Obesity, pregnancy, and tight clothing can impair the
ability of the LES to stay closed by putting pressure
on the abdomen.
Certain drugs, notably nicotine, alcohol, diazepam
(Valium), meperidine (Demerol), theophylline, mor-
phine, prostaglandins, calcium channel blockers,
nitrate heart medications, anticholinergic and adre-
nergic drugs (drugs that limit nerve reactions),
including dopamine, can relax the LES.
Progesterone is thought to relax the LES.
Greasy foods and some other foods such as choco-
late, coffee, and peppermint can relax the LES.
Paralysis and scleroderma can cause the LES to
malfunction.
Hiatus hernia may also cause heartburn according to
some gastroenterologists. (Hiatus hernia is a protru-
sion of part of the stomach through the diaphragm to
a position next to the esophagus.)Symptoms
Heartburn itself is a symptom. Other symptoms
also caused by gastroesophageal reflux can be associ-
ated with heartburn. Often heartburn sufferers salivate
excessively or regurgitate stomach contents into their
mouths, leaving a sour or bitter taste. Frequent gastro-
esophageal reflux leads to additional complications
including difficult or painful swallowing, sore throat,
hoarseness, coughing, laryngitis, wheezing, asthma,
pneumonia, gingivitis, bad breath, and earache.DiagnosisGastroenterologists and internists are best
equipped to diagnose and treat gastroesophageal
reflux. Diagnosis is usually based solely on patient
histories that report heartburn and other related
symptoms. Additional diagnostic procedures can con-
firm the diagnosis and assess damage to the esopha-
gus, as well as monitor healing progress. The following
diagnostic procedures are appropriate for anyone who
has frequent, chronic, or difficult-to-treat heartburn
or any of the complicating symptoms noted in the
previous paragraph.
X rays taken after a patient swallows a barium
suspension can reveal esophageal narrowing, ulcera-
tions or a reflux episode as it occurs. However, this
procedure cannot detect the structural changes asso-
ciated with different degrees of esophagitis. This diag-
nostic procedure has traditionally been called the
‘‘upper GI series’’ or ‘‘barium swallow’’ and costs
about $250.00.Esophagoscopy is a newer procedure that uses a
thin flexible tube to view the inside of the esophagus
directly. It should be done by a gastroenterologist or
gastrointestinal endoscopist and costs about $700. It
gives an accurate picture of any damage present and
gives the physician the ability to distinguish between
different degrees of esophagitis.
Other tests may also be used. They include pres-
sure measurements of the LES; measurements of
esophageal acidity (pH), usually throughout a 24-
hour period; and microscopic examination of biop-
sied tissue from the esophageal wall (to inspect
esophageal cell structure for Barrett’s syndrome and
malignancies).
New technology introduced by 2003 allows for
continuous monitoring of pH levels to help determine
the cause. A tiny wireless capsule can be delivered to
the lining of the esophagus through a catheter and
data recorder on a device the size of a pager that is
clipped to the patient’s belt or purse for 48 hours. The
capsule eventually sloughs off and passes harmlessly
through the gastrointestinal tract in seven to 10 days.
Note:A burning sensation in the chest is usually
heartburn and is not associated with the heart. How-
ever, chest pain that radiates into the arms and is not
accompanied by regurgitation is a warning of a possi-
ble serious heart problem. Anyone with these symp-
toms should contact a doctor immediately.TreatmentDrugs
Occasional heartburn is probably best treated
with over-the-counter antacids. These products go
straight to the esophagus and immediately begin to
decrease acidity. However, they should not be used as
the sole treatment for heartburn sufferers who either
have two or more episodes per week or who suffer for
periods of more than three weeks. There is a risk of
kidney damage and other metabolic changes.
H2 blockers (histamine receptor blockers, such as
Pepsid AC, Zantac, Tagamet) decrease stomach acid
production and are effective against heartburn. H2
blocker treatment also allows healing of esophageal
damage but is not very effective when there is a high
degree of damage. It takes 30–45 minutes for these
drugs to take effect, so they must be taken prior to
an episode. Thus, they should be taken daily, usually
two to four times per day for several weeks. Six to 12
weeks of standard-dose treatment relieves symptoms
in about one-half the patients. Higher doses relieve
symptoms in a greater fraction of the population, butHeartburn