How To Tell If That Holiday Heartburn Is Something More Serious

Main Category: Acid Reflux / GERD
Article Date: 01 Nov 2008 - 1:00 PDT

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For many people, Thanksgiving is about having family near and celebrating, sometimes in excess. That's because for some holiday revelers, perhaps the amount of time spent watching football on the tube is only surpassed by a second activity: eating. And with the turkey, sweet potatoes and pumpkin pie comes heartburn, but how do you know if you have a simple case of it, or something more serious? Simply put, if the heartburn you have affects your quality of life, you may have gastro-esophagael reflux disease, more commonly known as GERD.

"If a person has a burning feeling down in their gut that goes up into the chest, made worse by eating, or exercising or lying down, and this happens several times a week, then that's affecting their life and there's a good chance they have GERD,"said gastroenterologist Joel Richter, M.D., chair of the Department of Medicine at Temple University School of Medicine. "The next step is to see a doctor and have the condition evaluated because there is actually "good" and "bad" GERD."

And how doctors treat the two types are very different. Richter says "good" GERD is the most common; about 80 to 90 percent of patients have it. This group may have occasional to daily heartburn symptoms, but nothing more serious, such as esophageal damage by endoscopy or problems with swallowing.

"For this group, more medication may not be the answer. Rather," says Richter. "Those with intermittent symptoms need to modify their lifestyle by losing weight,reducing their fat intake and not eating late at night before going to bed."

And while they can take proton pump inhibitors, (PPI's) which ease heartburn by alleviating excess stomach acid that flows back into the esophagus, Richter recommends that many will only need to take these pills as needed when their symptoms are bothersome. But for the second group of sufferers who have "bad" or more serious GERD symptoms, a lifetime drug therapy regimen can not only improve their quality of life, but can be life-saving.

"About 10 to 15 percent of GERD patients suffer from a more severe form, in which they have scarring on the esophagus, problems swallowing, and may even have Barrett's Esophagus, in which the cells lining the esophagus can turn cancerous," said Richter. "So, even though PPI's pose the risk of side effects, they are very effective for this group and the benefits of using them far outweigh the risks."

Patients who rely on these drugs when they're not needed put themselves at unnecessary risk for side effects when used long-term, which include an increase in bacterial pneumonia, gastrointestinal infections, and hip fractures, especially in women. Richter warns that before a patient starts self-medicating with PPI's, it's crucial that they find out which type of GERD they're suffering from. The best way to do that is through a set of consults with a doctor. An initial visit will consist of an endoscopy and a review of the patient's medical history to determine what type of pill a patient should be on. A follow up visit to evaluate the patient's response to the drug determines which type of GERD they have.

"These visits are the two pieces to the puzzle when diagnosing someone with GERD," said Richter.

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