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anatomy jpg

 

Dysfunction of the lower esophageal sphincter can cause GERD. Internet graphic.

By Paul Goldfinger, MD, FACC

Most people get “heartburn” at least once in while.  Some get it often and  have significant problems with it.  The term refers to a form of indigestion where acid stomach contents regurgitate  (reflux) back from the stomach into the esophagus and/or throat.

GERD means “gastroesophageal reflux disease,” and regardless of the cause, it usually  results in chest and/or throat burning (“heartburn.”)

The term “heartburn” is an oxymoron, because this complaint has nothing to do with the heart.   The Italians call it “agita.”  And both words can have broader meanings such as the way Nora Ephron named her novel about a broken marriage, “Heartburn,” and  “agita” can mean a broad sense of upset.

“Heartburn” is a general term for that burning, but there are a variety of specific causes and/or triggers which have the same end result.  On the other hand, reflux can occur with symptoms other than heartburn.

Ordinarily, swallowed food (solid or liquid)  heads south to enter the esophagus from the throat.  It passes a muscular sphincter at the top of the esophagus (the upper esophageal sphincter) then moves through the esophageal tube to the open lower esophageal sphincter to enter the stomach. Then the sphincter closes to prevent regurgitation back into the esophagus from the stomach.

If the lower esophageal sphincter re-opens (relaxes) when it shouldn’t, acid fluid and partially digested food can go back into the esophagus—a process called gastroesophageal reflux, or GERD.  Acid in the esophagus can be propelled all the way north to enter the throat area.

That acid, which is manufactured by the stomach, can irritate and damage the lining of the esophagus, can irritate the throat,  and can upset the delicate balances which control swallowing in the throat.

If the stomach pushes its upper portion past the diaphragm into the chest, it is called a hiatus hernia which can cause GERD.

hiatus hernia

The result of GERD may be heartburn, but it may not cause that classic complaint while instead causing throat symptoms such as sore throat, chronic throat irritation (causing recurrent clearing of the throat,) recurrent cough and/or asthma, and other throat complaints including the sense of something “stuck” there, a “lump” in the throat,  mucus in the throat, and swallowing problems.

These throat problems might warrant a sub-diagnosis of GERD called”laryngopharyngeal reflux.” There is debate about the exact nature of this diagnosis. Ask your doctor about it—ENT or GI.

Many people are walking around with such varied throat symptoms who never get the proper diagnosis and curative therapy.

GERD may occur only at night, and that is very worrisome if it is frequent.  Nighttime acid damage to the esophagus lining can lead to permanent tissue injury and even cancer, and infected acid can be sucked into the lungs—aspiration.   Also, nighttime symptoms can result in serious sleep disorders.

There are many factors which can cause or trigger GERD and all its symptoms and complications:  Throat disorders such as thickening of throat muscles, dysfunction of upper and/or lower esophageal sphincters, esophageal disorders such as out-pouches called diverticuli, over-weight, pregnancy, lying flat in bed, overeating, going to bed too soon after dinner (allow 3-4 hours,) straining with constipation,  pressure on the abdomen as with tight clothing, eating the wrong foods (eg fried, fatty, onions, coffee, tea, spices, citrus, mint, tomato based, and chocolate among others).  Caffeine, alcohol, smoking and stress may also be factors.

In any given patient, one or more of these factors may be important.  Patients should pay attention to their individual symptom profile and write them down for review with a doctor.

For many, GERD is infrequent and easily treated even without medication. Certain life style changes may be all that’s needed.  If needed, there are medications and there are even some invasive/surgical approaches.

GERD/heartburn is a complicated subject, and if you go to a doctor because of recurrent symptoms,  he should consider it as a potentially complex situation.    If he does not,  see a gastroenterologist to be sure that nothing is being missed. Specialized tests may be needed.

Sometimes heart problems can be confused with GERD, so a cardiologist may be involved.  Also there is sometimes overlap with ENT and pulmonology.

GERD is becoming a sub-specialty of its own–let’s call them esophagologists.

Treatment:  In Part II we will discuss diagnosis and treatment.  Suffice it to say that new therapeutic approaches are now available, so most patients don’t need to suffer with GERD.

 

DIONNE WARWICK. “Alfie”. by Burt Bacharach for the movie.

 

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