What is heartburn?
Heartburn is a burning sensation behind the breastbone
which results from the reflux (back flow) of acid
and other stomach contents from the stomach into the
esophagus (swallowing tube). Normally, acid should
remain in the stomach when a meal is eaten. Heartburn
arises when the "valve" (called the lower
esophageal sphincter) between the esophagus and the
stomach relaxes abnormally.
How can I control my heartburn?
control of heartburn varies greatly among individuals.
If heartburn is mild and occurs only intermittently,
it is important for each person to determine what
precipitated it. For example, if heartburn occurs
only when eating late at night, one should avoid eating
within three hours of going to bed. In addition, if
heartburn occurs only after eating certain foods or
after consuming large quantities of coffee, these
foods should be avoided.
Is heartburn serious?
Although heartburn is merely a nuisance in the vast
majority of individuals, it can also be a warning
sign that more serious problems may be occurring.
If you are over age 40 and are having heartburn or
"indigestion" for the first time it is imperative
that you see a physician as soon as possible. Many
persons who are experiencing angina (decreased blood
flow to the heart) may experience what they consider
heartburn or indigestion. The possibility of angina
or a heart attack must be excluded. If you know you
have heartburn that has been occurring for a long
period of time, an evaluation by a gastroenterologist
is important. While the vast majority of individuals
have only symptoms, acid refluxing into the esophagus
may also damage the esophagus, leading to inflammation
or esophagitis. Esophagitis can progress to more serious
problems, including (in the most extreme cases) the
development of cancer of the esophagus. While this
is relatively uncommon, certain individuals are at
a high risk for the development of severe complications.
The most important factors include the duration of
heartburn (how many years) and the severity of the
symptoms. In addition, during the past several years,
it has been determined that the reflux of acid into
the esophagus can also lead to or worsen asthma, chronic
cough, hoarseness, and even erosion of the teeth.
Finally, the reflux of acid into the esophagus can
cause chest pain indistinguishable from the chest
pain of a heart attack or angina. If you are having
any of these symptoms, it is imperative that you seek
medical attention as soon as possible.
the past fifteen years, it has been determined that
ulcers are most commonly caused by infection with
a bacterium called Helicobacter pylori (H. pylori).
It resides in the stomach and causes an inflammation
of the stomach (gastritis). Although a very large
number of individuals, particulary those over the
age of fifty, are infected with this germ, in most
individuals is does not cause any harm or any symptoms.
In only a small proportion, less than five percent,
will ulcers develop. Currently, it is recommended
that antibiotics be used to treat this infection if
it is associated with a proven peptic ulcer. In addition
to H. pylori, one of the most common causes of ulcers
is the use of aspirin and a class of drugs called
nonsteroidal anti-inflammatory drugs (NSAIDs). These
latter drugs include prescription medication, such
as Motrin‘ and Naprosyn‘, as well as over-the-counter
medications such as Advil‘ and Aleve‘. Tylenol‘ and
other forms of acetaminophen do not cause ulcers,
but their use in very large doses, or in combination
with alcohol, can lead to liver damage. It is also
important to realize that certain medications that
one can purchase without prescription, such as Alka-Seltzer‘,
Goody Powder‘ and Standback‘, also contain aspirin
and can lead to serious damage to the stomach. Finally,
a significant proportion of individuals develop ulcers
without infection with H. pylori or without consuming
NSAIDs. If you are experiencing pain in the center
of the abdomen below the rib cage, it is advisable
to see a gastroenterologist to determine whether or
not you do have an ulcer
is Irritable bowel syndrome?
Irritable bowel syndrome (IBS) is a common disorder
of the intestine that leads to crampy pain, gas, bloating,
and changes in bowel habits. Some people with IBS
have constipation, others have diarrhea, and some
people experience both. Sometimes a person with IBS
has the urge to move the bowels but cannot do so.
