Your guide for healthy aging

Author: Leah Korkis, BSN, RN.

A registered nurse specialized in geriatrics. She is experienced in long term care, community health, and acute care. She currently works as a nurse and clinical educator in one of the top inpatient hospitals in the nation.

References
Clemons, M. (2014). Advances in understanding the pathogenesis of barrett's esophagus. Discover Medicine. 

Kahrilas, P., Talley, N., Grover, S. (2014). Patient education: Acid reflux in adults. Retrieved from http://www.uptodate.com/contents/acid-reflux-gastroesophageal-reflux-disease-in-adults-beyond-the-basics?view=print.  

Mayo Clinic (2012). GERD. Retrieved from http://www.mayoclinic.org/diseases-conditions/gerd/basics/definition/CON-20025201?p=1#.

Vaezi, M., Richter, J. (1996). Role of acid and duodenogastroesophageal reflux in gastroesophageal reflux disease. Gastroenterology 111(5), 1192-1199.

Video B: Antacids explained


Causes

Heart burn is a result of stomach acid making it's way out of the stomach. As seen in Photo A, between the stomach and the esophagus is whats called the "low esophageal sphincter". This acts like a one-way valve, allowing food and beverages to go into the stomach. However, due to various factors, this sphincter either stays open or becomes weak. Therefore, allowing stomach acid and other contents make their way up into the esophagus. Since the esophagus lining is not made to tolerate such acidity, it becomes irritated. 


Risk Factors

There are a handful of contributors when it comes to GERD. Here are the main culprits: 

  • Increased weight
  • Smoking
  • Pregnancy
  • Asthma
  • Diabetes 
  • Dry mouth

Symptoms 

Signs and symptoms can range from mildly uncomfortable to severely irritating:   

  • Burning sensation mid chest, possibly radiating to the throat.
  • Dry cough
  • Horsness or sore throat
  • Asthma
  • Spontanious vomiting 
  • The sensation of a lump in the throat


Note: Seek immediate medical attention if you experience chest pain, especially when accompanied by other signs and symptoms, such as shortness of breath or jaw, back, or arm pain. These may be symptoms of a heart attack.


Trigger Foods

Here is a list of foods that may trigger heart burn: 

  • Alcohol
  • Red Meats 
  • Foods high in fatty grease 
  • Coffee
  • Citrus fruits
  • Tomatoes 
  • Onions
  • Spicy foods


Complications

​When stomach acid repeatedly comes into contact with the lining of the esophagus, it may lead to esophageal bleeding or ulcers, along with scarring. This is referred to as, "Barrett's Esophagus". 


Barrett's Esophagus is a serious condition that may develop in people who have chronic GERD. Most people with GERD, however, do not develop Barrett's Esophagus because GERD itself is so uncomfortable that they take the necessary precautions to avoid it leading to Barrett's esophagus. In Barrett's Esophagus, damage to the lining of the esophagus causes abnormal changes in the cells that line the esophagus (see photo B). The normal cells that line the esophagus are damaged and replaced by a type of cell that are not usually found in the esophagus. Although this may lead to esophageal cancer, less than 1% of people diagnosed with Barrett's Esophagus are diagnosed with cancer. 

Stomach Acid Explained

​A common question then related to GERD is, "What is stomach acid?" 


Stomach acid is a fluid made by the lining of the stomach. The key role of stomach acid is to break up, protein by protein, the food that we put into the stomach. That being said, stomach acid must be highly acidic. It is so acid actually, that it has a pH between 1.5 and 3.5. In this level of acidity, it would take less than 12 hours to completely disintegrate the top of an soda can.


The stomach also contain another types of cell that acts as a protective layer that produce and secrete a bicarbonate-rich solution. Basically, an acid reducer that coats the stomach with a protective layer of mucus. Bicarbonate is alkaline, a base, and neutralizes the acid secreted by the parietal cells, producing water in the process. This continuous supply of bicarbonate is the main way the stomach protects itself from digesting itself and keeping the total acidity level in check. 


However, with high intake of the trigger foods (see above) it may be difficult for your stomach to catch up with the acidity level. Hence why some people need antacids. See video B for an explanation of how antacids work. 

Photo B: Normal lower esophagus compared to Barrett's esophagus.

Video A: GERD explained

Photo A: Basic stomach anatomy

Helpful Videos and Pictures

Heart Burn


Heart burn goes by many names but it is actually gastroesophageal reflux disease (GERD). It is a condition in which the contents of the stomach contents leak backwards from the stomach upwards, causing a burning sensation, among other symptoms.

Now & later