Heartburn Disease (2) – Prevention and Control

06 Dec 2012

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A man holding his chest

In continuation of the discussion on heartburn disease, the following passages perused the risk factors, who is prone?, recommended lifestyle changes , preventive measures and treatment options.

Who is prone?
Indivuduals across all age-groups are susceptible to heartburn disease. Elderly people with GERD tend to have a more serious condition than younger people with the problem.   

Anyone who eats a heavy meal, particularly if one subsequently lies on the back or bends over from the waist, is at risk for an attack of heartburn. In the same vein, those who snack at bedtime are also at high risk for heartburn.  

Pregnant women are particularly vulnerable to heartburn disease in their third trimester i.e. the last three months of pregnancy as the growing uterus puts increasing pressure on the stomach. Heartburn in such cases is often resistant to dietary interventions and even antacids.
Also worthy of note are individuals with Asthma: asthmatics are at very high risk for heartburn disease.  

Typical Symptoms
As mentioned in the preceding edition, the primary symptoms of heartburn disease or gastroesophageal reflux are heartburn, a burning sensation that radiates up from the stomach to the chest and throat, and regurgitation, in which the patient can feel the acid backing up. Sometimes acid regurgitates as far as the mouth and may come out forcefully as vomit.
Up to half of heartburn disease patients have dyspepsia, which is a syndrome consisting of heartburn, fullness in the stomach, and nausea after eating. The symptoms are most likely to occur after a heavy meal, while bending over, lifting, or lying down, particularly on one’s back.

Atypical Symptoms
On the othe hand, between 10% and 15% of people with heartburn disease have so-called atypical symptoms, which can occur with or without heartburn or acid regurgitation. These symptoms can resemble other serious conditions and may lead to an intensive diagnostic work-up.
These symptoms may come up as Chest Pain, Bleeding, Trouble Swallowing and Choking, Coughing and Asthmatic Symptoms (asthmatic symptoms, including coughing and wheezing). Others include Chronic Nausea and Vomiting, chronic sore throat, persistent dry cough and hiccup.

Sleep Apnea
Acid reflux can cause spasms of the vocal cords (larynx), thereby blocking the flow of air to the lungs. These spasms may cause sleep apnea in adults. In sleep apnea, breathing stops repeatedly-but temporarily-during sleep. Patients often experience restless sleep, morning headaches, and afternoon drowsiness. In time, they are at higher risk for high blood pressure.  

Diagnosis of heartburn disease
In the great majority of cases, a diagnosis of heartburn disease or gastroesophageal reflux disease is straightforward, particularly if heartburn and acid regurgitation are present and are lessened by taking antacids for short periods. However, laboratory or invasive tests are required if heartburn is persistent or if atypical symptoms or complications, such as signs of bleeding or difficulty in swallowing, are present.   

A Trial of Omeprazole 
This is a simple noninvasive trial using omeprazole, a drug that blocks stomach acid secretion, may help avoid some invasive tests for identifying GERD, such as endoscopy and pH monitoring. The test involves administration of high-dose omeprazole for several weeks. Studies have found this simple and noninvasive test to be sensitive and fairly specific. In one small trial, the omeprazole test accurately detected 80% of people who had GERD   

The majority of cases of gastroesophageal reflux can be managed with lifestyle changes and the use of antacids for episodes of heartburn. Never mind the fact that drug manufacturers have recently been aggressively promoting more powerful drug treatments for GERD that should be reserved for severe cases only.
Only if conservative measures fail to relieve symptoms are more intensive treatments needed to prevent persistent acid reflux. In such cases, the aim of drug therapy is to reduce the amount of acid present and improve any abnormalities in muscle function of the lower esophagus sphincter (LES), the esophagus, or the stomach.

Lifestyle changes
Individuals with heartburn should first try lifestyle and dietary changes. People with heartburn should avoid or reduce consumption of foods and beverages that contain caffeine, chocolate, peppermint, spearmint, and alcohol - both caffeinated and decaffeinated coffee increase acid secretion. All carbonated drinks increase the risk for GERD. 

Prevention of nighttime attack
After meals, chronic heartburn sufferers should take a walk or, at the very least, remain upright. Bedtime snacks should be avoided. When going to bed, it is recommended lying on the left side rather than on the right, because the stomach lies higher than the esophagus when a person sleeps on the right side, which can put pressure on the lower esophageal sphincter, increasing the risk for fluid back-up.
Lying flat, in any case, can produce intense acid reflux. To help keep acid in the stomach at night, a patient may need to raise the bed at an angle using four- to six-inch blocks at the head of the bed or a wedge-support that elevates the top half of the body so that the patient’s body is tilted up. Extra pillows that only raise the head actually increase the risk for reflux.   
Chewing Gum
Because saliva helps neutralize acid and contains a number of other factors that protect the esophagus, chewing gum 30 minutes after a meal has been found to help relieve heartburn and even protect against damage caused by GERD. In fact, chewing on anything at all can help, since it stimulates production of saliva.   

Avoiding NSAIDs
As mentioned in the preceding edition of the column, GERD patients should avoid nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Motrin, Advil), or naproxen (Aleve), among others. Paracetamol (acetaminophen) is a good alternative.   

Drugs for treating heartburn disease
A number of drugs are effective in managing both episodic heartburn and persistent GERD. Over-the-counter antacids e.g. Mist Magnesium trisilicate, which neutralize digestive acids, are the primary drugs for mild symptoms.
Also available over the counter are the a class of drugs called the H2 blockers, such as Tagamet HB, Pepcid AC, and Zantac, which block acid production.

These drugs provide relief for about half of people with chronic symptoms.
Another important class of anti-acid drugs are proton-pump inhibitors -  omeprazole (losec, meprasil) or lansoprazole, which suppress acid production. They can relieve symptoms in almost all people with GERD.   

Antacids are available without prescription and are the first drugs recommended to relieve heartburn and mild symptoms.
There are three basic salts used in various antacids: magnesium, calcium, and aluminum. Magnesium salts are available in the form of magnesium carbonate, magnesium trisilicate, and most commonly, magnesium hydroxide (Milk of Magnesia). The major side effect of magnesium salts is diarrhea. The most common side effect of antacids containing aluminum salts is constipation. 

The aluminum and magnesium salts are often offered in combination products, which balance the side effects of diarrhea and constipation.  Although is generally believed that liquid antacids work faster and are more potent than tablets, although evidence suggests that they all work equally well.

Tags: Health and Wellbeing, Featured, Heartburn Disease, Wellbeing

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