Treatment Options Depend on the True Cause of the Problem
Classic heartburn, accompanied by discomfort in the chest and a sour taste in the mouth, is a disorder of the esophagus. Ulcers, in contrast, tend to be felt as pain below the rib cage and often are accompanied by bleeding. But sometimes, it takes an astute doctor to decipher which is causing the patient’s distress.
If the patient is over age 40, doctors also need to consider the possibility of heart disease masquerading as heartburn-like discomfort.
“It’s an important thing to distinguish. That’s why they need to see a physician,” says Dr. Sassan Soltani, a gastroenterologist in Pasadena.
Heartburn affects those who overeat and is a common problem during pregnancy. In addition, some weightlifters have heartburn because their activity causes pressure on the abdomen.
Sometimes, the irritation of the esophagus may come from taking anti-inflammatory medications such as ibuprofen, or the osteoporosis drug Fosamax.
Heartburn sometimes disappears with age. This can indicate a positive change in diet, like giving up carbonated beverages and other foods that promote acid production. But it may also be a sign of Barrett’s esophagus, when the cells lining the esophagus become less sensitive to acid, but potentially more prone to becoming cancerous.
The majority of patients that come in for treatment have had trouble for years.
Sometimes, their primary care doctor can treat the symptoms with medications. Alternative medical practitioners, such as doctors of Oriental medicine, will try to treat some heartburn. Dr. Steven Rosenblatt, a medical doctor who incorporates Oriental medicine into his practice in Santa Monica, sometimes gives Chinese herbs to reduce excess acid and stomach gurgling, or homeopathic preparations. But with heartburn that’s severe or accompanied by bleeding, difficulty swallowing or anemia, he turns to the Western tradition and sends his patients to a specialist in digestive diseases for endoscopy. Afterward, he’ll often combine herbs and homeopathy with more traditional treatments.
Endoscopy is performed by a gastroenterologist, who checks for irritation and suspicious cells. A negative examination can give the patient peace of mind. However, in patients found to have Barrett’s esophagus, vigilance is needed because the cells can undergo more advanced changes called dysplasia. With severe dysplasia, doctors either surgically remove the cells or perform a type of laser therapy to get rid of the lining. About a third of severe dysplasia cases turn out to be cancer.
Doctors urge patients with symptoms that persist over a period of years to see a professional. Many patients spend nearly as much money on over-the-counter preparations as they might spend on more powerful prescription drugs that offer better therapy and relief.
