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Winnipeg Free Press - PRINT EDITION

Heartburn may mean lifestyle has to change

By: W. Gifford-Jones MD.

Posted: 07/30/2010 1:00 AM | Comments: 0 (including replies)

Do you suffer from a hot fire beneath the breastbone following a heavy meal? One that's often accompanied by belching and regurgitation of bitter fluid? If so, you're most likely suffering from heartburn. This common problem can be the forerunner of serious disease. But there are several ways to decrease the risk of developing one of the deadliest cancers.

Heartburn is triggered by several factors. Like other muscles, the lower esophageal sphincter muscle (LES), at the lower end of the food pipe (esophagus), can become weak and inefficient. And if you eat "the whole thing," the laws of physics cause heartburn. Large meals trigger more gas, and something has to give. Then the LES opens and gas, along with the stomach's acidic juice, flows into the esophagus, causing inflammation. This can be the prelude to esophageal cancer (malignancy of the food pipe).

Doctors call this problem gastrointestinal reflux disease (GERD). Studies show that chronic inflammation may lead to a condition called Barrett's disease. The lining of the esophagus, normally a pink colour, gradually changes to the colour of salmon. This change can be observed by passing a lighted instrument down the esophagus. Experts say that about one in 300 cases develops into cancer.

Patients with cancer of the esophagus complain of vomiting food, with or without blood, weight loss and/or black tarry-looking stools.

There are several ways to circumvent esophageal cancer. Nietzsche, the German philosopher, wrote that, "The belly is the main reason why man does not mistake himself for a god". Heartburn reminds us we are quite human. Who doesn't overindulge at times? But, if you make GERD a daily habit, it becomes a dangerous pastime.

Maintaining a normal weight is another prime way to decrease the risk.

Stay away from gas-forming foods such as cabbage and beans. Say no to onions, garlic, chocolate and tobacco. These decrease the stomach's motility as well as the tone of the LES.

Gastric juices, like water, do not flow uphill. So remain upright following a meal and don't take after-dinner naps. It's for this reason that doctors often suggest raising the head of the bed, as many attacks of heartburn occur during the night.

Try to avoid tension at the dinner table. Pent-up emotions impede the normal workings of the stomach.

If, in spite of these warnings, you've eaten too much, it's time to loosen your belt. This helps to take some of the strain off a weak lower esophagus sphincter.

Today there are several medications to ease heartburn. These are best used as a temporary crutch, not as a permanent solution. Taking increasing amounts of medication will provide temporary relief and quench the glowing fire beneath the breastbone. But it's like putting a blanket over a raging fire, which later on erupts with a vengeance. Rather, prudent medical consumers will change a faulty lifestyle.

One other point must be considered when anyone complains of chest pain. Every year patients are seen in emergency departments fearing their pain is due to heart attack. Since one in five people die of heart attack, it's good to know how to spot the difference. And in cases of severe heartburn, it may require sophisticated tests to determine one from the other since symptoms can be similar.

There are, however, certain features that help to point to heart attack. Patients with coronary attack usually complain of a crushing sensation, as if someone was tightening a rope around their chest. The pain normally lasts more than a few minutes. In addition, they may notice that chest pain is also spreading to the jaw, neck or back. And they may have nausea, sweating, a cold clammy skin, and complain of being short of breath.

But never be your own doctor with chest pain. If there's even a slight possibility it's not heartburn go as quickly as possible to the nearest hospital.

Republished from the Winnipeg Free Press print edition July 30, 2010 A21

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