteria that is associated with stomach ailments, called H. pylori. If your test is positive, then he or she will prescribe a combination of antibiotics and anti-acid medications for 10 to 14 days. For severe cases of GERD that do not resolve with lifestyle measures or medications, surgical options exist. Most of these can be performed laparoscopically, limiting hospitalization and healing time.
Dr. Zachary Levine is an assistant professor in the faculty of medicine at McGill University Health Centre and medical correspondent for AM740 (a ZoomerMedia property).