Rural Reflux

By Richard P. Holm, MD.
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​Mr. H came into the office because his wife made him do it. There was a guilty movement to his eyes, although he had the typical non-complaining, modest prairie-farmer way about him. He said his heart-burn problem was getting worse, particularly at night and when he has a second serving of ice cream before the ten o’clock news.

He admitted he had been chewing a bottle or two of Tums a day for several years, but the problem strangely got better about a year ago, until recent weeks. Now solid food like chicken breast wanted to catch on the way down. He admitted he had waited until he got the hay in before coming to the doctor.

About 35% of all people have acid reflux symptoms on rare occasion like once-a-year, and 20%, or about 50 million people in the U.S., suffer from recurring symptoms. They describe half-digested acidic food rolling up from the stomach, burning the esophagus, and into the throat and mouth.

Symptoms are generally made worse by big-belly-obesity; late in the evening food in the gut; caffeine, salt, and alcohol; certain arthritis and osteoporosis medicines; tobacco smoke; and sometimes by a stomach infection called H. pylori. And reflux is only made worse, more permanent, and destructive as it continues to occur.

The mainstay of therapy starts with avoidance of all those issues listed here, especially less food late in the day. Elevating the head of the bed with books under the bedstead is a powerful and underutilized treatment.

Fortunately, there are medicines that also can help. For occasional reflux, over-the-counter Mylanta or Maalox work, and these don’t stimulate acid-production like Tums, Rolaids, or baking soda. Fast acting, as-needed, histamine-2 blockers, like ranitidine (the generic version of Zantac,) also give quick relief. For persistent symptoms, slower-but-more-powerful proton-pump-inhibitors, or PPIs like omeprazole (or Prilosec) give a more enduring relief. But please remember: if reflux symptoms are severe enough to require the long-term use of any medicine, talk to your doctor. An underlying infection or cancer could be the cause.

I scheduled Mr. H for an EGD, where, under anesthesia, a scope was passed down the throat, esophagus, into the stomach and duodenum. We found a cancer in the lower esophagus. Following surgery, radiation, and some chemotherapy, the malignancy has not returned, and that was years ago.

Nowadays, when I see him in the clinic, he seems happy to see me, but it’s still only after the farm work is done, and only because his wife made him do it.

To hear more from Dr. Holm, visit his website, www.PrairieDoc.org. On Call with the Prairie Doc is produced by the Healing Words Foundation in association with the South Dakota State University journalism department and airs Thursdays on South Dakota Public Broadcasting Television at 7 p.m. CT, 6 p.m. MT, and streams live at www.PrairieDoc.org.