September 24, 2009
Acid Reflux Doesn't Just Cause Heartburn
Dr. Jon LaPook Discusses the Benefits of Undergoing an Upper Endoscopy
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Dr. Jon LaPook undergoes an upper endoscopy on-camera. (CBS)
But if you don't have those classic symptoms you may still have acid bubbling up from the stomach into the esophagus, a condition called "gastro-esophageal reflux disease" (GERD). Over the past decade, research has suggested that acid reflux can cause atypical symptoms such as cough, hoarseness, sore throat, asthma, and even chronic sinusitis. GERD can also cause chest pain, especially if the acid causes the muscle in the esophagus to go into spasm.
As an internist and gastroenterologist, I've seen patients who have suffered for years with atypical symptoms of GERD get better with treatment. Although I usually prescribe acid-reducing medication, I try to avoid an approach that relies exclusively on "better living through chemistry." In fact, my goal is to treat the symptoms with life-style adjustments alone if possible. Smoking and obesity both increase acid reflux and must be addressed. I tell my patients to limit alcohol, caffeine, chocolate, peppermint, and fatty foods (I know, basically anything that gives them even an iota of pleasure in life). I also suggest keeping a food diary to try to identify culprits such as tomato-based products or certain spicy foods. If their symptoms resolve then they can try to reintroduce the things they miss the most. Elevating the head of the bed can sometimes help.
The most serious consequence of chronic acid reflux is
It's estimated that almost 15,000 Americans will die from esophageal cancer this year. Fifty years ago, more than 95% of esophageal cancers were "squamous cell" - the kind caused by smoking and excess alcohol use. As smoking has declined, the incidence of squamous cell carcinoma has dropped. But for reasons that are not clear, esophageal adenocarcinoma - the kind linked to acid reflux (and smoking) - has dramatically increased over the past forty years and now accounts for about half the cases of esophageal cancer. From 1975 to 2001 there was a 600 percent rise in esophageal adenocarcinoma. The obesity epidemic may well be playing a role by increasing the number of adults with acid reflux.
Gastroenterologists can diagnose acid reflux by slipping a thin, flexible instrument (endoscope) through the mouth and down the esophagus. It's a lot easier than it sounds. Patients are usually given sedation and the back of the throat is sprayed with numbing medicine to avoid gagging. There's no problem breathing because the tube doesn't go into the breathing tube (the trachea). Biopsies can be taken from the last part of the esophagus to look for microscopic evidence of Barrett's and inflammation (esophagitis) caused by acid reflux.
There is currently a controversy about who should be endoscopically screened to look for evidence of Barrett's esophagus. Only a fraction of the millions of patients with chronic reflux will ever develop Barrett's. And many patients with Barrett's have no symptoms at all. In a study in Sweden, 1.6% of the population had Barrett's but only about 40% had heartburn. And only about half of esophageal adenocarcinoma is estimated to be a result of reflux.
The American College of Gastroenterology recommends against screening the entire population but says it may be appropriate in certain populations at higher risk - such as Caucasian males over 50 with longstanding heartburn. That would be me. So for this week's episode of CBS Doc Dot Com, I underwent an upper endoscopy, explained and performed expertly by Dr. Mark B. Pochapin, director of The Jay Monahan Center for Gastrointestinal Health at New York-Presbyterian Hospital/Weill Cornell Medical Center. For more information about the Jay Monahan Center, click here.
For information about GERD from the American Society for Gastrointestinal Endoscopy, click here:
To watch my upper endoscopy, click here:
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- Nick, died at age 61?.February 13, 2009
My husband Nick had heartburn for years; he took a little baking soda diluted in water to relive the symptoms. Finally he went to the Doctor in August of 2003 and the Doctor referred Nick to a GI Doctor. Nick had an Endoscope which detected Gerd and Barrett's Esophagus, he was told to take Aciphex indefinitely by his primary Internal Medicine Doctor and his GI Doctor. The biopsy showed no cancer. The primary Internal Medicine Doctor continued to prescribe Aciphex, but never once discussed Barretts, nor any discussion of Acid Reflex, Gerd, or Barretts, nor any notes in the file to schedule another Endoscope, even though the GI doctor gave the primary Internal Medicine Doctor copies of the report that Nick should have another scope in 2-3 years.
Nick?s Doctor failed to counsel him about the illness, no surveillance or preventive measures were made by the Doctors. We assume Doctors read the charts, medical reports, test results in the file of a patient that has a pre-cancerous condition. The Medical Board of California has ruled that the Internal Medicine Doctor failed to comply with the standard of care and the case is now with the Attorney General?s office.
What happened for Nick is the Aciphex worked great, the primary Internal Medicine Doctor continued to prescribe the Aciphex and my husband was able to eat and swallow in most cases with comfort. The Aciphex actually hid the severity of his condition, his Doctor neglected to treat or inform him that he needed to be re-tested periodically with an Endoscope.
In May of 2007 Nick began to have problems swallowing. The GI Doctor performed an Endoscope in hopes of stretching the esophagus. We were shocked when he awoke from the procedure and the Doctor told us that he was in stage 4 esophageal cancer, which is terminal, and he might live 6 to 16 months. Nick had Chemo & radiation. He fought a tough battle as the cancer continued to spread to his lungs, brain and liver. Nick past on February 13, 2009.
Nick would want me to tell the world that you must be very pro-active with your own life. Take good notes and research everything your Doctor tells you. You see, Nick feels he was never given a chance to save his own life. His primary health care physician failed to comply with the required "Standard of Care" and therefore was the direct cause of his deteriorating medical condition and death. - Reply to this comment
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