One of the adventures and complications of traveling to all ends of the earth in pursuit of big game, is exposing our digestive tracks to a multitude of different types of foods. With this exposure, travel and novelty comes an increased incidence of GERD. We docs love our acronyms so here goes: Gastro-Esophageal Reflux Disease. Anyway, some of the dishes that have been prepared for us include raw seal fat in the far north ranging to the heavily spiced delicacies in Central America to heavens knows what in the African bush. Most of us have experienced reflux to a variety of degrees even within our normal dietary habits at home. Some of us have the occasional mild case while other have it frequently and severe in nature. The overall perception from our patients is that it is just a nuisance with no particularly harsh potential consequences to it. It is really not just a disease exaggerated by drug companies to push their new pills and potions. Sure, it can be very simple and merely a brief inconvenience, but the reality is that uncontrolled reflux can set you up for some potentially very bad outcomes.
Letís understand what reflux is to begin with. After ingesting a meal, the food in your stomach is exposed to strong acid. This is vigorously mixed even as you add to the load by your next swallow. There is a one way valve made up of muscle called a sphincter which controls the flow of food and allows passage into the stomach. Now this sphincter isnít exactly the strongest muscle in your body. The esophageal sphincter can open up in a functional way, say if you eat spoiled food resulting in emesis (a nice way to say vomit). GERD occurs when food which is actively being digested is regurgitated back up into the esophagus because the esophageal sphincter is weak (incompetent).
The next thing to understand is that the cellular lining of the stomach is made to be able to handle the severe acidity but the esophagus is definitely not. This explains the burning feeling experienced with reflux. Besides the obvious discomfort and pain(which sometimes is mistaken for a heart attack) there are more serious problems with GERD. The two most serious things we all need to be aware of is that constant exposure of the lining in the esophagus to acid literally burns it. This chemical burning causes a change or transition of the lining from one type of cell to another in order to protect it more effectively. Unfortunately, that new cell type, known as Barrettís esophagus is very prone to degenerating/predisposing you to esophageal cancer. Esophageal cancer is a killer.
The changing of the lining also brings with it a scarring type phenomenon. This scarring of a soft tubular organ causes stiffening and a restriction of the size of the tube. The result can be quite severe. Food starts to get stuck on the way down. This relatively frequent adverse effect ends up requiring dilatation. The dilation treatment is, well kinda medieval. A large caliber, long, flexible solid rubber hose that is passed down your throat into your stomach which stretches the esophagus outwards again so you can swallow normally again. Again, unfortunately once this process starts, you usually must be redilated every so often. There are many other problems associated with reflux that can mimic other disease processes and if they go unrecognized, one can endure a host of tests before the real culprit is found.
Prevention of reflux actually isnít all that hard without medication. First and foremost, weight loss and exercise greatly reduces the incidence as does a reduction in spicy, acidic or heavily caffeinated foods or drinks. Also, having more frequent but smaller volume meals also will have a big impact. Some of these steps actually reduce the incidence of reflux by increasing the tone of the esophageal sphincter thus stopping your stomach contents from going the wrong direction. If you delay lying down for a couple of hours after meals you recruit gravity to your health team as well.
Treatment with over the counter and prescription medication is readily available as we all are very aware. The ads are unrelenting since this is a huge problem here in the U.S. Now realize before we go on any further that the following treatments are solely aimed at decreasing your acid load by either neutralizing the acid, decreasing its production or stopping its production all together. You still reflux but since the acid isnít present, there isnít any burning but the sphincter still isnít working correctly. Tums and similar products simply neutralize the acid and are very quick acting but offer short lasting results. Pepcid, Zantac and Tagamet are popular over the counter and prescription medications that belong to a group known as H2 blockers. They decrease the production of acid in the stomach and typically last around 12 hours. Prilosec, Nexium, Aciphex, Prevacid and Protonix are another group of meds available over the counter and via prescription that are known as PPIs. They block most of oneís ability to produce acid and last in general around 24 hours and typically are more expensive.
Beyond the scope of this article is the fact that there are some medications that actually do increase the muscular tone of the esophageal sphincter thus stopping the reflux itself. There are also surgical procedures whose aim is to make it almost impossible for you to reflux but these are specialized scenarios.
Pure and simple if you have reflux frequent enough that you are seeking medication as relief, try the above preventive measures. If these do not effectively resolve your problem, then try the over the counter medications as suggested. Your physician is your health care partner, we strongly urge a consultation. There may be a more serious underlying problem so please take this ďheartburnĒ issue seriously!
We hope this has taken some of the unknown out of this disease process and informed you of the treatments available as well as the potential consequences of GERD.
As usual, be safe and enjoy the outdoors.