September 30, 2005
Holiday Belly Ache
Just as he does every year, this holiday season UCSD Healthcare gastroenterologist Tom Savides, M.D., expects to see a fair number of patients complaining of indigestion and heartburn. But there’s another, lesser-known emergency that happens frequently during the holiday season.
“Nearly every weekend, year ’round, patients come to the Emergency Room with food stuck in their esophagus, but during the holiday season that number increases two- to three-fold,” says Savides. And he doesn’t know why. “Perhaps they’re not chewing their food properly or they’re overeating or taking bites too big to swallow. It happens most often when people eat chicken and steak,” he cautions. “The food gets lodged in the esophagus, it won’t go up or down. If the patient tries to swallow liquid, it comes back up. It’s a fairly alarming thing that won’t resolve on its own. The person needs to seek medical attention.”
Savides says the blockage doesn’t affect breathing because the food isn’t in the airway, but because it’s very uncomfortable, and unmovable, it can cause enormous anxiety. The gastroenterologist on call has only one option – to push the food down the esophagus using an endoscope, a small camera on the end of a long tube. Not the most fun way to spend a holiday evening.
Because people attend so many parties and food-centered activities during the holidays, Savides says they always see an increase of patients with the problem. He advises that people eat a little more slowly, be sure to eat smaller bites and drink liquid to help the food go down.
Unfortunately the problem often affects people with acid reflux. “Acid reflux sufferers sometimes have complications like inflammation that can lead to scar tissue, which leaves the esophagus a little narrower than normal,” he says. People with such scar tissue should be especially careful to eat smaller bites of food to compensate for the narrower tube.
If there’s one condition synonymous with the holidays, it’s indigestion and heartburn. “A lot of indigestion is actually acid reflux,” says Savides. He cautions that people with the condition be careful not to eat and drink beverages that exacerbate it. And if they do, to take medications to prevent its worst effects.
“There’s a muscle in the lower esophagus which acts as a sphincter,” normally tightening to close the opening between the stomach and esophagus, he explains. “It retains acid in the stomach and doesn’t allow it to come up into the esophagus. Smoking and certain foods relax that sphincter, letting the acid seep into the esophagus, causing heart burn, nausea and in some cases, pain where the chest wall meets the rib cage.”
Unfortunately many of worst offenders he warns are popular holiday favorites: alcohol, chocolate, and mint. Other culprits include citrus and tomatoes, caffeine, spicy foods, onions, black pepper and fatty foods. Savides says the best remedy is prevention. Avoid eating the foods that cause the heartburn and don’t eat for three hours prior to bedtime. Raising the head of the bed or using a wedge pillow and sleeping on the left side also minimalizes heartburn symptoms, he says.
When indigestion does set in, for immediate relief he advises people to take an over-the-counter antacid. Savides says that for most people with no long term heart burn problems who just need temporary relief from holiday over-indulgence, a liquid antacid will do the trick along with avoiding overeating and drinking.
For others with nagging problems he recommends patients try stronger over-the-counter medications. The next fastest remedy he recommends is an H2 blocker, also called an acid reducer. These medications take about an hour to bring relief.
If neither of these products reduces symptoms he suggests people go for the third and highest class of medications, called proton pump inhibitors (PPIs), which reduce acid from the source. Although obtainable only by prescription, one of them, Prilosec, became available over-the-counter earlier this year. But he warns that PPIs are not quick, they take at least a day to take effect. If those stronger acid suppressing medications stop the heartburn symptoms, then the patients most likely have acid reflux.
“PPIs can be used to heal or prevent symptoms,” he says. “However, a large percentage of the population will get acid reflux on a daily basis. That’s one reason why people will take a PPI indefinitely. They’re very good medications and they reduce the acid better than the H2 blockers.”
A pharmacist can provide guidance on these over-the-counter treatments. Savides warns that patients who have frequent acid reflux symptoms for more than a year, and/or who require daily medication of heartburn type symptoms, should talk to their doctor because they may be at risk for having developed a complication of acid reflux called Barrett's esophagus. This is a condition where the acid has damaged the lining of the esophagus, and has lead to a change in tissue lining creating increased risk for esophageal cancer. He recommends that patients with chronic acid reflux undergo an upper endoscopy to determine any presence of Barrett's esophagus. If there is, patients should undergo periodic surveillance to ensure no cancers develop.
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