More Answers to Your Heartburn Questions

Sept. 25, 2006 — -- Thank you for the continued interest in Dr. Tim Johnson's "World News" series on heartburn. The following is a representative sample of the questions you posted on the "World News" message board with answers from Dr. Felice Schnoll-Sussman of the Jay Monahan Center for Gastrointestinal Health at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.

Question: I am a 32-year-old female that suffers from acid reflux/GERD. It has been getting worse since my mid-twenties. I am now taking Aciphex daily and my symptoms have drastically reduced. Since this prescription is taking care of my problems right now, should I worry about my acid reflux getting worse and if so, should I be checking for stomach and esophagus cancer? -- alexlildemo

Answer: It is a very good sign that your current treatment is working to reduce the symptoms of acid reflux/GERD. For current and future monitoring and treatment, you should continue to follow-up with your physician.

In general, treatment for chronic GERD is necessary for two purposes: 1) to relieve symptoms of acid reflux and 2) to heal and prevent injury to the esophagus.

Since esophageal injury can be present even without symptoms, it still may be necessary for you to undergo testing, called an endoscopy, to ensure that your treatment is effective. Endoscopy will also help monitor for the development of a pre-cancerous condition called Barrett's esophagus, which can sometimes develop in people with chronic GERD. Bottom line: keep seeing your doctor for appropriate treatment and follow-up.

Question: Does weight loss help to prevent GERD or does it have any impact? Will I still have GERD if I loose the weight? -- mwennergren

Answer: Being overweight is a risk factor for GERD, so it is very possible that losing weight would lead to improvement in your GERD symptoms. You may also want to consider taking steps to reduce other lifestyle risk factors, such as: eliminating caffeine and spicy foods from your diet, eating smaller rather than very large meals, and eating your last meal at least 2 hours before bedtime.

In addition, it is important to see a doctor about any symptoms you may have, so that he or she can make a diagnosis, and recommend the appropriate treatment options. If you have already seen a doctor and have been diagnosed with chronic GERD, it's important to maintain a close partnership with your doctor to ensure optimal treatment (both lifestyle and medical options) and appropriate esophageal monitoring by endoscopy.

Question: Just a fellow GERD sufferer here. I also didn't want to be on meds for the rest of my life so I've explored natural options. I have found that eating a healthier diet (no processed foods, white flour or sugar) helps a lot and I take raw organic apple cider vinegar every day which allows me to eat anything I like with no symptoms. I can now drink coffee, eat oranges and anything spicy or acidic. Why does this help? Is there any medical research to support this treatment? -- tmarina61

Answer: It is wonderful that you have had relief of your GERD symptoms! Different things trigger GERD for different people. We know that common triggers include caffeine, citrus foods, spicy foods, and eating too close to bedtime.

When we talk about "treatment" for chronic GERD, we must address both symptoms and esophageal injury. So, while it is great that your symptoms have resolved, I would encourage you also to see your doctor about whether you will need ongoing care. This is because, in some people with chronic GERD, damage to the esophagus can occur even without symptoms. So, enjoy your coffee -- but check with your doctor to see if he or she has other recommendations to keep an eye on your esophagus, so to speak.

Question: Last year, I had an endoscopy and the gastroenterologist found that I have Barrett's esophagus. He prescribed Prevacid, which has eliminated the heartburn. He also said that I should have an endoscopy every two years and that, if cancer developed, part of the esophagus would be cut out and the stomach reattached. Do I assume correctly that an endoscopy every two years is often enough to catch esophageal cancer at an early stage? -- hlc333

Answer: As your doctor may have explained, chronic GERD increases the risk of developing a condition known as Barrett's esophagus. Barrett's esophagus is a condition where cells in the esophagus can show changes and in a small percentage of people, progress into esophageal cancer. In my patients who have Barrett's esophagus, I often perform frequent upper endoscopies and take biopsies of the abnormal-appearing esophagus. The goal is to prevent progression to cancer with medical treatment, but if the cells do progress, other options, such as surgery, may be considered. This is why it is so important to monitor people with Barrett's esophagus closely. Not knowing your situation personally, I could not give specific recommendations for monitoring. So, I would recommend that you check with your doctor again to have follow-up endoscopies at appropriate intervals for your personal condition and, if you have any question about the care you are receiving, get a second opinion to be sure.

Question: I'm a 27-year-old female and I have suffered with chronic heartburn since I was 22. A little over three years ago it got so bad that I am unable to swallow most foods. My doctors have scoped and stretched my esophagus three times with no change. My big concern now is that I'm 3 months pregnant and I'm not able to eat what I need to, to keep the baby and myself healthy. I have taken Prevacid and Nexium for years and neither of them work. I'm getting worried that I may never be able to eat normal foods again, but it's hard to live off of mashed potatoes -- trust me, I know. Is there anything else you can suggest for me? Thank you! -- rebma27

Answer: I am very sorry to hear that you are having such debilitating symptoms. I would recommend that you see a gastroenterologist. You first need to make sure that GERD is the correct diagnosis for you. Depending on your symptoms and examination, you may need diagnostic tests such as a CT scan or another upper endoscopy to view the esophagus. Once a correct diagnosis has been established, you can proceed with an appropriate treatment plan. In the meantime, it is imperative that you and your baby get the nutrition you need. Your doctor may want to refer you to a nutritionist, so that you can find nourishing foods and drinks that you can tolerate -- and even enjoy. And, please, if you are not happy with your care with one doctor, get another opinion.

Question: Thanks for the education about heartburn on the news. I'm a male, 48, and have been suffering increasing heartburn for several years. I take many Rolaids daily and 20 mg Famotidine tablets at least once a day which does seem to help. Lately, if I eat late, I'll wake up tasting acid in my mouth (and yaak). Should I be concerned and insist on further treatment or examinations? -- keithrminer

Answer: First, I would suggest that you stop eating at least 2 hours before bedtime, as eating late is a risk factor for GERD. Second, I would encourage you to tell your doctor about your symptoms -- those that are the same, better, worse, and/or new -- and discuss what lifestyle and medical treatment options, as well as endoscopic monitoring, are right for you. And, as always, if you are not happy with your care with one doctor, do not be afraid to seek a second opinion.