Heartburn after eating is often perceived as a harmless discomfort that can be controlled with over-the-counter medications. However, behind this seemingly simple symptom may be gastroesophageal reflux disease (GERD) – one of the most common diseases of the digestive system, which, if left untreated, can lead to serious complications, including Barrett's esophagus and esophageal cancer. (b.r. - Barrett's esophagus is a precancerous condition in which the mucous membrane in the lower part of the esophagus changes. It is replaced by tissue similar to the stomach or intestines (metaplasia), as a protective reaction against chronic damage from stomach acid in GERD (gastroesophageal reflux disease). What are the risk factors, which foods provoke complaints, when should we seek a specialist and how a proper lifestyle can reduce symptoms. Dr. Nikolay Tsonev, head of the gastroenterology department at the Fifth City Hospital, speaks to FAKTI.
- Dr. Tsonev, why is gastroesophageal reflux (GERD) often underestimated by patients, even though it can lead to serious complications?
- The basis of the diagnosis of GERD is a reliable history. The classic symptom is heartburn. However, it is important for the patient to define exactly what is meant by heartburn. Many Patients use the terms heartburn and indigestion interchangeably and with great variation in definition. Heartburn can be defined as a substernal burning sensation that usually occurs 30 minutes to 2 hours after eating, lasting more than 10 minutes, but is not typically present for many hours. Another symptom is regurgitation of undigested food contents minutes to an hour after eating. Another common symptom of reflux is chest pain. Acid reflux is the most common cause of noncardiac chest pain that may be indistinguishable from angina. Dysphagia and belching are atypical symptoms. Patients who may have heartburn and chest pain often have only mildly elevated acid exposure levels with a normal-appearing esophagus on endoscopy, whereas patients with mild symptoms may have high-grade esophagitis, strictures, or Barrett's esophagitis. The symptoms listed may occur sporadically in a large proportion of the population, but in order to To meet the definition of GERD, they must have occurred more than 2-3 times a week for the past 2-3 months. GERD affects 20% of adults and up to 10% of children.
- What are the most common dietary and lifestyle mistakes that trigger or worsen heartburn?
- Foods known to exacerbate reflux include caffeinated or alcoholic beverages, chocolate, mints, high-fat foods, and raw onions. Many patients also complain of other foods as a cause of heartburn, including tomato sauces, garlic, and other spices, as well as acidic beverages. Part of the difficulty in identifying some of these foods as a cause of reflux is that the osmolality and acidity of the food itself can contribute to reflux symptoms, regardless of their ability to cause acid reflux. Avoiding these foods, regardless of the mechanism by which they produce symptoms, is reasonable. Late heavy meals before bedtime, being overweight, and lack of physical activity worsen symptoms.
- Is there a link between stress, a hectic lifestyle, and an increase in GERD?
- Stress has long been thought to be a cause of reflux disease, but there is a lack of data to prove this claim. Factors that increase esophageal sensitivity include young age, female gender, and stress. Although reducing stress can reduce reflux symptoms, this does not mean that reflux itself is reduced. What can be observed is a decrease in esophageal sensitivity and less perception of symptoms, not a decrease in reflux itself. A hectic lifestyle with fast and heavy meals, a sedentary lifestyle, and obesity worsen symptoms.
- When is heartburn no longer a “simple discomfort“, but a signal of a disease that requires examination by a specialist?
- The most important thing in assessing symptoms is not the intensity of the pain, but the frequency and duration. A worrying symptom is when a person has heartburn every day for more than 2 years, especially in a white man over 40 years of age. According to recommendations, a patient with a history of symptoms that meet the criteria for GERD, who has not responded to self-treatment with antacids, needs an examination. Prescribed treatment and poor control after 1 month is an indication for endoscopy with a view to staging the disease.
- Many people self-medicate with over-the-counter medications for years?
- Neglecting symptoms carries a risk of delayed staging of the disease, with subsequent complications requiring subsequent non-drug therapy. Such are strictures, Barrett's esophagus and adenocarcinoma. A number of extraesophageal diseases associated with reflux esophagitis have also been described, including asthma, hoarseness, chronic cough, erosion of dental enamel, pulmonary interstitial fibrosis, noncardiac chest pain, and sinusitis. Data in the literature indicate that 50% of patients with asthma, when examined randomly, have abnormal acid exposure on outpatient monitoring.
- Why can untreated gastroesophageal reflux disease lead to conditions such as Barrett's esophagus and even cancer?
- Endoscopic data indicate that patients evaluated for GERD have an approximately 10% prevalence of Barrett's. Among users of over-the-counter heartburn medications, approximately 6% of patients have Barrett's. However, this apparently high prevalence of Barrett's is likely still a gross underestimate, as the prevalence at autopsy is six times higher than that found clinically in the normal population. Diagnosis is endoscopic with histological verification. Data indicate that patients with Barrett's esophagus have a 125-fold increased risk of esophageal adenocarcinoma compared with the normal population. The prevalence of adenocarcinoma in Barrett's esophagus is still estimated to be approximately 10%, indicating that patients who are at greatest risk of developing Barrett's esophagus cancer and who would benefit most from screening are not clinically detected until it is too late. A screening program for Barrett's esophagus would significantly reduce mortality from developing esophageal cancer. The natural progression from intestinal metaplasia to dysplasia and cancer, which most likely takes at least 2 years, is a reasonable interval.
- Are there foods and drinks that patients most often underestimate as a risk factor for heartburn?
- GERD can be caused by many things, including eating large portions. Fried or fatty foods. Spicy foods, citrus fruits (oranges, lemons, grapefruits and limes), chocolate, mint, tomatoes, caffeinated drinks such as coffee, tea and soda. It can also be provoked by taking a number of medications, such as calcium antagonists, nitrates, benzodiazepines, theophylline and anti-inflammatory drugs. It is also common in pregnancy and obesity.
- Is it possible that lifestyle and diet changes can be more effective than medication for some patients?
- The goal of GERD treatment is to reduce symptoms. Most people feel better with medication and lifestyle changes. Do not eat large portions, but smaller, more frequent meals. Go to bed at least 2 to 3 hours after eating. I have already listed the foods above. Stop smoking, wearing tight clothing, bending over, and sleeping at a 20-degree angle with your torso elevated.