Up In Flames

By Michael Gibson Morris/NEMS Daily Journal

Everybody feels the burn sometime.
But for some people heartburn or gastro-esophageal reflux disease, called GERD, is more than a minor annoyance.
If you feel the burn only once in a blue moon, a little bit of antacid is enough to put out the fire, said Tupelo gastroenterologist Dr. Sam Pace, who oversees the Heart Burn Center at Digestive Health.
“If you have heartburn five times a week and you’re constantly chasing the pain,” with over-the-counter medications, Pace said, “These are signs you need to see a physician.”
Relief is out there.
“About 95 percent of basic reflux cases are going to be controlled by lifestyle modifications and medications,” Pace said.
Chronic heartburn is more than an annoyance, he said. Acid reflux left unchecked can damage the sensitive lining of the esophagus and increase the risk of esophageal cancer.
American culture doesn’t help much.
“We eat the largest, fatty meal of the day and then go to sleep two hours later,” Pace said.
Some of the most important steps people with chronic heartburn can take is to avoid alcohol and stop using tobacco products, Pace said.
“It you have a fire in a waste basket, you don’t put it out with gasoline,” Pace said.

Family tradition
For the Westmorelands of Saltillo, chronic heartburn has been a family tradition.
“I guess it’s hereditary,” said Betty Westmoreland. “My two boys have it, and I have it.”
For years, Betty Westmoreland ingested so many Tums for her heartburn, her family joked she’d never have problems with osteoporosis.
“I would buy them in the big bottles,” said the 80-year-old Saltillo woman. “I had it for years before I ever went to the doctor.”
For her, relief has come with Prilosec. Her doctors have tinkered with her medicines over the years, but Prilosec seems to work the best.
“I am so much better,” said Westmoreland, who still has a little trouble from time to time. “I shouldn’t eat spicy foods. Sometimes I do and I pay for it.”
After years of chronic heartburn, Wes Westmoreland, now 40, his heartburn symptoms faded, which is a red flag for the more serious Barrett’s esophagus, a precursor for esophageal cancer.
“I started having choking spells,” another sign of damage from the acid reflux, Wes Westmoreland said.
Barrett’s esophagus occurs when the body tries to protect itself from the constant onslaught of stomach acid. The lining of the esophagus has a sensitivity similar to skin, Pace said. That’s why acid reflux hurts so much.
In some people with long-term acid reflux, the body tries to protect itself and the lining changes into a more acid-resistant lining similar to the lining of the small intestine, Pace said.
The acid reflux symptoms go away, but the damage continues.
“It can be silent,” Pace said.
Unfortunately, those cellular changes greatly increase the risk of esophageal cancer, which can be very difficult to treat.
People who have fought reflux for years and are over 50 need to be screened for Barrett’s, Pace said. This is especially important for people who have been able to partially treat with over-the-counter medications for years and may not have talked to their doctor about chronic heartburn.
“You need to be evaluated at least once,” Pace said.
Barrett’s can be reversed if it’s found before the cancer begins.
In Wes Westmoreland’s case, medication addressed the Barrett’s, but didn’t resolve the problems he was having with acid reflux.
After careful evaluation and consideration with his physicians, he opted to have a minimally invasive procedure called a Lap-Nissen, that strengthened the valve between his stomach and esophagus.
The recovery wasn’t easy – six weeks of a liquid diet and gas pains because he couldn’t burp – but the results have been worth it.
“Since the surgery, I haven’t had any problems,” Wes Westmoreland said. “But you do have to learn to eat differently.”

Control Heartburn
Here are some suggestions for the American Gastroenterological Association on how to keep heartburn under control.
• Avoid foods, beverages and medicines that aren’t nice to your esophagus:
– Fried or fatty foods, chocolate, peppermint, alcohol, coffee, carbonated beverages, ketchup and mustard, vinegar, tomato sauce, citrus fruits or juices, aspirin and anti-inflammatory meds other than acetaminophen.
• Don’t overeat. Reduce portion sizes.
• Eat meals 2 to 3 hours before lying down.
• Elevate the head of the bed by 4 to 6 inches, using blocks or telephone books.
• Don’t put the squeeze on your abdomen. Avoid tight clothing, control top hosiery and body shapers.
• Stop smoking. It keeps the esophagus from working properly.
For occasional heartburn, over-the-counter medicines – taken as directed – can help relieve symptoms. People should talk with their healthcare provider if they frequently take over-the-counter heartburn medicine or the medicine doesn’t control the symptoms.

Heart attack or heart burn?
We’ve all heard the stories of folks who thought they had bad heartburn when actually they were having a heart attack and vice versa.
When in doubt, go to the ER to be checked out. Any chest pain or difficulty swallowing requires prompt medical evaluation. Some situations will have to be sorted out by a medical professional.
Here are a few guidelines:
• It’s likely heartburn if tightness in the chest follows a heavy meal and is relieved quickly with an over-the-counter heartburn medicine or by belching.
Prescription: Make an appointment with your doctor, especially if it is a chronic problem.
• It could be a heart attack if the chest pain involves radiating pain, breaking into a sweat, shortness of breath, feeling nauseated.
Prescription: Seek immediate medical help. IF IN DOUBT, GO.