WHO'S AT RISK
With the days of holiday feasting ahead, do you find yourself stocking up on Tums and Maalox? "Millions of Americans — as much as 20% of the adult population — report having heartburn symptoms at least once a week," says Carr-Locke. "For a subset of that group, heartburn is a symptom of gastroesophageal reflux disease, or GERD, in which material substances are being forced up from the stomach into the esophagus at the wrong time for too long."
Heartburn is a symptom of a disease, not a disease in its own right. "There are 10 different underlying reasons a patient might experience heartburn," says Carr-Locke. "Often, GERD patients don't seek medical attention until the symptoms are really persistent — cases range from the very very mild to very severe."
GERD symptoms are caused by reflux from the stomach. "It's actually normal to reflux — everyone refluxes at some point during the day, but most of the time, the individual feels no symptoms," says Carr-Locke. "In GERD patients, the lining of the esophagus becomes irritated from the stomach acids, so the individual experiences frequent bouts of indigestion or heartburn."
There are many risk factors for developing GERD. "Being overweight, being pregnant, being a smoker, and having a family history of the disease are all major risk factors, and some medications can also increase your risk," says Carr-Locke. "Certain foods are also more likely to trigger reflux, including anything that contains caffeine or fat, and certain specific foods, like peppermint." Alcohol isn't itself a causative factor, but it does irritate the esophagus once it's inflamed.
GERD is one health complaint that affects the whole spectrum of the population. "It's an equal opportunity condition — there no gender difference and no ethnic difference in terms of who's affected," says Carr-Locke. "In the past, GERD was very unusual in East Asia, but that's changing as diet and average weights are changing and becoming Westernized." People can also experience GERD at any stage of life, from infancy to old age.
With the holidays coming up, heartburn is on the mind for many people — what is the line between garden variety heartburn and GERD? "The question is how much does your heartburn affect your daily life?" says Carr-Locke. "If you have a bottle of Tums on your desk at work, then it's GERD. If you have heartburn once every three months or at major holidays and you can pin it to something you ate, then that's not GERD."
SIGNS AND SYMPTOMS
The red flags of GERD aren't subtle. "Most people will recognize the burning sensation in the chest, behind the breast bone, as heartburn," says Carr-Locke. "Other things can happen at the same time: you can regurgitate acidic fluid into the mouth, and sometimes there's reflux salivation, in which the mouth produces excess saliva in response to reflux."
There are a few telltale signs that your heartburn is severe and probably requires more aggressive treatment. "We consider a line that patients cross if they have trouble swallowing, the sensation that food is getting stuck, retching, or if they are regurgitating food into the mouth," says Carr-Locke. "Other worrying features that should prompt a doctor's visit include losing unexplained weight, inability to eat, anemia, tiredness, lack of energy, and abdominal pain."
Most patients have been self-medicating for a while before they visit the doctor. "Usually, patients have been relying on over-the-counter drugs like Maalox, Mylanta, Prilosec, and Zantac," says Carr-Locke. "Either the drugs have solved the problem and the patient simply wants confirmation, or they haven't worked."
LIfestyle modifications are always the first line of attack. "It's a stepwise approach to treatment — first, we'll work on weight loss, smoking cessation, and work on dietary changes," says Carr-Locke. "If the symptoms are mild and not worrying, and there's not an obvious lifestyle modification fix — like losing weight or quitting smoking — then we'll try a H2 receptor antagonist like Zantac. The second class of drugs are proton pump inhibitors (PPIs) like Prilosec."
The drugs prescribed for GERD all aim to shut down acid production. "The advantage of PPIs is that they shut off acid production for longer, which allows you to take one pill a day," says Carr-Locke. "If the physician thinks something else is complicating your case, you should be referred to a gastroenterologist. Surgery to recreate the barrier between the esophagus and stomach can be an option for patients who aren't responding to other treatments."
One reason it's important to keep GERD in check is that it can lead to cancers. "After years of GERD and the acid reflux associated with it, the lining of the esophagus can change into a different type of tissue entirely — we call this Barrett's esophagus," says Carr-Locke. "The happens to a small minority of GERD patients, but it's important to follow because Barrett's esophagus has the potential to become cancerous."
The treatment options for GERD have improved dramatically in the past few decades. "Within my memory, first we only had antacids, then we also had Zantac, and then the Prilosec drugs were an additional vast improvement," says Carr-Locke. "There's no question that these drugs were huge steps forward. Now the next problem is: do patients continue taking these drugs forever? But researchers are hard at work on the next generation of drugs and other treatments."
QUESTIONS FOR YOUR DOCTOR
It may feel awkward to push your doctor, but you need to know that the diagnosis is correct. Don't be afraid to ask straight out, "Are you sure this is what I have?" and "Do I need any other tests to prove it?" Similarly, it's essential that the doctor is explaining and offering the full gamut of treatments. "What can I do about my symptoms other than taking a pill?" "We have a strong array of treatments, and they're only getting better with time," says Carr- Locke. "There's no reason to suffer through chronic heartburn. You don't have to grin and bear it - medical treatment can help."
WHAT YOU CAN DO
For trustworthy information online, start with the American Society for Gastrointestinal Endoscopy (asge.org/) and Mount Sinai (mountsinai.org/patient-care/service-areas/digestive-disease/areas-of-care/acid-reflux-gerd).
Cut your risk.
The big three steps you can take are straightforward, but they aren't easy: lose weight, stop smoking, reduce caffeine intake.
Know your triggers.