Dr. Kelly Zucker on treating chronic heartburn

While most of us suffer from occasional heartburn, approximately 1 in 5 Americans experience more intense heartburn. They suffer from gastroesophageal reflux disease (GERD) or chronic heartburn.

If left untreated, GERD can lead to serious health issues, including chronic coughing, scarring of the lung tissue and in some cases, esophageal cancer. Most people are able to manage the discomfort of GERD with lifestyle changes and medications.

During a free BCH health lecture, board-certified gastroenterologist Kelly Zucker, DO of Gastroenterology of the Rockies described GERD symptoms, diagnosis, risk factors, complications and treatment options.

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Watch: “Treating Chronic Heartburn"

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Heartburn vs GERD

Dr. Zucker explained, “Heartburn and GERD are often confused. They’re not the same.” She continued, “Heartburn is a symptom experienced as a burning sensation in the chest or upper abdomen caused by acid reflux.”

Acid reflux is experienced by most of us and often occurs after eating; it’s short lived and generally normal. However, GERD occurs when stomach acid repeatedly flows back into the esophagus.

“While heartburn is common and not worrisome, we become concerned when it transitions to GERD. When GERD is experienced, especially more than twice a week, it will begin to affect our daily activities,” said Dr. Zucker. “Within this diagnosis,” she explained, “there are two subtypes, non-erosive gastroesophageal reflux disease (NERD)—that doesn’t cause damage to the stomach lining, and erosive gastroesophageal reflux disease—that does cause damage to the stomach lining.”

GERD symptoms can include:

• Unintentional weight loss
• Difficulty or pain when swallowing or feeling like you’re choking
• Blood in your vomit or dark tarry stools
• A sour taste in your mouth
• Coughing or hiccups
• A hoarse voice
• Bad breath
• Bloating
• Feeling sick
• Chest pain

Dr. Zucker explained that having these symptoms does not necessarily mean you have GERD. She, said, “These symptoms can be present for different diagnoses that aren’t related to your gastrointestinal system.”

She indicated there is cause for concern, “if you are experiencing acid reflux frequently and for longer durations.”

Causes of Acid Reflux and GERD

• Hiatal hernia —This happens when the top of your stomach pushes up through the hole in your diaphragm causing acid to become trapped.
• Pregnancy —This is a common cause of temporary acid reflux.
• Obesity—This increases the pressure and volume in the abdomen and increases the risk of GERD and hiatal hernia.
• Smoking — Smoking can exacerbate acid reflux and GERD.
• Certain foods — Acidic and greasy food can exacerbate acid reflux and GERD.
• Esophageal hypersensitivity — May or may not indicate GERD.
• Diminished salivary function— Produces lower levels of saliva.
• Impaired defense against epithelial injury — The barriers are impaired that prevent acid from reaching the esophagus.
• Age — As we age, we may be more likely to experience GERD.

Untreated GERD

“Untreated GERD,” said Dr. Zucker, “can result in long term issues.” These include:

• Chronic interstitial lung disease that can result in scarred lungs and pulmonary complications,
• Chronic cough,
• Laryngopharyngeal reflux (LPR),
• Esophageal stricture/ring that wears away your esophagus and may result in the inability to swallow at all and may require surgery, and
• Esophageal cancer (if Barrett’s is not diagnosed) is the most severe complication resulting from GERD.

“The symptoms that indicate a sense of urgency are 1) unintentional weight loss, 2) progressive difficulty swallowing, and 3) black stools or blood in your vomit, which can mean bleeding in the stomach or esophagus,” said Dr. Zucker.

Lifestyle and dietary changes

“Before we recommend medications or surgery there are various dietary and lifestyle modifications that we will suggest,” Dr. Zucker stated. These include:

• Losing weight can help reduce pressure on the esophagus.
• Avoiding late meals so that you’re not eating right before bedtime. Once you lay down your food is no longer fighting gravity so the path of resistance to reach your esophagus is reduced.
• Avoiding tobacco, smoking and alcohol. Saliva helps to neutralize refluxed acid and smoking reduces the amount of saliva in the mouth and throat.
• Avoiding triggering foods such has spicy or greasy food. Trigger foods are different for everyone. For some it’s chocolate and peppermint.
• Elevating the head of the bed, again to work with gravity.
• Sleeping on your left side to position the stomach fluid away from the upper right side of the stomach where the esophagus connects, making it harder for reflux to occur.

Management with medications

If lifestyle and dietary changes do not work, your doctor may prescribe certain medications. There are two categories of medicines for GERD: one decreases the level of acid in your stomach and one increases the level of motility (movement) in the upper gastrointestinal tract.

• Antacids – Over-the-counter antacids, such as Tums or Mylanta, are best for relatively infrequent symptoms of GERD.
• Histamine 2 (H2) blockers – H2 blockers decrease the level of acid in your stomach. “They are often prescribed for use at night. Over time, it may be necessary to increase the dosage of H2 blockers to maintain efficacy, but the use of H2 blockers can result in a B12 deficiency,” said Dr. Zucker.
• Proton pump inhibitors (PPIs) –These medications reduce acid production and are prescribed for erosive esophagitis. They’re associated with a greater rate of more “complete” relief after 4 weeks. “While there are various PPIs available, there is little difference between them,” said Dr. Zucker. It’s important to take PPIs 30-60 minutes before a meal and they are safe long-term.
• VOQUEZNA® –This is a very new medication that is being prescribed to reduce acid secretion. It's a class of medication called a potassium-competitive acid blocker.
• Natural supplements – Natural supplements have not proved to provide significant benefit. However, if you have general heartburn or your GERD is non-erosive, a              banana, papaya, baking soda and acupuncture may be helpful.

Surgery and endoscopic therapy

Dr. Zucker noted, “Medications are not for everyone. For these patients there are surgical and endoscopic therapies available.” For these procedures, Dr. Zucker will refer patients to a foregut surgeon.

Schedule an Appointment

Call 303-604-5000 if you have any questions or to schedule an appointment with Kelly Zucker, DO, at Gastroenterology of the Rockies.

Click here to view/download a PDF of slides shown during the lecture.

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