FUNCTIONAL HEARTBURN
I had a patient in the office recently and we discussed her “heartburn”. She clearly has gastroesophageal reflux disease (GERD), and it is the source of her cough and, most likely, her recurrent asthma symptoms. She has tried so-called proton pump inhibitors (PPI’s) without success. This is a topic which I have mentioned in many ways to the patient and it is clearly a problem for the Gastroenterologist to deal with, but the effects of this problem often cross over to the Pulmonologist.
First, it is important to understand that heartburn is the symptom and reflux of acid is the condition. From the pulmonary standpoint, acid reflux may result in persistent cough and hoarseness of voice, along with recurrent asthma symptoms such as wheezing, and in patients with long standing reflux, scarring in the lung bases due to chronic aspiration of acid.
The initial treatment for patients with recurrent heartburn symptoms is usually a PPI taken daily for a period of 1-3 months. This treatment is usually started by the patient’s family physician, but we have often started this treatment as well. We also ask that the patient refrain from caffeine, tomato products, chocolate or cocoa, anti-inflammatory agents, and alcohol.
When patients do not respond to this regimen it is time to see the Gastroenterologist. A likely cause is a functional or hypersensitivity disorder of the esophagus which will need further evaluation. If this scenario is familiar to you, talk to your doctor about a referral to a Gastroenterologist.
