January 21, 1992|By Alyssa Gabbay
Mr. Smith is now taking medication to reduce the amount of acid produced by his stomach. But if the problem persists, he may have to undergo surgery to remove a portion of his esophagus, said his gastroenterologist, Dr. Mark Diamond, chief of gastroenterology at Franklin Square Hospital Center.
Barrett esophagus is another serious condition which can result from reflux, said Dr. Diamond. As a result of the acid entering the esophagus, the cells of this organ begin to change, resembling the cells of the stomach's lining, he said. This condition can be a precursor to cancer of the esophagus.
"These conditions are things that can happen only when [reflux] has been going on for many, many years," said Dr. Posner.
As far as gastritis is concerned, if untreated, it can eventually lead to gastric ulcers -- an erosion of the stomach's lining, said Dr. Sanzaro. A bleeding ulcer may require surgery, although medication which suppresses acid production can often do the trick.
Ulcerative colitis, a situation in which the lining of the colon becomes extremely inflamed, can be the ultimate result of irritable bowel syndrome, said Dr. Sanzaro. The bowel can cease to function as a result of the condition.
Lifestyle changes often can substantially improve gastrointestinal problems, according to Dr. Diamond. For example, cutting out fatty and spicy foods, as well as alcohol and tobacco, can reduce the occurrence of heartburn, since these substances are thought to weaken the lower esophageal sphincter, a muscle that controls the flow of acid from the stomach into the esophagus. Both regular and decaffeinated coffee stimulate the production of stomach acid, so many doctors recommend that those who suffer from gastritis, heartburn or irritable bowel syndrome avoid it.
"I love to get a person coming in who's telling me that he's drinking 15 cups of coffee a day and has heartburn, because that's so easy to correct," said Dr. Ravich.
Changing sleeping habits can also make a difference. Doctors encourage heartburn sufferers not to lie down immediately after eating a large meal, since a prone position permits stomach acid to travel more easily into the esophagus than an upright one. Angling your bed so that your head is elevated about six inches above your feet will discourage acid from flowing upward, said Dr. Ravich.
Moreover, weight loss can help to cut down reflux, said Dr. Diamond, since extra pounds can increase intra-abdominal pressure, which intensifies reflux. And since stress can aggravate the condition, finding ways to reduce anxiety -- such as taking a short vacation -- is sometimes suggested, said Dr. Ralph Updike, chief of gastroenterology at St. Agnes Hospital.
When lifestyle changes don't work, gastroenterologists turn to medications to control these problems. Bowel muscle relaxers such as dicyclomine (Bentyl) may ease irritable bowel syndrome, said Dr. Sanzaro. Cimetidine (Tagamet), ranitidine (Zantac) and omeprazole (Prilosec) all reduce the amount of acid produced by the stomach, said Dr. Posner, and are therefore effective in treating heartburn and gastritis.
Moreover, other drugs such as metoclopramide (Reglan) strengthen the lower esophageal sphincter, said Dr. Posner, who noted that if medication does not control the problem, surgery may be necessary.
For many people, however, medication provides the necessary relief. After beginning to take Reglan and Tagamet four years ago, Stephen Kaminski found that he woke up with heartburn far less frequently. Today, eating pizza and drinking beer no longer fTC lead to the condition. Heartburn is "still a disruption, but not as much as it used to be," he said.
Heart attack vs. heartburn
Not infrequently, patients are admitted to a hospital with the diagnosis of a heart attack -- only to learn that they are actually suffering from heartburn.
The mistake is understandable, according to Dr. David Posner, chief of gastroenterology at Mercy Medical Center. The esophagus and the heart are located close together in the middle of the chest, "and the body can't distinguish where the pain is coming from." Even physicians sometimes have trouble telling the difference.
Heartburn can also occasionally resemble angina pectoris, a squeezing, knifelike pain that can radiate to the back, said Dr. William Ravich, a gastroenterologist at the Johns Hopkins Hospital.
There are differences, however. Heartburn is often accompanied a sour, bitter or warm liquid washing up into the mouth, and is relieved very quickly by an antacid. Someone who is suffering a heart attack, on the other hand, may feel shortness of breath, pain radiating to the face, jaw, shoulder or arms, and a feeling of impending doom, said Dr. Posner.
In general, it is best to call your doctor when you experience pain in the chest, said Dr. Posner.
