Jim came to see me two weeks ago. He started off the visit by saying, “Dr. Sinclair, I think I have an ulcer or cancer.” He went on to explain a lot of common symptoms of dyspepsia or reflux.
Let’s face it – we have all eaten something that we knew was not a good idea. Then, two hours later in misery, belching, tasting that food intermittently, you are willing to do anything to make it stop. When is gastroesophageal reflux (GERD or dyspepsia) something more than just eating the wrong food at the wrong time? GERD is common. It is estimated that 60 percent of the population has symptoms of reflux at some point over the course of a year, and about 25 percent of people have weekly symptoms. This translates to a loss of productivity at work, poor sleep and altered sleep patterns. Some organizations estimate that GERD causes up to $2 billion dollars of lost work productivity each week.
Most commonly symptoms start within the first two hours after eating, bending over, or lying down after a meal. This then leads to symptoms of nausea, belching or burning sensation in the chest. All of these symptoms of dyspepsia usually respond to over-the-counter medication.
Some foods that have been associated with causing or worsening dyspepsia are citrus fruits (oranges, grapefruit), peppermint, chocolate, alcohol, caffeinated drinks, garlic, tomatoes and onions. Avoiding these foods alone or any other individual triggers of dyspepsia may be all that is needed to control your symptoms.
When the heartburn is causing you discomfort, what do you do? The easiest and quickest medication is milk. It can coat the lining of the stomach and help neutralize the acid in the stomach. Combine this with sitting upright or propping up several pillows behind you if you are in bed. The next line of treatment that many people try is over the counter antacids, such as Rolaids or Tums. They are cheap and work almost immediately by neutralizing the acid in the stomach. However, they rarely last for more than a couple of hours.
Those people who have dyspepsia on a more consistent basis will tend to try a H2 blocker such as Zantac or Pepcid. This class of medication works inside the stomach to decrease the amount of acid released by the cells. They can be combined with antacids as they will take a little longer to start working. H2 blockers can last for up to 12 hours and may be taken twice a day.
The final medication class currently available is the PPI, or proton pump inhibitor. This class of medications works in the stomach cells to stop the pump that puts acid in the stomach. It works to a greater extent than the H2 blockers and thus may last for up to 24 hours. Most of the time, it is best to take this medicine 30 minutes before the largest meal of the day so that it is at full strength in the bloodstream when the stomach cells are producing the most acid. About 90 percent of people find great long-term relief from this class of medications. These medications are available over the counter and include Prilosec or Prevacid. Others are available through prescriptions from your physician; however, studies question whether they work much better than those available over the counter.
Yet, the most important treatment that can be done is lifestyle modification. Propping yourself up while you sleep, whether with an extra pillow or a block under your bed frame, can help. Losing weight decreases the pressure on your stomach that may be causing acid reflux. Changing your eating habits may improve your dyspepsia. Start by avoiding foods that bring your reflux on, eating smaller meals, and finally not eating three hours before bed.
So let’s get back to Jim. Jim had no warning signs of cancer or ulcers. Those symptoms include blood in your stool or vomit, dark black stools, unexplained weight loss, trouble swallowing or difficulty breathing. If you have reflux symptoms and develop any of these symptoms or are not responding to over-the-counter medications, please make an office visit with your physician to discuss your concerns.
Aaron Sinclair practices family medicine with WesleyCare Family Medicine Residency.