How a Gastroenterologist Can Help Relieve Heartburn

We’re seeing more cases of Barrett’s esophagus and esophageal adenocarcinoma, and we’re seeing more people dying from this form of cancer as well. That’s why it’s so important to see a specialist like me for help with long-term heartburn.

Some of the common over-the-counter drugs patients often use for years before visiting a specialist include:

• Antacids, which include calcium carbonate, a substance that reacts with stomach acid to form water and carbon dioxide.
• Histamine H2 receptor blockers, such as Pepcid and Zantac, which reduce the amount of acid the stomach makes.
• Proton pump inhibitors, or PPIs, which block the enzymes that produce stomach acid. We use PPIs to diagnose GERD. The patient takes a PPI 30 to 60 minutes before their first meal of the day for two weeks, and if their heartburn symptoms stop during that time, that’s a pretty clear indication the patient has GERD.

When PPIs came on the market in the 1980s, they were considered wonder drugs. They quickly were classified as over-the-counter medications, available like aspirin or ibuprofen without a prescription. But we’ve started to see study results that show potential links between these medications and an increased risk for complications in certain populations, including:

• Decreased bone density
• Decreased magnesium levels
• Dementia in older adults
• Infections, such as pneumonia or a bacterial infection of the colon called clostridium difficile
• Kidney damage

Researchers are trying to determine whether PPIs actually cause some of these complications or if the link is coincidental. Because of the potential risks of these conditions, doctors have to think about how to get their patients off of PPIs over time if possible.

Managing heartburn and reducing your risk

Your doctor may recommend one or more diagnostic tests if you’ve had heartburn symptoms for a long time. A test called an esophagogastroduodenoscopy, or an upper endoscopy, can let us know whether your esophagus is damaged and, if so, how much damage it’s sustained. That can help us decide the best treatment options.

I work with my patients to make better lifestyle choices and avoid complications from acid reflux or GERD. Two of the most important approaches I recommend for my patients with heartburn are to maintain a healthy weight and, if they smoke, to quit. It’s often helpful for patients to keep a food diary for a period of time, so we can track what foods are more likely to cause their symptoms. Once we know the triggers, patients can avoid those foods. We’ll also track the severity of their symptoms:

• Are they coughing or having a lot of throat irritation?
• Is heartburn waking them up at night?
• Is stomach acid wearing the enamel off their teeth?

Patients who have severe, chronic GERD symptoms may be good candidates for surgical treatment. The most common surgical procedure to treat GERD is called fundoplication. In this procedure, the surgeon uses a thin, flexible tube called a laparoscope to sew part of the top of the stomach around the lower part of the esophagus. This makes it less likely that acid will back up into the esophagus.

With time and collaboration with your gastroenterologist, it’s possible to reduce or even eliminate the burning and discomfort of heartburn and reduce your risk for the dangerous complications it can cause.