Back in 2014, I had a procedure called an endoscopy — the doctor threaded a scope with a camera on the end of it through my mouth, down my esophagus, and into my stomach. He was looking for the cause of some strange symptoms I’d been having for about a year.
- I would often get hoarse after eating or drinking something and have to clear my throat.
- A few times food got caught in my esophagus, which is pretty freaky. Things like raw vegetables or peanut butter. All I could do was stay calm and take deep breaths and within a few minutes, all would be clear.
- Without warning and usually when I was resting I would sometimes get a sharp, sharp pain in the middle of my chest. The first time it happened, I had a cardiac workup to make sure it wasn’t a heart attack.
The endoscopy and the sharp eye of Dr. Doug Howell, now a retired gastroenterologist, revealed the cause of my symptoms. Acid. “It’s due to leakage of stomach acid because of what’s called an incompetent lower esophageal sphincter,” said Dr. Howell.
A sphincter is a circular band of muscle. When we swallow the one in the lower part of the esophagus relaxes so that food and liquid can pass down into the stomach. Then it’s supposed to close so that stomach acid doesn’t flow back up into the esophagus. My valve doesn’t close properly. As Dr. Howell put it, “Your sphincter has failed you, Diane.”
The persistent leakage of acid caused some esophagitis (inflammation) in the lower part of my esophagus, which made it narrower. There’s a name for the narrowing: Schatzki ring. “Everybody has a ring,” Dr. Howell explained. “It’s usually wide enough so that nothing ever gets caught. If it gets a little bit damaged, a little bit inflamed, it tends to narrow and catch your food.”
During the procedure, he stretched the Schatzki ring with a balloon. So far, knock on wood, I have not had further problems with food sticking. If it begins happening again, I might have another stretching procedure.
The constant hoarseness was also due to acid flowing back into my esophagus as were the sharp pains I got on occasion. “The cause of an esophageal spasm is usually acid reflux,” explained Dr. Howell. “Acid goes up the esophagus, which is unable to protect itself because the valve is no longer working. The remainder of the esophagus goes into an intense spasm to protect you from the acid getting all the way up your esophagus into your throat. It’s sort of a protective reflex.”
The most reassuring information he gave me was that I didn’t have cancer or a precancerous condition. The name for what I did have is gastroesophageal reflux disease (GERD). Everybody experiences reflux. When it happens a lot, or symptoms and/or complications occur, it’s considered GERD — an extremely common disease in this country — affecting nearly 30 million people. I didn’t have any of the common risk factors. Just the luck of the draw.
Common risk factors for GERD
- Hiatal hernia
- Connective tissue disorders, such as scleroderma
Being hoarse and other GERD symptoms
Here’s a list of common symptoms:
- Burning sensation in the chest (heartburn), sometimes spreading to the throat
- Sour taste in the mouth
- Chest pain
- Difficulty swallowing
- Dry cough
- Hoarseness or sore throat
- Regurgitation of food or sour liquid (acid reflux)
- Sensation of a lump in the throat
- Nausea after eating
Nearly everybody gets heartburn from time to time. If your symptoms are severe or you have to take over-the-counter medications for heartburn more than twice a week, you should see your doctor.
Stomach acid that persistently leaks into the esophagus can lead to a precancerous condition called Barrett’s esophagus. The lining of the esophagus becomes damaged and increases the risk of a type of esophageal cancer called adenocarcinoma. Dr. Howell says adenocarcinoma of the esophagus is the number one most rapidly increasing cancer in our society.
Known risk factors for adenocarcinoma of the esophagus
- Barrett’s esophagus
- Obesity (which increases the risk of GERD)
Some people might opt to take an over-the-counter PPI or proton pump inhibitor, which prevents the stomach from producing acid. Because using it long-term may reduce the absorption of important nutrients, vitamins, and minerals and increase the risk of bone fractures and some infections, I decided to carefully weigh the risks and benefits, and start with some lifestyle changes instead.
The Mayo Clinic offers a list of lifestyle changes that might help reduce GERD symptoms:
- Maintain a healthy weight. Excess pounds put pressure on your abdomen, pushing up your stomach and causing acid to back up into your esophagus.
- Avoid tight-fitting clothing. Clothes that fit tightly around your waist put pressure on your abdomen and the lower esophageal sphincter.
- Avoid foods and drinks that trigger heartburn. Common triggers such as fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine may make heartburn worse. Avoid foods you know will trigger your heartburn.
- Eat smaller meals.
- Don’t lie down after a meal. Wait at least three hours after eating before lying down or going to bed.
- Elevate the head of your bed. Place wood or cement blocks under the feet of your bed so that the head end is raised by six to nine inches. Raising your head with additional pillows is not effective.
- Don’t smoke. Smoking decreases the lower esophageal sphincter’s ability to function properly.
The biggest change for me was to avoid the foods and beverages that seemed to trigger my hoarseness. In particular, I gave up minty things, which I consumed more than I realized — Mentos, Altoids, mints, tea — I like them all, but apparently, peppermint relaxes the valve that has failed me. Giving them up definitely made a difference. Caffeine can also trigger it, but I really enjoy that early morning cup of coffee, so didn’t give that up.
As for other things on the list, I would have to say rather than avoid, I don’t overindulge, but I do indulge on occasion, which means I still contend with hoarseness and having to clear my throat, but no sharp pains in my chest (have to knock on wood, again). I now have a prescription for a medication called Famotidine, which I take as needed.
If you are interested in alternative treatments, talk to your doctor about what may be safe for you. Options may include:
- Herbal remedies. Some used for GERD symptoms include licorice, slippery elm, chamomile, and marshmallow. Some herbal remedies can have serious side effects, and/or may interfere with medications. Ask your doctor about a safe dosage before beginning any herbal remedy.
- Relaxation therapies. Techniques to calm stress and anxiety may reduce signs and symptoms of GERD.
- Acupuncture. One small study reported that acupuncture helped people with heartburn that persisted despite medication.
I’d rather not have GERD, but I’m glad to know what was causing my strange symptoms. If you have it too and want to pass along some advice, please do.