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Common sense eating hinders holiday heartburn

graphic

November 23, 2000
Web posted at: 9:17 a.m. EST (1417 GMT)

(CNN) -- Often when holiday mealtimes roll around, it isn't just the turkey that gets stuffed.

"Moderation is the key" to avoiding holiday heartburn, advised Dr. Joel Richter, Cleveland Clinic gastroenterology chief, who has been studying the condition for 20 years.

"Almost everybody has an occasional episode," he added. "During the holidays you overeat, the stomach fills up, fatty, greasy food (slows digestion) and acid builds up."

About 20 percent of Americans -- and as many as 40 percent of Europeans -- suffer from the burning chest pain and acid taste of heartburn, according to recent surveys.

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In the United States, the problem is becoming even more prevalent, said Richter, because "No. 1, the American population tends to be somewhat on the gluttonous side, and we're heavier."

And in an ironic twist, heartburn rates may be increasing because people's stomachs are actually healthier now than they were in days gone by. Bacteria such as Helicobacter pylori -- found to be associated with ulcer formation -- also act as an acid suppressant. "And in the attempt to get rid of acid, we forget it does good things," added Richter.

Stomach acid is just that -- hydrochloric acid mixed with digestive enzymes. In the simplest terms, heartburn happens when stomach acid flows back into the esophagus. Unlike the stomach, the esophagus has no protective mucosal lining, so stomach acid backup can cause inflammation and pain.

"Generally, heartburn is brought on by overindulging," noted Richter, saying that such "nuisance heartburn" can be managed by treatments ranging from a simple glass of water or milk to commercial antacid or H2 blocker preparations.

But when heartburn transcends nuisance, becoming as frequent as two or more times a week on a regular basis, it's time to sit up and take notice.

"That's a sign of gastroesophageal reflux disease, or GERD. It also can be associated with trouble swallowing, bleeding, difficulty sleeping, chest pain, hoarseness or asthma," said the gastroenterologist. "In that case, you've got a more severe problem and these over-the-counter medications are not going to help you."

A diagnosis of GERD requires a doctor's care to make sure it doesn't lead to Barrett's Esophagus, a chronic inflammation that can be a precursor to esophageal cancer.

White men are more susceptible to Barrett's Esophagus, but women also can get it. Still, only 10 percent of people who have serious heartburn develop Barrett's, according to Richter.

"There's more good news here than bad news. Most people have the 'good form' of heartburn -- they have symptoms, but don't have damage to the esophagus," he said. "They don't have Barrett's, and it's not going to get worse."

Some 60 or 70 percent of heartburn sufferers have the "good form" of the disorder, estimated the physician.

"The other group can be effectively treated" as well, he added. "But the patient has got to come to the doctor, and the doctor has got to take it seriously."

Frequent recurring heartburn calls for possible examination with an endoscope, a telescopic instrument used by physicians to visualize the interior of the body. This examination can determine whether a patient has Barrett's Esophagus, said Richter, adding that Barrett's patients should undergo endoscopy yearly because of the risk of esophageal cancer.

Surgery to tighten the valve barrier between the stomach and esophagus is becoming increasingly more common, Richter noted, saying that rates have "doubled or tripled over the past five years." Such surgery is very effective, but, as with any surgery, also carries risk -- not to mention cost. Average cost is $10,000, the physician said.

"I think people are now becoming more aware of heartburn," Richter added. "You can't watch TV without seeing an ad." Still, he said, "it tends to trivialize the problem. It can confuse the patient so they don't really know when they ought to see a physician."



RELATED STORIES:
Heartburn, acid reflux linked to cancer risk
March 17, 1999
Handling holiday heartburn
December 11, 1997
Taking the heartburn out of holiday eating
November 22, 1995

RELATED SITES:
Cleveland Clinic Foundation
National Institutes of Health: Gastroesophageal reflux disease information
National Heartburn Alliance
International Foundation for Functional Gastrointestinal Disorders
American College of Gastroenterology


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