A burning sensation in the chest. An acid taste in the throat. These are typical heartburn symptoms. And when they happen occasionally, and are solved by popping a couple antacid tablets, there’s likely nothing to worry about. But if symptoms happen frequently or interfere with your quality of life, your heartburn is likely Gastroesophageal Reflux Disease (GERD).
GERD is one of the most common conditions I treat as GI doctor. It occurs when acidic stomach contents reflux from the stomach into the esophagus. Not only can it be uncomfortable, it can be damaging. GERD can cause inflammation of the lower esophagus and changes in its tissue, which can lead to problems.
Anyone can be diagnosed with GERD. However, one of the biggest contributors is weight gain. Carrying around extra weight can put pressure on the abdomen, forcing acidic stomach contents out and up. Age is another reason patients develop GERD. The sphincter that keeps everything in the stomach tends to weaken as people get older.
Doctors have many options for treating GERD. Before suggesting medication, I like to recommend diet and lifestyle changes. Many patients can significantly improve their symptoms with just a modest weight loss—even 10 or 20 pounds. Avoiding foods that trigger acid reflux can also help. Greasy foods and spicy foods are the worst culprits. Think pizza, fast food, and chili. Also, tomato-based foods, citrus, coffee, and alcohol can trigger symptoms. Buying a wedge pillow and sleeping with the head of the bed raised can also reduce symptoms.
For patients who are unable to make changes, or who are still uncomfortable despite these diet and lifestyle modifications, medication is a good option. Proton-pump inhibitors (PPIs) such as Prilosec and Nexium—available over the counter—reduce acid levels in the stomach. Some patients are able to get their GERD under control by taking a PPI for a short period. Other patients need to be on them long-term.
It’s not uncommon for patients to be worried about how long they are taking this medication. Several years ago, a study suggested a link between PPIs and some serious side effects: early dementia, pneumonia, cancer, and osteoporosis. However, this particular study was not well designed. Since then, better studies have come out and none of them have found a clear association between PPIs and these conditions. The medical community considers PPIs to be generally safe, and a good choice for people who would otherwise feel miserable. For some people—especially those at risk for the GERD complication called Barrett’s esophagus—it makes sense to be on a PPI long-term to prevent acid damage.
For most patients, combining diet and lifestyle changes with medications allows them to control their GERD fairly well. However, if that still isn’t working, GI doctors can look in the esophagus and stomach via endoscopy, or measure the pH of the esophagus over 24 hours, to better understand the problem. In rare cases, a patient might need surgery to stop their GERD symptoms.
If you have persistent acid reflex a few times a week, and it’s not responding to medications, it’s important to bring it up with your primary care doctor. It’s better to get help managing the condition than to suffer unnecessarily. Similarly, if you’ve been taking a PPI for more than two weeks, but have not had a conversation about it with your doctor, it’s best to make an appointment. Even though PPIs are generally safe, I caution against taking something indefinitely without seeking professional advice. There might other ways to manage symptoms, or a bigger problem that needs to be addressed.
Dr. Jaime Wilson-Chiru is a gastroenterologist at Vancouver Clinic–87th Avenue. He is dedicated to providing high-quality care with the upmost empathy and compassion.