|
Heartburn:
What Happens
|
 |
| Heartburn,
or gastroesophageal reflux, happens when the stomach
(gastro) contents backup or return (reflux) into the
esophagus (esophageal). Normally when you digest foods,
the lower esophageal sphincter (LES) opens, allowing
foods to pass into the stomach, then closes to prevent
the food or other stomach fluids, such as acids, from
returning back into the esophagus. But when you have
GERD, the LES doesnt function properly causing stomach
contents to flow back into the esophagus, and heartburn
results. |
|
Many
patients live with daily heartburn without being aware of the
potential danger. Barrett's esophagus is a condition that develops
in some people who have chronic gastroesophageal
reflux disease (GERD).
What
Causes Barretts Esophagus?
With
GERD, also called heartburn , the lower esophageal sphincter
(LES)--the muscle connecting the esophagus with the stomach,
relaxes too much, and allows the return of the stomach's acid
back up into the esophagus.
When
this happens, you usually feel a burning-like chest pain that
begins behind the breastbone and moves upward to the neck and
throat--the heartburn. More than 60 million American adults
experience heartburn at least once a month, and about 25 million
adults suffer daily from heartburn.
Many
people say it feels like food is coming back into the mouth
leaving behind an acid or bitter taste. The burning, pressure,
or pain of heartburn can last as long as two hours and is often
worse after eating. Heartburn pain is often mistaken for a heart
attack.
If
you have GERD, the constant reflux of stomach acid can eventually
lead to esophagitis, inflammation of the cells lining the food
pipe. Esophagitis may cause esophageal bleeding or ulcers. Sometimes
the damaged lining of the esophagus becomes thick and hardened,
causing narrowing (stricture) of the esophagus.
Strictures
can interfere with eating and drinking by preventing food and
liquid from reaching the stomach. They are treated by dilation,
in which an instrument inserted into the esophagus gently stretches
the strictures and expands the opening in the esophagus.
| If
you have a history of gastroesophageal reflux disease
(GERD), be sure to keep the following information
in your medical records: |
-
Name,
address, and telephone number of your doctor
-
Previous
medical and surgical history
-
Date
of your last visit to your doctor
-
Results
of any tests performed, such as an upper GI,
acid perfusion (Bernstein) test, or endoscopy;
and the results of your physical examination
-
Treatment
plan and/or recommendations including over-the-counter
(OTC) and/or prescription medications
-
Date
of your next appointment, or when you need
to schedule another examination
|
|
Some
people go on to develop a condition known as Barrett's esophagus,
which is severe damage to lining of the esophagus. In Barrett's
esophagus, the normal cells that line the esophagus, called
squamous cells, turn into a type of cell not usually found,
called specialized columnar cells. Damage to the lining of the
esophagus--for example, by acid--causes these abnormal changes.
Doctors believe this condition may be a precursor to esophageal
cancer.
How
Is It Diagnosed?
Diagnosis
involves an endoscopy
to look at the lining of the esophagus and a biopsy to examine
a sample of tissue. To do an endoscopy, the doctor gently guides
a long, thin tube called an endoscope through the mouth and
into the esophagus.
This
scope contains instruments that allow the doctor to see the
lining of the esophagus and to remove a small tissue sample,
a biopsy. The biopsy will be examined in a lab to see whether
the normal squamous cells have been replaced with columnar cells.
How
Is It Treated?
Once
the cells in the lining of the esophagus have turned into columnar
cells, they will not change back to normal. The goal of treatment
is to prevent further damage by stopping any acid reflux from
the stomach. Medications that are helpful include histamine
2 (H2) blockers and proton pump inhibitors, which reduce the
amount of acid produced by the stomach.
Examples
of H2 blockers are cimetidine
(Tagamet, Tagament HB), ranitidine
(Zantac), and famotidine
(Pepcid, Pepcid AC); the drugs omeprazole
(Prilosec) and lansoprazole
(Prevacid) are proton pump inhibitors. If these medications
do not work, surgery to remove damaged tissue or a section of
the esophagus itself may be necessary.
People
who have had regular or daily heartburn for more than five years
may be at risk for Barrett's esophagus. About 5 to 10 percent
of people with Barrett's esophagus develop abnormal cells changes,
which may then go on to develop cancer.
Because
of the cancer risk, people with Barrett's esophagus should be
screened for esophageal cancer regularly. If the abnormal changes
are recognized at an early stage, the chance of having cancer
detected when it's curable is greatly increased.
Feature Archives