Gastric Reflux - 30 Seconds with Dr. Jay Goldstein, MD, NorthShore University HealthSystem Family Health
Dr. Jay Goldstein, a gastroenterologist with NorthShore University HealthSystem, took time to chat with me about gastric relux and what you can do about it.
What causes gastric reflux? Normally, at the end of the esophagus there should be a “one-way valve” that allows food and drink to enter into the stomach but not go back up into the esophagus. This is called the lower esophageal sphincter. When that one-way valve is not fully functional, either because it is lax and doesn’t stay closed or because it relaxes periodically and then returns to its normal state, there is the potential and increased likelihood of gastric content (gastric reflux) moving into the esophagus.
The treatment of choice for reflux disease generally depends on how frequent and how severe the symptoms are. Some people take a graded approach to the treatment, starting out with lifestyle changes, which include avoiding tight clothing, not lying down after eating, not eating before bedtime and avoiding trigger foods that may cause symptoms.
Other classic foods like peppermint, strawberries and chocolate are said to trigger reflux episodes, but if someone is able to eat them without difficulty I have no problem with them continuing. Avoidance of alcohol and smoking of course are good things in general and may even help with reflux disease. Stress reduction is often talked about; there are few studies suggesting that stress causes reflux.
What about medication? There are two classes of medications that block acid. They are called the histamine receptor blockers and proton pump inhibitors (PPIs). These medications are often used to reduce acid output in the stomach so that when stomach contents reflux, they contain less acid and in this way they will be less injurious. My cut off for treating people with these type of medications is generally when they have heartburn symptoms three times or more a week. Once the medications are started they generally are used for a long period of time because reflux is a chronic problem. Some people try to reduce the dosage or frequency of use of these medications after a period of time and in some cases this is successful. However, for the majority they will get their symptoms back, if not immediately, over the next several months to a year. If a patient has new onset of heartburn, it would be prudent to review the medications they are taking with the physician.
At the drugstore, look for:
Histamine blockers - Ranitidine (Zantac), Cimetidine (Tagamet), Famotadine (Pepcid) and Nizatidine (Axid)
PPIs - Omeprazole (Prilosec), Isomeprazole (Nexium), Lansoprazole (Prevacid), Pantoprazole (Protonix) and Rabeprazole (Aciphex).