|
Heartburn is a major public health
problem - affecting 50 million people in the
United States and the condition may increase
the risk for developing serious complications,
according to The America Gastroenterological
Association (AGA). The AGA's annual meeting,
Digestive Disease Week, is taking place in San
Francisco this year from May 19 - May 22.
Members of the AGA include physicians and
scientists who research, diagnose and treat
disorders of the gastrointestinal tract and
liver.
Dr. Chandra Prakash, a member of the AGA,
takes your questions on heartburn, its
prevalence, its effects, dangers associated
with the condition, lifestyle modifications
that can be made to alleviate symptoms, and
treatment options available. He is currently
an Assistant Professor of Medicine in the
Division of Gastroenterology at the Washington
University School of Medicine in St. Louis,
Missouri.
Columbus, OH: What's the difference between
daytime and nighttime heartburn?
Chandra Prakash: The main difference is that
at night patients are recumbent so it is
difficult to eliminate acid from the
esophagus. Of course it interferes in restful
sleep and even causes day time problems. It is
also associated with a higher likelihood of
long term complicates like narrowing of the
esophagus, formation of a abnormal type of
lining called Barrett's and in rare cases even
cancer.
--------------------------------------------------------------------------------
Atlanta, GA: Are you seeing an increase in
the number of yearly cases of GI disorders and
is this increase, if any, grounded in changes
in the social and work environments we live
in?
Chandra Prakash: We always see an increase.
It is difficult to say if that is related to
an increased awareness of potential problems
or if it's due to an actual increase in GI
problems. However, we do know that the
incidents of cancer of the esophagus arising
from long-standing reflux in increasing in
middle aged white men in this country. Also,
there is an increase in patients who are
overweight and we know being overweight is a
risk factor for reflux disease.
--------------------------------------------------------------------------------
New Orleans, LA: Do spicy foods always cause
heartburn?
Chandra Prakash: They can in certain people.
It's usually the greasiness or fat in the food
that promotes reflux. Foods with a high acidic
content can also cause heartburn. Foods like
tomatoes, citrus fruits, etc are acidic.
--------------------------------------------------------------------------------
Comment from Chandra Prakash: It is highly
variable in patients. If you experience
heartburn with spicy foods, it is possible
that you may have an element of acid
reflux. Please see your doctor if you
suspect a medical problem.
--------------------------------------------------------------------------------
Washington, DC: I'm pregnant and have been
experiencing horrible heartburn, especially at
night. Is there anything I can take that will
help it to go away?
Chandra Prakash: Pregnancy is a known risk
factor for reflux disease. Any of the
treatments for reflux will work during
pregnancy as well. How this is approaches
depends on how frequent the problem is for
you. If you are only having a problem
occasionally, you could just use antacids. You
could also try sleeping with your head
elevated, avoiding lying down immediately
after eating. Your doctor can suggest
prescription medications if your symptoms are
frequent or constant. Please talk to your
doctor about your specific issue.
--------------------------------------------------------------------------------
Colorado Springs, CO: Why is gastric "backup"
so bad at night once you've gone to
bed?
Chandra Prakash: It is mainly because when we
are upright during the daytime, the earth's
gravity helps keep the acid in our stomachs.
At night, when we lay flat, the effect of
gravity is eliminated. Also, the natural body
mechanisms by which the swallowing tube pushes
the acid back into the stomach are suppressed
during sleep. Thirdly, saliva which helps
neutralize acid, is also suppressed at
night.
--------------------------------------------------------------------------------
Manassas, VA: At night, I often have a pain
in my chest that keeps me awake. I eat late,
so my wife thinks it may be heartburn. Is that
normal? What should I do?
Chandra Prakash: From what you've said it
sounds like you have nighttime heartburn. This
is the exact situation that we are focusing on
this year, with this chat and other events.
You are definitely someone who needs to see
your doctor for treatment and testing as
necessary. Of course if you have risk factors
for heart disease, your doctor may want to
look into that as well.
