The question: I was diagnosed with reflux about six months ago. I'm on medication – now what? Does it ever get better? Can it lead to cancer? What is the best course for me to follow from now on?
The answer: We can all feel bloated, overly full and have occasional heartburn after indulging in a spicy or fatty meal. For most people, this is short-lived and doesn't cause any long-term effect. For others however, these uncomfortable symptoms can persist and lifestyle changes or medications may be needed.
Let's review how and why reflux happens in the first place: When you eat, food goes down the throat into the esophagus to the stomach. Once food enters the stomach, a ring of muscle known as the lower esophageal sphincter acts as a doorway to prevent a backflow of stomach contents. Sometimes, if this doorway becomes loose or the stomach is too full, partially digested food and acid can leak back up into the esophagus, causing a burning sensation that is felt as heartburn.
Let me reassure you that having reflux alone does not mean you will develop cancer. Long-term exposure to acid can cause inflammation and damage to the cells of the esophagus, but it's only in rare cases that this leads to cancer. However, reflux should be a warning sign to make adjustments to your diet and lifestyle to decrease acid production and reduce the cancer risk.
It sounds like you're already taking the right steps to manage your reflux. The first change that I suggest to my patients who struggle with these symptoms is to identify what may be triggering them. Common culprits that increase acid production and irritate the stomach are spicy, fatty or protein-rich foods. Caffeine, chocolate, peppermint and alcohol can also trigger reflux symptoms. Smoking can loosen the sphincter doorway, so try to cut back on cigarettes if you have a habit. Finally, eat smaller portions and avoid lying down after meals to reduce backflow.
If these changes don't help with your symptoms, medications may be needed. Over-the-counter antacids can sometimes do the trick, but you may need prescription-strength formulations to noticeably decrease acid production.
With lifestyle modification and medications, the stomach and esophageal lining should heal and your symptoms will resolve. If you've been on medications for several months and symptom-free, you can try working with your doctor to taper the dosages. During this time, you should still maintain the lifestyle changes you've made. But you may find that you'll need to continue medication long-term may in order to control the symptoms.
If you have symptoms despite taking medication, there may be something more serious than just reflux or indigestion. It would be prudent to have further testing done. Ask your doctor about a barium swallow or gastroscopy to look directly at the esophagus. If you're having persistent symptoms – especially more serious ones like difficulty swallowing, pain or unintentional weight loss – contact your doctor for a possible referral to a specialist.
Dr. Sheila Wijayasinghe is the medical director at the Immigrant Womens' Health Centre, works as a staff physician at St. Michael's Hospital in their Family Practice Unit and at Hassle Free Clinic, and established and runs an on-site clinic at Women's Habitat Shelter in Etobicoke.
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