Heartburn and Gastroesophageal Reflux Disease (Women's Health Matters article) (Web resource; WHM resource) Author: Deborah Jones Organization: Women's College Hospital, Women's Health Matters Almost everyone experiences heartburn occasionally. Heartburn or 'reflux' occurs when stomach acid flows back up into the esophagus, causing an uncomfortable burning sensation behind the breastbone. Up to 20 percent of adults experience heartburn almost weekly and up to 10 percent have heartburn on a daily basis. Acid-related disease is the fourth most-common reason to visit a doctor. As you age, you're more likely to experience heartburn and its related problems. Symptoms of heartburn are usually caused by the disorder gastroesophageal reflux disease (GERD). In normal digestion, the lower esophageal sphincter (LES) at the bottom of the esophagus opens to allow food to pass into the stomach, and then closes to prevent acid and stomach contents from flowing backwards into the esophagus. GERD occurs when the LES is weak or transiently relaxes inappropriately, allowing stomach acid to flow up into the esophagus, explains Dr. Jeff Stal, a gastroentrologist at Women's College Hospital in Toronto. Potential complications of GERD The most common symptom of GERD is heartburn. However, reflux can also lead to other 'extra-esophageal' symptoms. For example, reflux can cause respiratory symptoms such as wheezing or cough. In the throat, the acid can also damage the vocal cords and cause hoarseness. Chronic severe reflux can potentially lead to erosion of the teeth enamel. If chronic GERD is left untreated, over time the acid reflux can cause inflammation of the delicate lining of the esophagus, resulting in ulcers, bleeding and/or scar tissue. This scar tissue (peptic stricture) can lead to swallowing difficulties in which individuals complain that food gets stuck when they eat. In some individuals with chronic reflux, the healthy cells in the esophagus are replaced with abnormal cells, a condition known as Barrett's esophagus. A minority of people with Barrett's esophagus can go on to develop cancer of the esophagus. Prevention and treatment There is a lot you can do to control the symptoms related to GERD. The first step is to try lifestyle modifications such as: avoiding large meals elevating the head of the bed refraining from eating within three hours of bedtime losing weight if you are overweight avoiding foods that can potentially aggravate reflux (e.g., caffeine, alcohol, chocolate, peppermint) stop smoking In some cases, over-the-counter medications such as antacids may be enough to curb symptoms. In some cases, over-the-counter medications such as antacids (e.g. Tums, Rolaids) may be sufficient enough to relieve symptoms. 'People should seek medical attention when they have frequent or severe symptoms,' advises Dr. Stal. 'People who have chronic GERD may need to undergo a gastroscopy to ensure there are no serious complications such as Barrett's esophagus developing.’ During a gastroscopy, the doctor inserts a flexible tube down the throat to examine the esophagus and stomach. The most common treatment for GERD are H2 blockers such as ranitidine (Zantac®) and proton pump inhibitors (PPIs) such as omeprazole (Losec®) and esomeprazole (Nexium®). These drugs suppress acid secretion in the stomach. The symptoms resolve and the esophagus heals in the vast majority of cases, says Dr. Stal. However, these acid-suppressive medications must often be continued on a long-term basis and sometimes for the rest of your life to control the symptoms. Medical therapy with acid suppressive medications is almost always successful in controlling patient’s reflux symptoms, says Dr. Stal. In fact, surgery is rarely required for the treatment of GERD given the usual efficacy, safety and success of the PPI medications, says Dr. Stal. Currently the most common indications for surgery is either when a patient can’t afford the rather expensive PPIs, or alternatively when a patient simply does not wish to take medication indefinitely. The future of GERD treatments, says Dr Stal, probably lies in perfecting the PPI medications further to allow for better and quicker on-demand therapy, and in new endoscopic techniques that will strengthen the sphincter through a gastroscopic approach without the need for surgery. Editor’s Note: Written by Deborah Jones. Article reviewed and revised by Dr. Jeff Stal, August 2005. Purpose:  Consumer information/support; Health information Information Source:  Hospital/Clinic Geographic Origin:  Canada Language of Resource:  English Last Reviewed by Women's Health Matters:  March 01, 2007