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Rich chocolate, plates of buttery Christmas cookies, and mugs of eggnog. They're all signs the holidays are near, but for millions of us, these tummy-tempting treats signal only one thing--heartburn.
An estimated 21 million Americans suffer frequent heartburn, with two or more attacks a week. Heartburn happens when acid from the stomach backs up into the esophagus, the upper portion of the digestive tract. It often occurs after meals or while lying down.
People with persistent heartburn--a condition called gastroesophageal reflux disease or GERD--can't eat their favorite foods, relax with a glass of wine, or get a good night's sleep. Studies measuring the quality of life of people with GERD show that, overall, they have a worse general sense of-well-being than people with heart disease, according to Dr. J. Patrick Waring, a gastroenterologist at Emory University Health Sciences Center in Atlanta.
GERD almost destroyed Lori Buxton. She began to involuntarily regurgitate food as early as age 7. Puzzled, Lori's pediatrician referred her to a psychologist who concluded that emotional conflicts were causing her digestive problems. At 17, Lori was rushed to the emergency room with severe chest pain. Eventually, she had surgery to remove her gallbladder, on the mistaken belief it would cure her reflux. It didn't. "It's a terrible disease," says the 24-year-old graduate student.
Digest this. Acid reflux occurs when the muscular valve at the end of the esophagus relaxes too often, allowing stomach acid to escape. Add irritates the esophagus lining and feels like a burning pain that seems to move up the chest and neck behind the breastbone. Some people experience a bitter or sour taste in the back of their throat.
Acid reflux can lead to other complications as well, such as asthma, hoarseness, and even esophageal cancer. Each year, about 5 million Americans are rushed to hospital emergency rooms with chest pain. A significant proportion have heartburn, not heart disease, says Dr. M. Michael Wolfe, an associate professor of Medicine at Boston University and coauthor of Heartburn: Extinguishing the Fire Inside. Since the two conditions cause similar symptoms, patients with reflux often undergo a series of expensive tests to rule out heart disease.
But confusing symptoms are only partly to blame, says Dr. Wolfe. Doctors may not even consider heartburn when examining a patient, so many patients don't get treatment. While gastrointestinal specialists have become more adept at treating GERD in the past decade or so, some doctors don't appreciate how much havoc that heartburn can wreak. "There's a lack of understanding of the process, and of the severity, and also of the complications that can arise," Dr. Wolfe says.
A potentially fatal outcome of severe heartburn is asthma. A large percentage of asthmatics also suffer from acid reflux. And a significant proportion of asthma attacks are tied to reflux, since stomach acid can irritate the airways as well as the esophagus. About 50 percent of asthma patients experience significant improvement in breathing when their reflux is treated, Dr. Wolfe says.
Constant irritation from stomach acid also can lead to Barrett's syndrome, a serious condition in which the tissues lining the esophagus become abnormal. Some Barrett's patients eventually develop esophageal cancer.
Living with chronic heartburn for years on end is typical, says Dr. Waring, but it doesn't have to be. "A lot of people see the heartburn ads on television, and kind of come to the conclusion you're supposed to have some," he says. "The message consumers need to be aware of is that they may have a more serious problem, and they certainly don't have to suffer. It's really unusual to find somebody we can't help."
Here's how you can prevent heartburn during the holidays and any other time of year.
* Lifestyle. Christmas parties may not seem like that much fun without a glass of wine, but alcohol, coffee, and tobacco can all cause heartburn. You'll probably have to forgo some of your favorite foods too. Most people with acid reflux can't eat tomatoes, citrus fruits, and other foods with a high acid content. Fatty foods are also usually banned, since they relax the esophageal airway, causing the stomach to churn out even more acid. Heartburn patients were once told to eat dairy products. But it's now known that milk, cheese, and ice cream actually trigger heartburn because calcium stimulates acid production. Also, many dairy foods are high in fat.
But not everyone reacts to certain foods the same way, says Dr. Walter J. Hogan, a gastroenterologist at the Medical College of Wisconsin. Some patients, for instance, can eat a large serving of ice cream, but can't tolerate spaghetti sauce. Others can drink beer, but not wine. "It's individual," he says.
When--and how--you eat is very important. Don't eat large amounts in one sitting, since big meals take longer to digest. Also, eating fight before you sleep doesn't allow food to digest, making it easy for stomach acid to wash up into the esophagus. For this reason, it's a good idea to eat several hours before sleeping or to elevate the head of your bed by 4 to 6 inches so your entire torso is raised while you sleep.
Sometimes the solution is even simpler. Dr. Wolfe has seen a few patients completely recover once they stopped wearing tight clothes. Snug-fitting garments can promote acid reflux by putting pressure on the abdomen.
* Medicine. Drugstores carry a wide variety of over-the-counter antacids, which chemically neutralize stomach acid. These fast-acting compounds, such as Maalox and Mylanta, are designed to treat infrequent, mild heartburn. These drugs have side effects, and they can be dangerous for patients with certain conditions. Antacids also can mask a more serious underlying problem, such as esophageal ulcers.
H2 blockers, such as Tagamet, Zantac, and Pepcid, are available in over-the-counter and prescription strengths. The nonprescription versions, many of which have initials behind them, such as Tagamet HB and Pepcid AC, are about half the strength of the prescription versions. By switching off certain receptors in the stomach, H2 blockers relieve heartburn for about two-thirds of patients.
The newest heartburn-fighting drug is Prilosec. Known as a proton pump inhibitor (PPI), Prilosec works by shutting down the so-called "pump" that secretes acid into the stomach. Prilosec, and a similar medication called Prevacid, can help patients with severe reflux--even those who haven't responded to other treatments. PPIs also reduce the need for invasive tests. If someone gets better after taking a high dose, it can safely be assumed that reflux is the problem.
The same principle applies to asthma. If an asthma attack stops or significantly decreases while taking a PPI, it's likely reflux is a contributing factor to the attack.
Alma Owens, 51, of Cummings, Georgia, has taken a PPI for the past five years, and she no longer has daily heartburn. But she can't stray far from her low-fat diet. "If it tastes good I can't eat it," says Alma, a speech pathologist. "I can eat two French fries, but I can't eat an order of French fries. If I eat the wrong thing, it will feel like knives in my stomach."
* Surgery. This is typically reserved for patients who don't respond to drug therapy, or for people who don't want to take medication indefinitely. (Both H2 blockers and PPIs are considered safe for long-term use.) The operation involves wrapping part of the stomach around the lower esophagus, strengthening the muscular valve on the end of the esophagus.
Laparascopic techniques allow many patients to avoid an open incision, shortening the typical hospital stay from seven down to one or two days. Current success rates range from 85 to 90 percent. But this operation isn't perfect. Between 10 to 15 percent of patients feel permanently bloated afterward, says Dr. Wolfe. Your chance of being cured depends largely upon a surgeon's experience. Choose a doctor who does this procedure often.
Lori Buxton had surgery last August and is finally cured of the pain and frustration that has haunted her since she was a child. "Now I know what it's like to lead a normal life," she says.
RELATED ARTICLE: OTHER UPSETS
Reflux isn't the only affliction that can ruin your appetite. Plenty of other things can--and do--go wrong as food winds its way through your digestive tract.
But pinpointing the problem isn't always easy. Occasionally, even exhaustive testing yields no clues. In general, though, discomfort in the lower chest is usually caused by acid reflux. Stomach problems are usually signaled by pain in the upper abdomen. Anything below that probably arises in the intestines.
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