The cause of IBS is unknown and while there is no
cure, effective treatment is available.
refers to procedures that visualize the gastrointestinal
tract utilizing high definition video equipment.
It is an endoscopic procedure that visualizes
the esophagus, stomach, and the first portion of the
intestine. Upper endoscopy (also known as an upper
GI endoscopy, or EGD) is a procedure that enables
your physician to examine the lining of the upper
part of your gastrointestinal tract, i.e. the esophagus,
stomach, and duodenum (first portion of the small
intestine) using a thin flexible tube with its own
lens and light source. Upper endoscopy is usually
performed to evaluate symptoms of persistent upper
abdominal pain, nausea, vomiting, or difficulty swallowing.
It is also the best test for finding the cause of
bleeding from the upper gastrointestinal tract, way
to find the bacteria which cause ulcers.
• Is endoscopy
in general is very safe. The majority of endoscopic
procedures are performed in an outpatient setting.
Patients can be discharged home after the procedure
is completed. As with any medical procedure, there
are some small risks associated with endoscopy.
is a polyp and does it do any harm?
polyp is a growth often occurring in the large intestine
(colon). Polyps rarely cause symptoms. Some polyps
are precancerous (adenomas) meaning that if not removed
they could develop slowly in to a cancer. Gastroenterologists
can perform a procedure called colonoscopy to detect
polyps of the large intestine and remove them preventing
cancer of the colon.
is yellow jaundice?
is a yellow discoloration of the skin. It can be best
recognized in the eyes and under the tongue. Sometimes
it is accompanied by dark urine. In almost all instances
is it caused by a liver condition that must be evaluated
by a physician. If you do have jaundice, see your
• I saw
blood on my stool; what should I do?
need to consult your doctor first. Blood in the stool
warrants an endoscopic examination of the large intestine
(colon) to identify a possible source of the bleeding
even if you suspect hemorrhoids. If you bleed a lot
you must go to the nearest ER for immediate evaluation.
• Why do
I have trouble s
are many reasons why swallowing is impaired usually
related to the esophagus (swallowing tube) such as
acid reflux or cancer. You must see a gastroenterologist
in consultation to rapidly identify the reason of
is a rare disease in which the pancreas becomes inflamed.
Damage to the gland occurs when digestive enzymes
are activated and begin attacking the pancreas. In
severe cases, there may be bleeding into the gland,
serious tissue damage, infection, and cysts. Enzymes
and toxins may enter the bloodstream and seriously
injure organs, such as the heart, lungs, and kidney.
There are two forms of pancreatitis. The acute form
occurs suddenly and may be a severe, life-threatening
illness with many complications. Usually, the patient
recovers completely. If injury to the pancreas continues,
such as when a patient persists in drinking alcohol,
a chronic form of the disease may develop, bringing
severe pain and reduced functioning of the pancreas
that affects digestion and causes weight loss.
• Who should
be screened for colorectal cancer?
Anyone over the age of 50, regardless of gender or
race/ethnicity, is at increased risk of colorectal
cancer and warrants screening. Individuals with a
family history of colorectal cancer or polyps are
at an even higher risk and warrant screening at an
even younger age. Screening should begin around age
40 if only one first-degree relative (parent, sibling
or child) had either cancer or polyps, and as early
as 25 if multiple first-degree relatives were affected.
Patients with a personal history of colorectal polyps,
cancer or inflammatory bowel disease (ulcerative colitis
or Crohn’s disease) are also at high risk and warrant
• Can I
reduce my risk of getting colorectal cancer?
Eat a healthy diet
5 or more servings of fruits and vegetables
red meat with chicken, fish, nuts, and legumes
a multivitamin containing 0.4 mg of folic acid
alcohol to 2 drinks per day for men and 1 drink
per day for women
Participate in moderate physical activity for
at least 30 minutes each day
activity includes brisk walking, dancing and
slowly and build up to 30 minutes per day
Maintain a healthy weight