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Saturday, December 20, 2014

Dr. Pegs Prescription

Before reaching for pills, retire heartburn-provoking habits

Do you suffer from sour burps and a burning pain under the ribcage after you eat? Do you wake up at night with a cough, or greet the day with a gnawing pit in your stomach? Do you shout, “Yes, that’s me!” at the television when the purple pill commercials come on?
If so, you might have heartburn.

Heartburn is actually neither: it’s not in the heart, nor is it technically a burn. But it can feel like both — like your heart is on fire.

The medical term for heartburn is reflux. Flux usually means constant change and instability. It is also an old medical term for “excessive bodily discharge or flow from the body, especially the bowels.” Reflux is flux in reverse, bodily flow going the wrong way.

Normal flow through your digestive system goes from top to, well, bottom. After you swallow, the food goes down the esophagus into the stomach. There it is partially dissolved by strong stomach acid. From the stomach it passes into the small intestine, where smooth muscle contractions help break it up further and move it along to the large intestine.

The small intestine is where absorption of nutrients takes place (fun factoid: the surface area of the inside of the small intestine is as big as a tennis court!). The small intestine is only called “small” because the diameter of the tube is smaller than that of the large intestine, which is the next and final section. In the large intestine, excess liquid is absorbed and the waste is then expelled in the usual fashion.

If this system is disrupted up near the top, flow goes backward, from the stomach up into the esophagus. Remember, I said the stomach has strong acid in it. Thankfully the lining of the stomach can withstand that low pH level, but the esophagus is another matter. You can feel stomach acid in the esophagus, throat and mouth, and that stuff stings.

Reflux is caused by a variety of factors. Heredity might play a part; some people’s plumbing is just more likely to go in reverse. Gravity plays a role, too. Bending over or lying down after eating makes it easier for acid to go in the direction that is usually up when you are sitting or standing. Tight clothing can constrict your stomach, restricting and reversing the normal flow.

Smoking makes reflux worse, as do stress and obesity. Stress causes your body to produce more stomach acid, and obesity works like the tight pants do. Some people experience heartburn with certain foods and drinks. Common culprits are coffee, alcohol, tomato sauce, onions and, sad to say, chocolate.

The pain is worse after eating because eating triggers your stomach to produce more acid. It is worse in the morning because there is no food in the stomach to absorb the acid. It is worse at night because you are lying down; again, the gravity effect. It can cause a night-time cough because up in your neck, where the swallowing and breathing tubes come together in one big tube, acid can get from the intestinal system into the breathing system. Your lungs don’t like acid in them, so they cough it out.

If you have these symptoms occasionally, it is no big deal. It’s uncomfortable, but not dangerous. But if your esophagus is taking an acid bath on a regular basis, that is called GERD for Gastroesophageal Reflux Disease.

You now have a diagnosis, and with a diagnosis come complications. The worst complication of GERD is chronic damage in the esophagus, called Barrett’s Esophagus. The worst complication of Barrett’s Esophagus is cancer of the esophagus. Yikes.

If you have symptoms of GERD or heartburn, first take some basic preventive measures. Don’t get horizontal right after you eat.

Allow at least two hours between eating and lying down. If you do this and are still bothered at night, try putting a block under the head of your bed to elevate it an inch or two — just enough to take advantage of gravity while you sleep.

Avoid foods that trigger your symptoms. These are different for everyone, so find your way by trial and error.

Stop smoking and lose weight if you need to. Trust me, I know those last two are not easy, but they are important for your health in many ways and I’d be remiss as a doctor if I didn’t remind you.

In addition to the preventive measures, you can go after the acid itself. Over-the-counter remedies such as liquid antacids, chewable antacids and DGL (Deglycyrrhizinated Licorice) neutralize the acid so that even if it does go up into your esophagus it doesn’t hurt or cause damage. Other medicines block the production of acid. These are pills, some purple, and are available at SHAC pharmacy or your other favorite pharmacy. Most of these are available without a prescription.

If you do all these things and are still suffering, or even if you want to consult with an expert before you do them, you know what to do. Come to SHAC. Call 277-3136 for an appointment.

Dr. Peggy Spencer is a physician at Student Health and Counseling. She is also co-author of the book “50 Ways to Leave Your 40s.” Email your questions directly to her at pspencer@unm.edu. All questions will be considered, and all questioners will remain anonymous.