By Dr. Andrew Ellsworth
Most of us have experienced heartburn or acid reflux at some point. It may happen after eating too much. You might burp up food or liquid, notice a sour taste in your throat, or feel a burning pain in the middle of your chest. Sometimes there is discomfort in the upper middle part of the abdomen, called the epigastric region.
Heartburn and other symptoms of acid reflux are very common, affecting about one-fourth of people at least once a week. Some people are more prone to reflux than others.
Diet and lifestyle changes can often help. Eating smaller meals, avoiding foods that trigger symptoms such as spicy or acidic foods, reducing caffeine or alcohol, losing excess weight, avoiding tobacco, reducing chocolate, and not eating close to bedtime may make a difference. Elevating the head of the bed can also help, particularly with nighttime symptoms.
Some medications that can cause symptoms of reflux include NSAIDs such as ibuprofen or aspirin, antibiotics like doxycycline, or GLP-1 weight loss medications.
An occasional antacid, such as Tums, can be an appropriate treatment for mild, infrequent symptoms. A short course of an acid-reducing medication, such as a proton pump inhibitor like omeprazole or an H2 blocker like famotidine, may also help. However, if symptoms are frequent or ongoing, it is worth discussing them with your healthcare provider.
Daily acid-reducing medication is a common treatment for chronic GERD (gastroesophageal reflux disease). These medications can be very effective, but long-term use should be periodically reviewed with a healthcare provider. The goal is generally to use the lowest effective dose for the shortest appropriate duration. Long-term use has been associated with some infections and nutritional deficiencies, although research linking these medications to conditions such as dementia, cardiovascular disease, and kidney disease has produced mixed results.
When GERD is severe or poorly controlled, repeated exposure of the esophagus to stomach acid can cause inflammation and damage. Over time, this can lead to changes in the esophageal lining, including Barrett’s esophagus, which can increase the risk of esophageal cancer.
For people with longstanding or difficult-to-control GERD, or concerning symptoms, a physician may recommend an EGD, or upper endoscopy. This procedure allows a physician to look directly at the esophagus and stomach for inflammation, ulcers, or other abnormalities.
Unlike a colonoscopy, an EGD does not require a bowel preparation. The patient simply needs to fast so the stomach is empty. For convenience, an EGD can sometimes be performed during the same appointment as a colonoscopy.
The take-home message is that if you have frequent heartburn or reflux, talk with your healthcare provider. Medication may be appropriate, and an EGD may be recommended in certain situations. But don’t overlook the importance of diet and lifestyle changes. When possible, those changes can help reduce symptoms and the need for medication.
Your stomach—and your esophagus—will thank you.
Dr. Andrew Ellsworth is a Family Medical Physician at Avera Medical Clinic in Brookings, SD. He serves as a volunteer host for the Prairie Doc® team, which is currently celebrating its 25th season of providing health education based on science and built on trust. Follow us on Facebook, Instagram, YouTube, and TikTok to stay connected. Our programming includes the medical Q&A show On Call with the Prairie Doc® (most Thursdays at 7pm on YouTube, and Facebook), along with two podcasts and a weekly radio program (Sundays at 6am and 1pm on SDPB).