<![CDATA[GERD - Health.com]]> en daily 1 <![CDATA[Study Shows Heartburn, Mental Stress Link in 9/11 Workers]]>

The findings suggest that mental stress and depression can be a factor in GERD, which is characterized by persistent heartburn, says study coauthor Benjamin Luft, MD, a professor at the State University of New York at Stony Brook. And several factors may be playing a role in people who worked at Ground Zero.

“It was a very complex exposure,” he says. “You had a combination of both physical exposure and it also had a very potent impact on their mental health as well. Certainly a large percentage of patients had a variety of mental health problems.”

About 1 in 5, or 20%, of people in the general population has GERD. About 58% of the 9/11 workers reported heartburn and other gastrointestinal problems shortly after the events of 2001, and 42% had mental health problems such as depression or PTSD.

When the researchers followed up with 697 workers in 2005 and 2006, 42% still had GERD symptoms. There was also a link between persistent problems and mental health distress. Overall, 72% of those workers who had multiple mental health problems had heartburn and other GERD symptoms, and those with GERD were two to three times as likely to have depression or PTSD than those who were heartburn-free.

“This was really a very clear example of how mental health and physical disease can impact one another,” says Dr. Luft.

The researchers did not expect to find that so many people had problems that had persisted for so many years. “There is somewhat of a surprise that people continue to be symptomatic,” Dr. Luft says. “That we have such a high percentage of patients that continue to have GI disturbance and mental health distress, it was really something of great concern.”

The study was presented recently at the American College of Gastroenterology meeting in San Diego. The heartburn symptoms were unrelated to smoking or obesity, two factors known to increase the risk of GERD.
Next Page: Toxic dust a factor too
The symptoms are likely due to a combination of factors, including exposure to environmental toxins, according to Dr. Luft. The workers not only inhaled toxic dust, but they also most likely swallowed it.

“The material had two characteristics—one, it contained a lot of different chemicals and potential toxins, but the other thing about it was the dust itself was extremely caustic,” says Dr. Luft. “The pH was very high. The feeling was that with such a high pH, it could almost cause something analogous to a chemical burn.”

Although most people think the inhaled dust might affect the nose, throat, and lungs, “it also could impact your upper digestive tract as well,” he says.

The researchers did not look at what kinds of GERD treatments the workers were using and whether one type was better than another. GERD can be treated with antacids, histamine-2 blockers, and proton pump inhibitors; in very severe cases, surgery may be recommended, although results can be mixed.

David A. Johnson, MD, a former president of the American College of Gastroenterology, calls the study “provocative” but suggests that it’s “not absolute that the two are related; there are several issues that can also play into this.”

He notes that psychological trauma can also interrupt sleep, and “sleep dysfunction may also sensitize people to recognize other conditions like reflux disease.”

However, stress can play a role too. Animal research has shown that stress can lower the resistance to stomach acid during reflux, resulting in more damage to the esophagus, notes Dr. Johnson, a professor of medicine and chief of gastroenterology at Eastern Virginia Medical School, in Norfolk. Plus, “we do know that stress in and of itself may cause people to be sensitive to gastroesophageal reflux disease,” he says.

If people truly have GERD (misdiagnosis can occur), proton pump inhibitors—drugs that are “the cornerstone of treatment”—should help, Dr. Johnson says.

Both experts recommend talking to your doctor if you have persistent heartburn symptoms.

“My advice is that they basically talk to their doctor or find a physician who is really attuned to what their particular needs are,” says Dr. Luft. “The one thing we do know for sure is that if we don’t treat the patient as a whole, dealing with both their psychic injury and their medical injury, we are not going to be able to effect a cure.” ]]> LIFE.com <![CDATA[Sleeping Pills Make Acid Reflux Worse, Study Says]]>

In a new study, researchers at Thomas Jefferson University Hospital, in Philadelphia, found that people taking the popular sleep aid zolpidem (Ambien) snoozed through nighttime reflux instead of arousing from slumber for the second or two it takes to swallow. Swallowing is the body’s natural defense against the backwash of stomach acids that can bathe the esophagus at night.

“[Swallowing] protects your esophagus because you neutralize the acid with saliva, which is rich in bicarbonate,” explains lead author Anthony J. DiMarino Jr., MD, the William Rorer Professor of Medicine at Jefferson Medical College and the chief of the hospital’s Division of Gastroenterology and Hepatology.

That’s true for people diagnosed with gastroesophageal reflux disease (GERD), a condition characterized by persistent acid reflux, as well as people who experience only occasional bouts of heartburn.