--------------------------------------------------------------------------------
Comment from Chandra Prakash: Also, in the
meantime, you can avoid lying down within 2-3
hours after meals and avoid late night snacks.
Sleep with the head end of the bed elevated on
2-4 inch blocks. If you are overweight, losing
weight will also help.
--------------------------------------------------------------------------------
Comment from Chandra Prakash: For more
information, please see www.gastro.org.
--------------------------------------------------------------------------------
tampa, fl: I sometimes cough at night
accompanied by reflux. Could this be
serious?
Chandra Prakash: It definitely can be. Cough
is not a very common symptom of relux and your
doctor can decide if you have an alternate
explanation for it. However, if the cough
happens at the same time as the heartburn or
acid backup, it could be related. You should
see your doctor and be evaluated for this.
--------------------------------------------------------------------------------
norfolk, VA: I take things like tums and
rolaids for heartburn, is there anything else
I can do?
Chandra Prakash: Generally, if you have
heartburn just a couple of times a week and
only during the day time, they can get by with
over the counter medications like the ones you
mentioned or others like Tagamet or Pepcid AC,
etc. However, if you have symptoms more often
than 3-4 times a week or at night or if you
have symptoms like difficulty swallowing or
chest pain, you should see your doctor for
prescription medications that can be very
effective in treating your symptoms. In the
meantime you can try losing weight, stopping
smoking, stopping alcohol consumption,
avoiding greasy food, decreasing caffeine and
chocolate intake. Also, avoid lying down
within 2-3 hours of meals, avoiding late night
snacks and sleeping with the head end of the
bed elevated 2-4 inches on blocks. Also,
please get more information at
www.gastro.org.
--------------------------------------------------------------------------------
Boston, MA: Can dairy foods cause
heartburn?
Chandra Prakash: Usually not unless you're
eating very high fat content dairy.
--------------------------------------------------------------------------------
Comment from Chandra Prakash: Sometimes
symptoms with dairy can relate to lactose
intolerance which means that the individual
does not have adequate amounts of the
intestinal enzyme that digests milk. More
common symptoms are diarreha and abdominal
cramps. It is easily avoided by not consuming
dairy products.
--------------------------------------------------------------------------------
Atlanta, GA: I've been diagnosed with severe
esphogeal erosion and am now on twice-daily
medication. There were no symptoms prior to
the diagnosis. How will I know when I'm
healed?
Chandra Prakash: It is very difficult to
decide if your esophagus has healed if you did
not have symptoms at the outset. Your doctor
may have to look inside your esophagus again
after a period of time if they feel they need
to confirm healing or screen your esophagus
for long-term changes from reflux. Typically,
severe erosions heal very well with 8-12 weeks
of effective acid suppression which you are
most likely on now.
--------------------------------------------------------------------------------
Comment from Chandra Prakash: It is crucial
that you follow up with your doctor and take
your medications as directed to avoid
complications.
--------------------------------------------------------------------------------
Sacramento, CA: Can I talk to my regular
doctor about my heartburn?
Chandra Prakash: Yes, absolutely. Everyone in
the medical community is aware of heartburn.
Your doctor will decide whether you need to
see a specialist or undergo further testing.
So yes, please do talk to your regular
doctor.
--------------------------------------------------------------------------------
Boston, MA: Can nighttime heartburn really
cause cancer?
Chandra Prakash: In patients with
long-standing reflux, there is a change in the
lining of the swallowing tube where the cells
try to protects itself from acid. In doing so,
they become unstable and some patients can
devlop cancer. Patients who have reflux
symptoms for a long period of time and
patients who have significant nighttime reflux
for reasons we mentioned, are most prone to
the changes that may lead to cancer. So, the
simple answer is yes. But the clarification is
that it takes a long time and not everyone
with any kind of reflux develops cancer.
Effective medical therapy and periodic
surveillance by your doctors can pick up these
early changes and direct appropriate therapy.
So it's crucial that you follow up with your
doctor if you suspect a problem.
|
MEDICAL EXPORTS
FEATURED
PRESCRIPTIONS
|
