aswander

Heartburn is acid reflux. There are 2 main ways to develop reflux.

1) The first is when the lower esophageal spinchter mucle (an area of pressure at the bottom of the esophagous that prevents stomach contents from flowing upwards into the esophagous- we'll call it the "LES") weakens and becomes flaccid. Weight gain is the primary cause, but other things, like various prescription drugs can also weaken the LES - in particular, some classes of antidepressants, beta-blockers, and benzos like Xanax and Ambien.
You get heartburn because there isn't enough pressure in the LES to keep your stomach acid from getting out. Please note - reflux and heartburn have nothing to do with producitng too much stomach acid - it's the LES that is the problem.

2) The second way is to get a hiatal hernia. Typically it's caused by weight gain as well. A hiatal hernia occurs when a portion of the stomach slips up into the bottom part of the esophagous, exposing the esophagous to a lot of stomach acid. This can also be painful, but the symptoms are pretty much the same - heartburn.


You mentioned you'rre having a sensation of food getting stuck. I believe you are demonstrating symptoms of the other kind of acid reflux that is lesser known - larygopharyngeal reflux. This occurs when the other esophageal spinchter muscle, the upper one we'll call it the "UES", becomes flaccid. The UES is located at the top of the esophagous where it meets the throat. When acid escapes the esophagous compeltely, it can cause symptoms of laryngopharyngeal reflux. The four most common symptoms are:

1. Feeling of something stuck in the throat / sensation of lump
2. Difficulty swallowing
3. Chronic Cough
4. Sinusitis -like symptoms.

You can experience just one or all 4 of these symptoms. But they are caused by the same thing - declining pressure in the UES. Since you already have heartburn, you know you probably have trouble with the LES, so it's not surprising that the UES is now a problem as well.

The bad news is that laryngopharyngeal reflux (LPR) is usually with you for life. The good news is that 1) weight loss can help somewhat with the hearburn and 2)these conditions are easily treatable with medications.

The medication for treating both kinds of reflux is called a PPI (proton-pump inhibitor). These significantly reduce the amount of acid your stomach produces, thereby allowing less to get out of the stomach and into your esophogous and throat.

The most common PPIs are Nexium, Aciphex, Prevacid, Protonix and Prilosec. Only Prilosec is available OTC - but that's because it's the oldest PPI on the market. Nexium is the most recent PPI on the market, and is considered, in general, to be the best. However, reflux patients usually have to experiment with the different brands to find the one that works best for them. The PPIs have few side effects and are generally considered to be safe. Your Primary Care Physician can presribe them easily. You don't have to see a specialist quite yet if you don't want. Once you begin a steady regimen of PPIs, you should begin experiencing relief withing 2 weeks. Some people (myself included) experienced relief in 30 minutes after starting them.

I'd recommend that you choose Nexium, and that you start off with 2 doses per day. Most doctors prescribe one dose per day, which is adequate for heartburn, but not adequate for patients who are experiencing UES failure as well. For people suffering heartburn and LPR, you really need to take 2 doses a day. The medications are all somewhat expensive, so I hope you have insurance. The 4 prescription-only drugs run about $4 per pill without insurance, and a month on Prilosec 2x a day would cost about $45.00 OTC.

I'd strongly recommend that you start with Nexium 2x a day (taken together), and only begin to experiment with the dosage and brand once you have obtained relief. It is possible that Nexium won't work for you, and if that is the case, just switch to another PPI and see if that's effective. Some people have to try all 5 PPIs, but hopefully, you'll get a bull's eye on the first try.

I understand how being overweight may play into this - I gained 50 pounds a few years ago, and in the last 8 months I've lost 40 of them. I wish that it helped the reflux, but it didn't. However, I suspect that my eating large meals and large portions may have contributed to the distortion of the LES.

Remember - some people have just GERD. Some people have just LPR. But some people, like you and I, have both GERD and LPR. And anyone who has any LPR needs to treat it with 2 PPIs per day.

You might want to visit the GERD board, as about 50% of the posters have LPR and the other 50% have GERD.