Heartburn and Acidity

Do you get burning sensation behind your chest bone, or have sour food come into your mouth? Do you wake up at night with “heartburn” or “acidity”, and need to drink water or take antacids for relief? If this happens more than once a week, you are suffering from GERD (Gastro-Esophageal Reflux Disease) one of our modern day maladies.

GERD is caused by refluxing of acid that is normally produced by the stomach, into the food pipe or esophagus, due to malfunctioning of the one-way valve located at the stomach-foodpipe junction (GE valve). A recent nation-wide survey from 25 centers, conducted by the Indian Society of Gastroenterology, found that 8.4% of Indians suffer from this disorder. If you are a sufferer, you have 80 million in India for company!

GERD is a lifestyle disorder, and hence a phenomenon of our times. Those who are overweight or obese, tend to have loose GE valves and are prone to reflux. Alcohol, nicotine (in tobacco), caffeine (in coffee and tea), fatty food ( pastries, fried food, cheese, cream),chocolates, and pungent spices cause relaxation of the GE valve and are notorious for causing GERD, accounting for the early morning “heartburn” often experienced after that perfect late night party. An aspirin or pain killer swallowed to clear the headache can worsen the reflux.

Diagnosis of GERD is fortunately not difficult as the symptoms are quite specific for this disorder. The commonest test advised is an endoscopic examination, during whcih the doctor assesses whether ulcers have formed in the foodpipe (esophagitis) by the refluxing acid chyme. In many with severe symptoms, the changes on endoscopy are surprisingly mild, prompting specialists to coin a term ENRD (endoscopy negative reflux disease).In few however, ulcers form in the foodpipe, often leading to scarring and narrowing, and sometimes to cancer. Lower esophageal cancer is on the rise in most parts of the world due to increasing frequency of GERD.

Changes in life style certainly help; the problem today is the practical feasiblity to adhere to them. Regular exercises, maintainance of ideal body weight, avoiding all the predisposing foods and beverages, a small early dinner of “sukhi roti” and boiled veggies, and elevating the head end of the bed, do work. Those who can’t change their ways, prefer to take pills that reduce acid production in the stomach (Proton Pump Inhibitors or PPIs) or tighten the GE valve. They work well, but only as long as you keep taking them.  Pharmaceutical companies claim they are safe when taken for as long as15 -20 years. Longer studies are needed as many youngsters start on them from their teens and have 50 years ahead.

Recent research has identified a phenomonon called Rebound Hyperacidity Syndrome in people who have been on PPIs for long periods. On stopping, their stomachs produce large amounts of hydrochloric acid on the rebound, making them dash back for their pills, creating a kind of dependence. Refluxers are often confronted with a life of “Pleasure and Pill”or that of a “Frugal Pauper”. Not easy!

 As published in HT City ( Hindustan Times) dated 8 november , 2009.