The study, which was funded in part by AstraZeneca (which makes heartburn drugs), appears in the September issue of Clinical Gastroenterology and Hepatology. One of the coauthors of the study, Karl Doghramji, MD, the director of the Sleep Disorders Center at Thomas Jefferson University Hospital, serves as a consultant to Sanofi-Aventis, the maker of Ambien.

Over time, acid can damage the esophagus
Donald O. Castell, MD, a professor of medicine at the Medical University of South Carolina, says the study is “extremely important” for GERD patients. “It sends a definite warning that serious levels of acid reflux can occur without detection after a sleeping aid, and that the prolonged acid exposure has the potential to produce injury to the esophageal lining that might not otherwise occur,” he says.

If left untreated, long-term acid reflux can damage the cells lining the esophagus, leading to a precancerous condition known as Barrett’s esophagus, which, in turn, increases the risk of esophageal cancer. Although the study showed that sleeping pills might increase nighttime exposure to stomach acid, it’s not clear if they increase the risk of Barrett’s esophagus or other conditions. (Ambien is only recommended for short-term use.) The study was also relatively small, the researchers note, and it only looked at acid reflux for two nights.

However, it may be the first study to systematically examine the effect of taking a sleep aid on nocturnal acid exposure, says Dr. Castell, who was not involved in the study. “In this sense, a good night’s sleep may be dangerous.”

More than 40% of Americans have GERD, which occurs when the muscle between the esophagus and stomach is weak or relaxes inappropriately. This allows the acid contents in the stomach to back up, or “reflux,” into the esophagus, typically causing heartburn and other symptoms. About one-third of Americans have insomnia, and 15% have used prescription or over-the-counter medications to help them sleep.


Next Page: Acid reflux lasted much longer
Acid reflux lasted much longer
In the study, Dr. DiMarino and colleagues recruited 16 GERD patients and eight people without the condition who served as controls. Each person participated in two nocturnal sleep studies. During each study, the participants were hooked up to catheters that measured the pH levels in their esophagus, in order to measure reflux. Then they were sent to the Jefferson Sleep Lab, where they were monitored throughout the night.

The investigators used a “cross-over” design in which the participants received the sleeping pill and a placebo. But no one—not even the investigators—knew in which order the drugs would be administered to a particular subject.

Among the 23 people who completed the study, bouts of acid reflux roused people 89% of the time if they were taking a placebo, but only 40% of the time when taking a sleeping pill.

In the eight control subjects, acid reflux lasted a little more than a second, on average, when they took a placebo. On the nights they took a sleeping pill, the acid reflux event lasted 15.7 seconds.

In GERD patients, acid reflux lasted an average of 37.8 seconds on a placebo, versus 363.3 seconds—more than six minutes—when they took the sleep aid.

“It means that in patients with GERD who have sleep issues, that their management needs to be addressed in a heightened way if they are in need of these type of sleep aids,” says Philip O. Katz, MD, the chairman of the division of gastroenterology at Albert Einstein Medical Center, in Philadelphia, who was not involved in the study.

How you can limit acid reflux at night
If you experience nighttime reflux, talk to a doctor about your symptoms. He or she may want to adjust your medications. Experts also recommend trying these nighttime techniques to help reduce acid reflux:

  • Avoid eating three to four hours before bed
  • Elevate the head of your bed 4 to 6 inches
Dr. DiMarino advises primary-care physicians to use caution when prescribing sleeping pills to GERD patients. “Beware, because they may not be adequately suppressing the acid,” he says. “If you just willy-nilly go out and write a prescription for a sleeping pill in that setting, I definitely think you’re setting [patients] up for complications.”]]> Sleeping pills may cause acid reflux episodes to last longer. Istockphoto <![CDATA[5 Reasons Why Your Heartburn Medicine Isn’t Working]]>
can be as simple as popping a pill once or twice a day. Proton pump inhibitors, or PPIs, put the kibosh on the stomach’s acid production, keeping gastric juice from backing up into the esophagus and causing pain. (PPIs include brand names such as Nexium, Prevacid, Prilosec, and Protonix.)

But they don’t work for everyone. Even if you’re one of those people who does well on PPIs you can still have “breakthrough” symptoms from time to time, when heartburn flares into an agonizing episode.

Studies suggest that up to 40% of people with heartburn who take a PPI once a day still experience heartburn or other breakthrough symptoms once in a while, says David A. Johnson, MD, a professor of medicine and the chief of gastroenterology at Eastern Virginia Medical School in Norfolk, Va., and past president of the American College of Gastroenterology.

Find out why heartburn meds can let you down—and what to do about it.

Why heartburn drugs can fail
It’s possible that PPIs aren’t curing your heartburn because you’ve been misdiagnosed, says gastroenterologist Joel Richter, MD, the chair of the department of medicine at Temple University, in Philadelphia.

