When heartburn turns serious

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Heartburn and asthma. Although no hard empirical evidence exists, these does seem to be an association between heartburn and asthma. There are two possible ways that reflux can affect the airways and make asthma worse. First, the stomach acid tracks up the esophagus, particularly when one lies down. Small amounts of acid trickle into the airways, causing them to spasm, which creates shortness of breath and wheezing. Alternatively, acid reaches the lower part of the esophagus and stimulates nerve endings. This causes the smooth muscle in the airways to contract and consequently narrows the breathing tubes. Patients perceive this sensation as shortness of breath. There are some particular symptoms that may indicate that you have GERD-induced asthma. They include;

1. Asthma symptoms becoming worse after eating a high-fat meal, coffee, chocolate or alcohol:

2. Wheezing and shortness of breath while also experiencing heartburn symptoms such as a burning, acid taste in the mouth

3. Persistent cough, particularly when lying down. Empiric treatment with acid-suppressing medication can help in diagnosing reflux-induced asthma. The esophageal Ph testing also can be useful in monitoring the effectiveness of ant reflux therapy.

An estimated 80 percent of asthma sufferers have acid reflux. According to Professor of Medicine and Physiology at Tulane University Health Sciences Center, some studies suggest that when acid reflux is treated aggressively, asthma improves. Asthma can get worse, however, even in those who don’t have GERD. So the question exists as to whether one influences the other. It may be necessary for some patients to take medications that treat both diseases. Also, some patients may benefit from a surgical procedure known as fundoplication, in which the LES is strengthened by wrapping tissue from the stomach around it. The same lifestyle advice applies to patients with and without asthma symptoms: lose weight if necessary, eat a low-fat diet, elevate the head of the bed; avoid certain foods known to worsen reflux, such as coffee, alcohol and caffeine; and avoid large meals late at night.

Other lung problems can develop when reflux causes acid to overflow into the lungs. This typically occurs when the person is lying down and is serious in that it can lead to bronchitis and pneumonia. If you are experiencing any breathing difficulty, seek the advice of a physician to avoid serious consequences.

Heartburn as a risk factor for Barrett’s and cancer. Before a 1999 article in The New England Journal of Medicine, heartburn was mostly looked at as a nuisance to the sufferer. But that study reported a link between heartburn and esophageal cancer by demonstrating that patients with regular heartburn were 43 times more likely to develop esophageal cancer than the general population. The risk was greater the longer; the more severe and the more frequent the heartburn. In addition, a recent study published in The New England Journal of Medicine reports that those who suffer nighttime symptoms of heartburn are more likely to develop cancer than those who do not.

Heartburn and Barrett’s Esophagus: Approximately 10 to 15 percent of heartburn sufferers develop a condition known as Barrett’s esophagus, which implies the presence in the esophagus of a specialized intestinal type of epithelium (tissue lining). This tissue becomes unstable in part because of its high turnover rate and so increases the risk of becoming cancerous. Barrett’s develops because acid and digestive enzymes reflux into the esophagus needs to regenerate after the cells are destroyed to create a new barrier lining. This prevents gastric juice from further damaging the wall and causing heartburn and ulcers or bleeding. In Barrett’s the cells that form the new lining are abnormal and precancerous tissue.

This new lining grows very rapidly and does not disappear or regress on its own. Much scientific evidence suggests that Barrett’s is a precursor to esophageal cancer. Early screening of heartburn patients fro Barrett’s can prevent further complications. Associate Professor of Medicine says that screening reveals cancer at earlier and far more treatable stages in patients known to have Barrett’s than in those not screened with serial endoscopies.

Diagnosis of Barrett’s: Barrett’s doesn’t have its own set of symptoms, so it is difficult to diagnose. It is usually found when heartburn patients seek medical attention. Unfortunately, these patients are only the tip of the iceberg. And it make it even more confounding, many people who have Barrett’s don’t have heartburn, so when, how or why they get the disease is unknown. What’s interesting to note is that if everyone in the population were screened, about one percent would have Barrett’s , and many of those (about 50 percent) would not have heartburn.

Precursor to cancer. The problem with missing a diagnosis of Barrett’s is that this condition is recognized as a precursor to cancer. But if we don’t know a person has Barrett’s, then how can we screen for cancer? This is where a new strategy will have to come into play: finding Barrett’s in those with no heartburn history. Doctor notes that they really need to determine how to find those Barrett’s sufferers who don’t have heartburn symptoms because most who get cancer come from this group. They point out that the risk of cancer in a patients with heartburn alone (that is, without Barrett’s) is possible but very infrequent. However, if Bret’s is present, cancer risk goes up; this is true especially in cases in which high-grade dysplasia, 59 percent progressed to cancer. Based on cancer rates, the risk of developing cancer over the course of any given year for a patient with heartburn once a month is one in 10,000, whereas for a patient who experiences heartburn once a day, the risk is one in 2,500. And in Barrett’s patients, the overall risk increases to one in 200 per year.