Is your heartburn just a nuisance, or a sign of something more?
By Roberta Cannon, RN
Approximately 15 million Americans have heartburn symptoms each day and more than 60 million experience it once a month, according to Medline Plus. If you suffer from acid reflux – which causes heartburn - on an ongoing basis, it can be miserable and affect your quality of life.
This chronic form of acid reflux is called gastroesophageal reflux disease (GERD).
“There are many predisposing factors that can lead to GERD,” said Aaron Dickstein, MD, a gastroenterologist in Hyannis. “The most common reversible causes are obesity, smoking and alcohol.”
Acid reflux occurs when the muscle between your esophagus and stomach relaxes too much or too often after eating. The acid in your stomach backs up into your esophagus leading to a burning feeling.
Many treat themselves with over-the-counter antacids, like Tums, Mylanta or Rolaids, but there are warning signs that may indicate a more serious concern.
“When the symptoms become more persistent and if there are red flags, such as weight loss, trouble swallowing, anemia or bleeding, it’s time to see a gastroenterologist,” said Dr. Dickstein.
Lifestyle Changes to TryThe first thing he recommends are lifestyle changes, such as:
“If those medications don’t help, the next step is to start proton pump inhibitors, (PPI) namely Prilosec, Nexium, and Prevacid which are more potent and better at controlling daily acid reflux,” he said. “Some patients are concerned about the long-term use of proton pump inhibitors because there are some studies that have identified association with pneumonia, diarrhea, osteoporosis, and chronic kidney disease among others. Those studies have flaws and are not considered definitive in establishing cause and effect. Gastroenterologists generally agree that for the treatment of GERD, the well established benefits of PPIs far outweigh their theoretical risks.
Diagnostic TestingA trial of proton pump inhibitors to see if that improves and resolves their symptoms is often recommended, said Dr. Dickstein. “Sometimes we’ll try to discontinue them over time. If patients have incomplete relief or their symptoms recur after stopping PPIs, then we tend to do an upper endoscopy so we can look at the esophagus, stomach, and upper section of the small intestine. GERD can be diagnosed with this procedure if there is esophagitis which is inflammation and erosion of the esophagus lining. It also can help rule out a precancerous lesion called “Barrett’s esophagus”.
While symptoms and an upper endoscopy help diagnose GERD, there are times when diagnosis may still be questionable, said Dr. Dickstein. A patient may have other effects from GERD like a cough, or throat clearing. In this case, there are other types of tests that measure how much acid is backing up into your esophagus. They are:
about the expert
Aaron M. Dickstein, MDDr. Dickstein earned his medical degree at Tufts University School of Medicine in Boston. He completed his residency in internal medicine at Yale-New Haven Hospital, in New Haven, CT, and a fellowship in gastroenterology at Tufts Medical Center in Boston. He was previously an assistant professor of medicine at Tufts University and director of the Tufts GI fellowship before coming to Cape Cod Healthcare. He is certified by the American Board of Internal Medicine and the American Board of Gastroenterology. He has been affiliated with Cape Cod Hospital since 2019 and is a member of both Medical Affiliates of Cape Cod and Cape Cod Preferred Physicians. Dr. Dickstein’s clinical interests include colon cancer prevention, gastrointestinal endoscopy and colonoscopy, gastrointestinal bleeding, constipation and GERD (gastroesophageal reflux disease). His office is located on Attucks Lane, Hyannis.
View Physician Profile
Originally published on Cape Health News January 16, 2024
This chronic form of acid reflux is called gastroesophageal reflux disease (GERD).
“There are many predisposing factors that can lead to GERD,” said Aaron Dickstein, MD, a gastroenterologist in Hyannis. “The most common reversible causes are obesity, smoking and alcohol.”
Acid reflux occurs when the muscle between your esophagus and stomach relaxes too much or too often after eating. The acid in your stomach backs up into your esophagus leading to a burning feeling.
Many treat themselves with over-the-counter antacids, like Tums, Mylanta or Rolaids, but there are warning signs that may indicate a more serious concern.
“When the symptoms become more persistent and if there are red flags, such as weight loss, trouble swallowing, anemia or bleeding, it’s time to see a gastroenterologist,” said Dr. Dickstein.
Lifestyle Changes to TryThe first thing he recommends are lifestyle changes, such as:
- Weight loss if overweight.
- Avoid eating for two to three hours before going to bed to prevent reflux.
- Elevate the head of the bed or use a wedge pillow to get the head higher and allow gravity to keep things moving down instead of up.
- Avoid spicy foods that can trigger acid reflux.
- Stop smoking.
- Avoid fried foods, citrus, caffeine, and alcohol if they are triggers for you.
“If those medications don’t help, the next step is to start proton pump inhibitors, (PPI) namely Prilosec, Nexium, and Prevacid which are more potent and better at controlling daily acid reflux,” he said. “Some patients are concerned about the long-term use of proton pump inhibitors because there are some studies that have identified association with pneumonia, diarrhea, osteoporosis, and chronic kidney disease among others. Those studies have flaws and are not considered definitive in establishing cause and effect. Gastroenterologists generally agree that for the treatment of GERD, the well established benefits of PPIs far outweigh their theoretical risks.
Diagnostic TestingA trial of proton pump inhibitors to see if that improves and resolves their symptoms is often recommended, said Dr. Dickstein. “Sometimes we’ll try to discontinue them over time. If patients have incomplete relief or their symptoms recur after stopping PPIs, then we tend to do an upper endoscopy so we can look at the esophagus, stomach, and upper section of the small intestine. GERD can be diagnosed with this procedure if there is esophagitis which is inflammation and erosion of the esophagus lining. It also can help rule out a precancerous lesion called “Barrett’s esophagus”.
While symptoms and an upper endoscopy help diagnose GERD, there are times when diagnosis may still be questionable, said Dr. Dickstein. A patient may have other effects from GERD like a cough, or throat clearing. In this case, there are other types of tests that measure how much acid is backing up into your esophagus. They are:
- The Bravo pH monitoring test - done during an endoscopy where a specialized capsule is placed in the esophagus and left for five days. It measures acidity and transmits pH levels to a recording device. The capsule does not need to be removed, as it drops off the wall of the esophagus in one to two weeks and passes through your GI system.
- Catheter pH monitoring - done by placing a tube through the nose into your esophagus. The tube is attached to a small recorder that you wear on your belt. The tube is left in for 24 hours and then removed.
about the expert
Aaron M. Dickstein, MDDr. Dickstein earned his medical degree at Tufts University School of Medicine in Boston. He completed his residency in internal medicine at Yale-New Haven Hospital, in New Haven, CT, and a fellowship in gastroenterology at Tufts Medical Center in Boston. He was previously an assistant professor of medicine at Tufts University and director of the Tufts GI fellowship before coming to Cape Cod Healthcare. He is certified by the American Board of Internal Medicine and the American Board of Gastroenterology. He has been affiliated with Cape Cod Hospital since 2019 and is a member of both Medical Affiliates of Cape Cod and Cape Cod Preferred Physicians. Dr. Dickstein’s clinical interests include colon cancer prevention, gastrointestinal endoscopy and colonoscopy, gastrointestinal bleeding, constipation and GERD (gastroesophageal reflux disease). His office is located on Attucks Lane, Hyannis.
View Physician Profile
Originally published on Cape Health News January 16, 2024