Many conditions cause symptoms that mimic those of gastroesophageal reflux disease (GERD), the medical term for persistent acid reflux that damages the esophagus. Muscle contractions, stretching, and non-acidic reflux in the esophagus can all lead to heartburn (the main symptom of GERD), as can unrelated conditions such as heart disease. “There is a big group of people who get put on these medications and don’t get better, and most of the time it’s because they don’t have an acid-related problem,” says Dr. Richter.

To find out if your symptoms are due to acid reflux, doctors may perform a test that combines pH monitoring, which measures stomach-acid levels in the esophagus, and impedance testing, which detects the movement of fluid and gas (acidic or otherwise) along the esophagus. This combination can help gastroenterologists distinguish acid- and non-acid reflux episodes. (For instance, if the impedance test registers a reflux but the pH level remains above a certain point, that indicates the reflux contains little or no acid.)

Experts say that if your symptoms are in fact related to acid reflux you should do well on PPIs.

But don’t assume that taking medication means you can eat whatever you want, whenever you want. Numerous indiscretions—overloading on fatty or fried foods, say—can trigger breakthrough symptoms. So downing a huge meal, eating late at night, or hitting the sack shortly after a meal can be detrimental to your condition.

“You can eat your way out of these PPIs,” says Dr. Richter. They don’t completely knock out acid, he explains. Although it sounds counterintuitive, that’s a good thing. Stomach acid plays a key role in sanitizing the digestive tract and in killing off the bacteria that produce nitrosamines, a chemical compound that has been associated with an increased risk of gastric cancer. So a little stomach acid is good; too much, however, can be painful.

Many times symptoms arise because people aren’t taking their medication correctly or at a time that optimizes its effectiveness, Dr. Johnson explains. “Typically, the proton pump inhibitors are given 30 to 60 minutes before breakfast,” he says. However, some people do better taking two doses a day to stave off nighttime symptoms, he adds.

And missing a pill may readily ignite that familiar burning sensation in the chest and throat and sour taste in the mouth.


Next Page: What to do when the pain won’t stop
What to do when the pain won’t stop
Even if you’re doing well on PPIs, it’s a good idea to have a backup plan to cope with breakthrough symptoms.

About 73% of people with GERD taking prescription PPIs say they’re satisfied or very satisfied with the medication, according to a 2009 survey of 617 patients published in Current Medical Research and Opinion and funded by Takeda Pharmaceuticals, the makers of Prevacid. Nevertheless, more than half—56.7% of patients on once-a-day PPI therapy and 65.9% in the twice-a-day group—had heartburn in the week before they took the survey.

Overall, 40% said they resorted to other medications for acid reflux, mostly over-the-counter antacids or histamine-2 (H2) blockers. (Antacids are drugs like Tums; H2 blockers include Tagamet HB, Pepcid AC, Axid AR, and Zantac 75.)

“The most common reason that they were using the over-the-counter medication…is related to incomplete relief of their heartburn,” explains lead author William D. Chey, MD, a professor of internal medicine and the director of the gastrointestinal physiology laboratory at the University of Michigan Health System, in Ann Arbor.

Patients weren’t reaching for additional heartburn soothers on their own. It turns out that roughly 60% were advised by their doctors to take antacids or H2 blockers to help with residual reflux symptoms, he says.

Breakthrough symptoms may be a particular problem at night. Dr. Chey’s team found that most people in the survey, or 82.6%, reported nighttime symptoms in the month prior to taking the survey. Nearly one in four described those symptoms as severe or very severe, while close to half of the patients surveyed said their symptoms were moderate.

5 ways to help your heartburn
Fortunately, there are things acid reflux patients can do to help prevent and minimize breakthrough symptoms.

  • Take your medication as prescribed. If you don’t know how and when to take it, call your doctor for specific instructions.

  • Don’t hit the sack on a full belly. Lying down within three to four hours of consuming a large meal, particularly a late-evening feast, could spell trouble. "My big push is to keep the patients away from late eating, large meals and recumbency," Dr. Johnson says. Such a triple threat may pose too large of an insult on the body, one that even PPIs—the gold standard in GERD treatment—can’t handle. For nighttime symptoms (especially regurgitation of fluid back into the esophagus or mouth), Dr. Johnson suggests elevating the head of the bed with some blocks or using a bed wedge to elevate the upper torso.

  • Shed a few pounds. A 2006 study in the New England Journal of Medicine found a strong link between GERD symptoms and body mass index, even in women of normal weight. Using data from a survey of more than 10,500 participants in the Nurses’ Health Study, researchers from Boston University and Harvard Medical School found that overweight and obese women were two to three times as likely as thinner women to have frequent reflux symptoms. Moderate weight gain, even in normal-weight people, may exacerbate reflux symptoms, according to the study. "A reduction of even 2.5 pounds may be enough for some patients to decrease or eliminate their reflux symptoms," Dr. Johnson points out.

