Health & Fitness

Smoking, alcohol and weight contribute to reflux

Dr. Alberto Iglesias, surgeon at Memorial Hospital Miramar
Dr. Alberto Iglesias, surgeon at Memorial Hospital Miramar

Ronald Laugherty has dealt with symptoms related to acid reflux since he was in college.

“I was eating Rolaids like they were going out of style,” he said. “That to me was normal.”

Laugherty, 46, was diagnosed with gastroesophageal reflux disease, or chronic acid reflux, in his early 20s. Doctors also found he had Barrett’s esophagus, a complication of acid reflux that causes the lining of the esophagus to look like the lining of the intestine. Barrett’s esophagus increases the risk of developing esophageal cancer.

He also has a hiatal hernia, a condition in which part of the stomach pushes up through the hiatus, the opening in the diaphragm through which the esophagus passes, and into the chest. He may be able to have surgery to fix the hernia.

Laugherty has been taking prescription and over-the-counter medications to ease his symptoms.

“I guess these issues are truly never going to go away,” he said. “I’d do the surgery in a heartbeat if it would help.”

Acid reflux is a condition in which stomach acid is brought up into the esophagus and irritates the esophageal lining. At the entrance of the stomach is a valve called the lower esophageal sphincter, which separates the esophagus from the stomach. This valve opens for food to enter the stomach and closes to keep food and other stomach contents from re-entering the esophagus. When the valve relaxes too often or does not close all the way, stomach acid can move up into the esophagus and cause of acid reflux.

The condition affects both men and women, but according to Dr. James Leavitt, gastroenterologist at Baptist Health’s Galloway Endoscopy Center, the discrimination comes from some of the complications of acid reflux.

“The risk factors are the same,” Leavitt said. “The consequences can be different.”

Barrett’s esophagus, a condition that causes the lining of the esophagus to change and look like the lining of the intestine, is a precursor to esophageal cancer.

“This tends to be a disease of white men,” Leavitt said. He sees the illness in Hispanic men less frequently and rarely in black and Asian men.

Men’s lifestyle can also contribute to the slightly higher incidence of acid reflux. According to Dr. Jamie Barkin, professor of medicine at the University of Miami Miller School of Medicine, that’s because as men get older, they tend to decrease activity, increase diet and gain weight.

“The other thing men do more than women is alcohol intake, smoking and intake of nonsteroidal anti-inflammatories,” Barkin said. “Alcohol and smoking predisposes to reflux, NSAIDS can beat up the esophagus and you can get inflammation and and men don’t recognize their weight gain like women do.”

Obesity, diet, alcohol intake and smoking are all factors that contribute to acid reflux. Doctors recommend seeking medical attention if people experience symptoms of acid reflux — heartburn, stomach cramps, regurgitation, cough, difficulty swallowing or sore throat — twice a week or more.

Chest pain is another symptom. Dr. Alberto Iglesias, surgeon at Memorial Hospital Miramar, said the incidence of acid reflux in the United States is increasing because it’s being diagnosed properly.

“A lot of patients come to the emergency room with chest pain and think they’re having a heart attack,” Iglesias said. “It could be a heart attack, but patients sometimes leave the hospital and find out they have severe reflux. What’s important is that, because of the concern over heart attacks, people are seeking medical attention.”

When people seek treatment for acid reflux, doctors advise them to make lifestyle changes, like losing weight, eating smaller meals, cutting down on caffeine, alcohol and smoking and staying away from fatty foods and other dietary triggers of reflux.

“If you’re going to have pizza and know it gives you reflux, don’t be silly, just avoid the pizza,” Barkin said.

If lifestyle changes alone don’t work, prescribing medication is the next step. Proton pump inhibitors like Prilosec and Nexium work to reduce stomach acid production.

When people don’t respond to medications, there’s surgery. Laparoscopic Nissen fundoplication is done to recreate the damaged lower esophageal sphincter, the valve that allows acid to enter the esophagus. A part of the stomach is wrapped around the lower end of the esophagus to recreate the closing function of the valve.

Iglesias said people undergoing the surgery spend just one night in the hospital and experience few complications. The surgery treats hiatal hernias and severe reflux.

However, Leavitt said the surgery may not be a permanent cure for everyone 10 to 15 years down the line. He said there is a possibility that people who undergo the surgery will be back on medications after five to 10 years.

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