There are always lots of interesting new findings presented at the American College of Gastroenterology (ACG) annual meetings, but also as always, some of this gastric and colonic news may be hard for some of you to stomach.
But hey! Swallow hard, work up some guts, and settle back with a cappuccino or latte (if that doesn't give you heartburn, of course) and read on, because there's something here for practically everyone.
First, now that I've brought up the subject of caffeine, which is notorious, of course, for making acid reflux symptoms worse, I'll start with studies at one of the ACG meetings that focused on GERD (gastroesophageal reflux disorder), a very common condition that is often undiagnosed and under-treated.
In GERD, stomach acid washes back into the esophagus - that tube that connects your mouth to your stomach. When acid enters the esophagus it irritates the esophageal lining, leading to inflammatory changes that in the worst cases can go on to become a condition known as Barrett's esophagus, a precursor to cancer of the esophagus, which is a deadly malignancy.
And the scary thing, folks, is that both GERD and cancer of the esophagus are increasing in prevalence in North America, and if that information has led you to spill any of you precious coffee, I apologize, but hey! you have to know these things.
Anyway, treatment of GERD starts with prevention, which includes avoiding excess alcohol, avoiding food products that make your symptoms worse (raw onions, for example, which I simply adore, are a real killer for me, so I've given up eating them, something that, for obvious reasons, has pleased my wife to no end), not smoking, wearing loose pants and undies (to minimize pressure on the belly), not bending over after eating (that one has been real easy for me to give up), avoiding large meals, especially fatty ones (that one hasn't), not lying down for several hours after eating, elevating the head of the bed (that gets gravity to help keep stomach acid contents down lower where they belong), and (but of course!) losing weight.
If those preventive strategies don't work, and they often don't, then a host of medications can reduce your acid output, the most effective being that class of medications known as proton pump inhibitors. Although these are excellent medications and ameliorate symptoms in most GERD sufferers, you must beware that when you try to get off them, as all GERD sufferers attempt to do periodically, you will run into a "rebound" phenomenon that can temporarily make your symptoms much worse.
Anyway, back to GERD studies I mentioned earlier. One study found that in many people, GERD significantly interferes with sleep, which will not, of course, surprise those of us who suffer from long-term GERD and who on many nights have awoken with pain, indigestion, or asthma symptoms (another ACG meeting study confirmed that stomach acid can indeed reflux up to irritate the airways at night, producing symptoms of asthma, but the researchers also concluded that GERD therapy will ameliorate that kind of nocturnal asthma). And of course, since many GERD sufferers sleep less soundly, according to this study, they also suffer much more from daytime fatigue than do non-GERDers, and they also complain of poorer quality of life.
This GERD-poor sleep link, by the way, also works the other way around, that is, another study found that people who complain of poor sleep and daytime fatigue (but who have not yet been diagnosed with GERD) are actually much more likely to have GERD than are people who sleep well, so the researchers advise that if you're sleeping poorly, and there's no good reason for it, you might want to talk to your doctor about seeing if you have GERD and getting treated for it.
Speaking of GERD therapy, another ACG meeting study concluded that getting surgery to correct GERD is not cost effective, which just confirms what other studies have shown, namely that surgery often doesn't work as well as it might for this condition.
You see, many GERD sufferers opt for surgery when their symptoms are so severe that they can't stand it any longer and medications are not helping, or because they don't want to take a lifetime of medications (unfortunately, many GERD sufferers, like me, are unable to discontinue their meds without the condition coming back).
In surgery for GERD, surgeons tighten the muscle sphincter between the esophagus and the stomach, the idea being that a tighter sphincter won't permit anything to spill through. So surgery sounds very appealing in theory: snip, cut, tighten, and no more symptoms or need for medications.
That, as they say, is the theory. But to cite Homer Simpson, "In theory, communism works, too," so several studies have concluded that surgery for GERD has drawbacks that make it less than ideal for many people.
First, depending on how tight the sphincter becomes, you may end up with discomfort after swallowing as well as trouble burping, and although most parents of teenage boys would at first think that anything that prevents burping is a blessing, the reality is that not being able to burp is very uncomfortable.
Equally important, long-term follow-up studies have shown that many people who have opted for GERD surgery nonetheless still have to take medications from time to time anyway, in other words, the surgery did not produce a tight enough sphincter to prevent all GERD symptoms.
And finally, because surgery for this condition is a relatively new phenomenon, no one yet knows what happens to these people 20 years on and more.