What would you do if you had recurring muscle aches a few times each month that you could manage with over-the-counter medication? Ignore it, right? It’s just a nuisance. What if on occasion those pains were so severe that you lost sleep, missed work, or even cancelled important plans? Still just a nuisance?
One in three American adults suffer from such a nuisance – heartburn – and they suffer monthly. Twenty percent of all adults lose sleep, miss work, and change their plans due to heartburn symptoms. The incidence of people suffering from these symptoms is increasing at a rate of 30% every decade.
For many, a condition called gastroesophageal reflux disease, or GERD, causes these symptoms. Heartburn, that burning sensation in the chest and the feeling of fullness that often results from eating too much, is the most common symptom of GERD, but some also experience regurgitation, difficulty swallowing, a persistent cough, and/or hoarseness. Over time, GERD symptoms can become more and more frequent – and much more severe. Many medical experts view reflux disease as an epidemic, yet most sufferers continue to think of this as a nuisance.
Here is what you need to know:
Myth #1: Food is the reason for heartburn.
Heartburn is just a result of what we eat, right? WRONG!
Heartburn is a symptom of reflux disease, a progressive, long-term condition caused by a weak lower esophageal sphincter, or LES. The LES is a ring of muscle in the lower end of the esophagus just above the stomach. It acts as a valve, opening to allow food to pass into the stomach and then closing to prevent the contents of the stomach from flowing, (or “refluxing”) back into the esophagus. Because the contents of the stomach are highly acidic, reflux can irritate the lining of the esophagus and cause the painful symptoms many sufferers know all too well.
Malfunction of the LES can happen for a variety of reasons – overeating, obesity, smoking, or excessive drinking. When it happens on occasion, reflux usually has no long-term consequences. Over time, though, the more you reflux, the weaker the LES becomes and the more you damage the esophagus. Reflux disease develops when the LES no longer functions as an effective barrier. Reflux disease can lead to complications such as inflammation, erosion of the lining of the esophagus, narrowing of the esophagus, Barrett’s Esophagus (a pre-cancerous condition), and esophageal cancer.
Myth #2: Heartburn is just a nuisance.
No one ever died from heartburn, right? WRONG!
Esophageal adenocarcinoma, a type of cancer of the esophagus, is directly linked to reflux disease. In fact, reflux disease is the only cause of this type of cancer. The number of esophageal cancer cases has grown more than 600 percent since 1975, making this deadly disease the fastest growing type of cancer in the United States. When charted against the incidence of all other cancers, esophageal cancer is in a league of its own. Sadly, esophageal adenocarcinoma is also one of the most lethal types of cancer. The overall likelihood of surviving five years is only 10-15 percent. This year alone, approximately 20,000 deaths will result from reflux-induced esophageal cancer.
Myth #3: Today's medications cure reflux disease.
Over-the-counter and prescription medications stop the reflux, right? WRONG!
Many times when a patient experiences the symptoms of reflux disease, he simply purchases one of the many medications available over-the-counter at a drug store. If he complains to his doctor, the doctor will likely prescribe a proton pump inhibitor, or PPI, such as Prilosec, Prevacid, or Nexium to relieve his symptoms. All of these drugs work by reducing the amount of acid produced by the stomach, which helps minimize or even eliminate heartburn symptoms, but they don’t stop the reflux.
Reducing heartburn doesn’t mean that the reflux disease is cured. Unfortunately, even when taking PPIs and other acid reducing medications, the reflux continues! You just can’t feel it. Furthermore, it can continue to damage and deteriorate the LES. The disease progresses even though the symptoms aren’t apparent. Treatment with PPIs does not prevent the complications associated with reflux disease, and the conditions can still progress to Barrett’s esophagus and cancer.
Myth #4: PPIs can be taken with no risk as long as necessary.
Those PPIs must be safe since they are sold over the counter and don't require a prescription, right? WRONG!
Consumers spend more than $24 billion worldwide each year on PPIs ($14 billion in the US annually), looking for relief from their reflux symptoms. While they have helped millions of people manage their symptoms, there are risks that users must understand.
Reflux disease is a chronic, progressive disease, so once PPIs are started, use typically continues on a daily basis indefinitely. Studies have shown that long-term daily use of these drugs may be correlated to an increase in the incidence of:
· Bone fractures
· Clostridium difficile colitis (a potentially deadly infection of the intestines)
· Low magnesium levels
PPIs are also known to interact with other drugs. The most important of these is Plavix, a blood thinner used for prevention of heart attacks and strokes.
What’s most concerning is that several studies have demonstrated that 30 percent of PPI users don’t even have reflux. That means that millions of people are at risk for these drug-related side effects when they don’t even need the medication.
PPIs do have a role in the management of reflux disease, but they must be used carefully as a maintenance medication and only under the care of a well-informed physician. Never take over-the-counter PPIs for more than 14 days without consulting a physician. And remember, even when they are used appropriately to treat reflux disease, PPIs simply control the symptoms of the disease. They don’t stop or cure reflux, they don’t reverse the damage to the LES, and they don’t stop reflux disease from progressing.
Fact #1: You can manage your reflux disease
There must be something that can be done to stop the progression of reflux disease, right? RIGHT!
The good news is that, although reflux disease cannot be reversed, most people in the early stages of the condition can effectively manage their disease. By creating an action plan and following it, most can find relief for their symptoms AND keep their GERD from getting worse.
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If you’re suffering from reflux disease, your first step should be to learn where you are in the progression of the disease. Then, you can identify the steps you can take to manage your condition, including working with a knowledgeable physician to design a personalized reflux disease management plan. Your plan will likely include monitoring your symptoms, incorporating lifestyle changes, taking intermittent medications, and/or undergoing minimally invasive surgery based upon the progression of your reflux disease.
Don’t be discouraged. The reality is that you are in control. And you don’t have to suffer.
William C. Dengler, M.D., is medical director of RefluxMD, an Internet resource for GERD patients. Dr. Dengler developed the nation’s first heartburn treatment center in 1996 and is a top authority on diagnostics, medical, and surgical therapies for reflux disease.
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