  • Try an over-the-counter drug. Drugs like Tagamet HB, Pepcid AC, Axid AR, and Zantac 75 are very effective in knocking out acid, Dr. Richter says. The paradox is they’re not very effective when taken daily, because people develop a tolerance to the drug, he adds. "What I suggest to my patients is that they take an over-the-counter H2 blocker when they have their breakthrough symptoms," he says. "That seems to give them better control."

  • Recognize the foods that trigger your breakthrough symptoms. If jalapeños or onions always get the better of you, consider skipping those items. If you’re going out for a spicy Mexican meal, taking an H2 blocker an hour or so before may help ward off your symptoms before they start.
“If people are having residual symptoms several times per week, and certainly if they’re having residual symptoms to the point that it’s interfering with their ability to sleep…or function on a day-to-day basis, they should definitely talk to their physician about it,” Dr. Chey advises.

]]> (ISTOCKPHOTO) <![CDATA[Antacids Are a Quick-Acting Way to Fight Heartburn]]>

One of the biggest advantages of antacids are that they can offer rapid relief and are ideal for the occasional bout of heartburn. However, they may not be as effective if you have chronic, prolonged symptoms, which are characteristic of gastroesophageal reflux disease (GERD). Antacids aren't as powerful as some other heartburn remedies, so if you have GERD, or severe acid reflux, they may not do the trick.

In general, antacids are relatively inexpensive, have been around for decades, and have a long safety record. There aren't many side effects, and it's fine to use them in the long-term. However, they can cause a "rebound" reaction—heartburn pain can actually worsen—and some people experience diarrhea or constipation from certain antacids.

To find out more about antacids, how they work, and how to take them correctly, check out the following information from our A–Z Health Library.

]]> <![CDATA[Endoscopy: What It Is, How It's Performed]]>

To diagnose GERD, your doctor will ask you some detailed questions about your symptoms. She may also refer you to a gastroenterologist, a specialist, for diagnostic tests. The most common such test is an endoscopy, in which a tiny camera attached to a thin, flexible tube is guided through your esophagus (while you're lightly sedated). This allows the doctor to survey the condition of your esophagus and stomach and look for signs of GERD.

To learn more about endoscopies, check out the following information from our A–Z Health Library.

]]> (GETTY IMAGES) <![CDATA[How Your Doctor Diagnoses GERD]]>

To determine whether you have GERD, your doctor will ask you some detailed questions about your symptoms. You may also be referred to a gastroenterologist, a specialist who may perform diagnostic tests such as an endoscopy, in which a tiny camera attached to a thin, flexible tube is guided into your esophagus.

To find out more about how doctors diagnose GERD, check out the following information from our A–Z Health Library.

]]> <![CDATA[How to Fight Heartburn at Home]]>

But in some cases, avoiding certain foods or popping antacids simply aren’t effective. If you experience heartburn frequently, you may have gastroesophageal reflux disease (GERD). Although watching your diet and eating habits is always important for fighting heartburn, chronic heartburn may require more aggressive treatment, such as prescription medicines. Left untreated, GERD can erode the esophagus and lead to more serious health problems.

To find out more about GERD, check out the following information from our A–Z Health Library.

]]> (ISTOCKPHOTO) <![CDATA[See How Acid Reflux Causes Heartburn]]>

If you have symptoms more than twice a week, you may have gastroesophageal reflux disease, GERD.

To find out more about how stomach acid causes heartburn and GERD, check out the following image from our A–Z Health Library.

]]> <![CDATA[Soothing Heartburn in Pregnancy]]>

The good news is that heartburn usually goes away once the baby is born. In the meantime, there are several diet and lifestyle changes—as well as certain medications—that can make expecting moms feel better.

To find out more about GERD, check out the following information from our A–Z Health Library.

]]> (123RF) <![CDATA[9 Good Reasons Not to Ignore GERD]]>

A burning sensation in the chest and a sour taste in the mouth are the most common symptoms of GERD. If you experience these symptoms only occasionally, it's fine to treat them with antacids and other over-the-counter remedies.

But if left untreated, chronic and prolonged acid reflux due to GERD can result in more serious complications, ranging from tooth decay to ulcers. GERD may even lead to a precancerous condition known as Barrett's esophagus, or make you more susceptible to esophageal cancer. If you experience heartburn on a regular basis, consult a doctor.

To find out more about GERD, check out the following information from our A–Z Health Library.

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