Everyone has experienced the gnawing, burning, nausea of acid heartburn or reflux at least once, even if it was just the result of a monstrous burp. Some of us experience heartburn way too often. Before describing what to do about it, let me describe what heartburn really is.

When you swallow food or liquid it goes down the esophagus, passes through a muscular ring at the end of the esophagus as it enters the stomach itself. The purpose of this little muscular ring is to relax when we swallow, allowing the stomach to fill up appropriately and to tighten up appropriately not allowing stomach contents to splash upward. A burp is simply when the stomach pressure is greater than that little muscle's ability to hold things back.

An occasional backsplash is a common, albeit nasty thing. It's when this little muscle relaxes inappropriately for some reason and can't hold its own against greater pressures that heartburn becomes more of a nuisance and leaves patients with the diagnosis of gastroesophageal reflux disease or GERD. Left untreated, chronic heartburn could lead to problems that are more serious.

The first thing to do is to nail down the diagnosis. No one wants to mistake heartburn for heart pain. You and your provider need to figure out if your symptom is coming from your heart or your stomach. Making this distinction is sometimes a piece of cake and sometimes more challenging. Your provider will ask lots of questions and probably order a few imaging (X-ray) tests and blood tests. But once the conclusion is reached that you are suffering from GERD the treatment is easy. Prescriptions and some over-the-counter medicines slow down the stomach's production of acid so the backsplash is less "burning." If you are overweight or obese, losing weight would help simply by virtue of easing the backward pressure on that muscle we talked about earlier. If you can identify certain foods that make your reflux worse you could limit or avoid them entirely. You could even raise the head of your bed with a couple of bricks or sleep on a couple of extra pillows to raise the upper part of your body. And finally, you could avoid eating large meals at least three hours before actually going to bed.

Allowing chronic reflux to persist does run risks. This chronic exposure to the stomach's acids could cause the esophagus to develop narrowing, strictures or ulcerations that could bleed; furthermore, very severe cases could lead to cancer of the esophagus. Injury to the vocal cords is also a possibility, as well persistent hoarseness and cough (from stomach contents irritating the trachea or windpipe, which runs parallel in the throat to the esophagus).

So, I hope I haven't ruined anyone's appetite with this month's topic, but rather shed some light on a common complaint. Questions or comments are always welcome.

Agnes Oblas is a nurse practitioner with a private practice and residence in Ahwatukee Foothills. For questions, or if there is a topic you would like her to address, call her at (602) 405-6320 or e-mail her at agirnnp@cox.net. Her Web site is www.newpathshealth.com.


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