HEART BURN

It seems there is a poor correlation between reflux and esophagitis. Only a third of people with esophagitis complain of heartburn and reflux symptoms, and two thirds of those who do complain, don’t’ have esophagitis.

One must consider heartburn possibly a symptom of coronary disease, gallbladder disease, cancers of the stomach, or a peptic ulcer. Heart burn occurs in 20% of Americans. The stomach acids, with the same acidity as battery acid, help you digest the food you eat. The stomach acids splash up to the esophagus, causing heartburn. Many of you may simply have laryngitis or chronic dry cough, and it is uncertain that this is gastric reflux.

Inflammation of your esophagus occurs when acid and pepsin cause ulcers in the lining of your esophagus. Belching is a normal release of some gastric juices. Other causes include hiatus hernias, abdominal obesity, and overeating.

Lifestyle changes are the best treatment for reflux. Avoid acidic spicy foods that irritate the stomach. Raising the head of the bed may prevent nighttime heartburn and sleep disturbances and of course losing some weight.

You are told that it could cause cancers of the esophagus if not controlled. Yet 40% of these cancers never had reflux at all. Since there are about 8000 cases a year, only 4800 are due to reflux. There is a very low risk of cancer in patients with reflux. Not many cases for all the medications and endoscopies performed.

The Canadian guidelines do not advocate screening endoscopies stating: ‘the procedure has not shown to reduce mortality from adenocarcinoma”. The American College of Gastroenterology hedges, saying ‘ there is not enough evidence to recommend for or against endoscopy to screen for esophageal cancers or diminish the risks of esophageal adenocarcinoma.

Restaurants are often responsible for your reflux.

Drinks with chocolate, alcohol, caffeine, cola, lemonade and orange juices, tea, all add to reflux events.
Problems increase with foods that are fried: as burgers, fried chicken and fish, club sandwiches, French fries, gravies, mayo, creamy soups, pizza with extra cheese all cause havoc.

Avoid catsup, onions, peppers, chili, and tomato and spaghetti sauces.
Solution foods: white lean meats, turkey chicken or roast beef on whole grain bread, grilled foods, broth based soups, steamed veggies, baked potatoes without high fat dressings, low fat salad dressing, and light deserts.

You will lose weight, save money, and can quit taking Beano, antacids, and proton pump medications as Prilosec. Endoscopy will not be in your future.
Source: NEJM Oct. 16, 2008

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