Heartburn and Reflux
Almost everyone suffers daily from some measure of heartburn. Heartburn occurs when stomachacid comes back up into the esophagus [the food pipe that carries food to the stomach] causing aburning sensation felt behind the breastbone and sometimes in the throat and neck. You can alsohave regurgitation of food and bitter-tasting stomach acid often referred to as reflux. Constantexposure to stomach acid can cause irritation of the lower lining of the esophagus as well as othermedical problems.
The esophagus carries food and liquids to the stomach. There is a valve between the stomach andesophagus called the lower esophageal sphincter [LES]. A sphincter is a circular muscle thatshould remain closed except to allow food and liquids to enter the stomach. Reflux occurs whenthis muscle does not work properly. There are many factors cause increased pressure on the LESmuscle leading to heartburn and reflux. The most common cause is eating a large meal.
Other causes are: COMPLICATIONS
Complications can occur when heartburn and reflux go untreated. Some major problems that canoccur are: TREATMENT
Treatment is aimed at reducing reflux and damage to the lining of the esophagus as well asavoiding associated complications. Initial treatment involves lifestyle changes. General measures Eat smaller and more frequent meals.
Avoid eating anything within three hours before bedtime.
Stop smoking. Nicotine in the blood can weaken the LES.
Avoid excessive bending, lifting, abdominal exercises, girdles and tightbelts, all of which increase abdominal pressure and increases episodes ofreflux.
Eliminate or significantly reduce consumption of fatty foods, citrus fruitsand juices, tomato products, onions, pepper seasoning, alcohol, coffee,chocolate, and peppermint.
Lose weight if overweight. This may relieve upward pressure on thestomach and the LES.
Elevate the head of the bed or mattress 6 to 8 inches. This helps to keepthe acid in the stomach by gravity when sleeping. You need to elevateyour upper body [not just your head] to reduce episodes of reflux. Youmay achieve this by placing a wedge or extra pillow under the upper part ofthe mattress.
Review all medications with the physician. Certain drugs can weaken theLES.
[Levsin, Librax, Bentyl, Procardia, Cardizem, Calan, Isoptin, Elavil,Doxepin and others] These can and should be used often. Generally, you shouldtake antacids 30 to 60 minutes after eating and at bedtime.
Medicines are now available to reduce stomach acid. Theseinclude Pepcid, Zantac, Tagamet, and Axid. Newermedicines such as Prevacid and Prilosec can almosteliminate stomach acid production. Other drugs, such asPropulsid and Reglan tighten the LES.
If heartburn is persistent, it needs to be evaluated, and long-term follow up care is often required.
Medical treatment is usually very effective and can prevent complications. For the few patientsfor whom medical treatment does not work, surgery may be a successful alternative 1993. American Academy of Otolaryngology-Head and Neck Surgery, Inc. This leaflet is published as a public service. The material may be freely used so long as attribution is given to the American Academy of Otolaryngology- Head and Neck Surgery, Inc., Alexandria, VA


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