Esophageal reflux (stomach acid going backwards into the esophagus) is a serious problem, that can result in heartburn, "indigestion," hemorrhaging, scarring with food getting stuck and causing vomiting (often fatal when inhaled), cancer, asthma, sinus inflammation, sore throat, chest pain, laryngitis and chronic fatigue. It is the most common cause of voice box (larynx) cancer and emphysema in non-smokers. Much of the time it occurs without symptoms - most people only experience heartburn when the problem is moderately severe. A "hiatal hernia" means part of the stomach is in the chest. While severe hiatal hernias have GERD (and sometimes need surgery), the percentage of people suffering from heartburn who have hiatal hernias is the same as those who don’t. Most chest pain problems that are not heart related are due to spasm of the esophagus from GERD (it appears to cause the emotional sensation of "heartache" as well). Many people undergo needless cardiac catheterizations because of untreated GERD. Ulcers have similar but different symptoms - 20% of people who bleed to death from ulcer have no symptoms! The diagnosis is made by history, response to medications, X-rays, and direct visualization (endoscopy).

Treatment involves the use of antacids such as Tums or Riopan (aluminum containing antacids like Mylanta and Maalox are best avoided chronically until the aluminum/Alzheimer’s controversy is settled), stomach gas medicines (simethicone - one of the few totally safe medicines), "H2 blockers" such as Zantac, Axid or Pepcid (Tagamet is best avoided due to side effects and drug interactions) - they can be very safe and effective, but are expensive and you may need up to four of the over-the-counter pills twice daily to get relief, and "Proton pump inhibitors" such as "Prilosec" and "Prevacid" (miraculously effective once daily medicines, however they are expensive and the long term safety is in question). Since the long term risk of untreated GERD is potentially disastrous, medication when needed seems the smart approach. "GERD precautions" are non-medical and safe treatments - they include: raising the head of the bed 4-6 inches (put wooden or concrete blocks under the head posts - wedges and extra pillows don’t work), wearing loose fitting clothing, avoid being overweight, eat sitting up and remain upright for 30 minutes after eating, avoid lying down after eating, avoid meals before bedtime, and avoiding alcohol, caffeine, coffee, chocolate, and any food that causes symptoms.

October 22, 1999