Will I ever be able to eat without bad heartburn? DR MARTIN SCURR answers your health questions
Q I have had persistent heartburn for some time, and was recently diagnosed with Barrett’s oesophagus. I take an omeprazole tablet after breakfast, another after teatime, and two teaspoons of Gaviscon before bedtime. Will it ever ease?
F. Busby, Worcs.
A Any persistent problem can be terribly frustrating but it is not the Barrett’s oesophagus that is causing your symptoms.
Barrett’s oesophagus occurs when cells that line the lower oesophagus — the tube between the mouth and stomach — are damaged by long-term exposure to stomach acid.
Any persistent problem can be terribly frustrating but it is not the Barrett’s oesophagus (pictured) that is causing your symptoms
By the way… allow virus patients time to recover
images of nursing staff clapping as once critically ill Covid-19 patients leave hospital is a cheering sight — but this is not the end of the story.
Many of those who have recovered are still far from being in full health, and might suffer from lingering lethargy or impaired mobility, for example.
I believe a plethora of new health problems is waiting in the wings, post-pandemic.
Even those who were not ill enough to have been admitted to hospital may be left with lingering health issues.
We know, for instance, that some people develop depression after experiencing other viral illnesses. There is no reason why Covid-19 should be any different.
Now is the time to identify those most at risk of failing to get back to full health and ask how to help them.
Should they have a chance to convalesce, for example? Up until the 1940s, spending a period of time relaxing in a peaceful rural environment, or by the sea, was regarded as an essential step towards the restoration of good health.
The discovery of a trio of drugs capable of curing tuberculosis in the 1950s meant the sanatorium industry died away.
Yet giving patients a chance to ease back into normal life has something to be said for it.
With that in mind, Covid-19 patients must not be pushed to go back to work or their normal life with indecent haste.
We must also be able to offer them the medical care they need after recovery.
Physios, dietitians, psychotherapists and GPs will all play vital roles here.
In this fast-paced world, great emphasis is placed on immediacy, but when it comes to recuperating from Covid-19, it may just require time.
This is due to reflux, when stomach acid spills up as the valve between the oesophagus and stomach relaxes at the wrong time. It is this that is causing your symptoms.
Repeated exposure to acid can lead to the development of pre-cancerous cells. These new cells can be identified via an endoscopy, in which the lining of the oesophagus is examined by passing a thin, flexible tube with a camera on it down your throat.
Biopsies (tissue samples) are then taken for laboratory examination. If the usual cell type, known as stratified squamous cells, have become cells more akin to those found in the stomach or intestinal lining, a diagnosis of Barrett’s oesophagus is confirmed.
As many as 5 per cent of middle-aged adults may have the condition, but it is only discovered if the acid reflux is causing symptoms such as heartburn. Indeed, Barrett’s is most often silent, and many cases may go undetected.
Patients are given acid suppression medication such as omeprazole and Gaviscon, as further reflux can damage the DNA of the Barrett’s cells. This, in turn, may cause them to become cancerous.
Remember that the risk of this sinister change is low — less than 1 per cent of those with Barrett’s will develop cancer this way.
The persistence of your symptoms despite the twice-daily omeprazole, a proton pump inhibitor that greatly suppresses stomach acid production, is not unusual.
Between 10 to 40 per cent of patients continue to experience some symptoms.
It is important to reinforce lifestyle modifications that are known to be helpful.
These include weight loss for those who are overweight, to reduce pressure on the stomach valve, and elevation of the head of your bed, to help gravity keep the acid in your stomach. Do this by placing a brick, for example, under each foot of the bed at the top end.
You should also avoid heartburn triggers such as fatty foods, chocolate, peppermint and caffeine.
Make your consultant aware of the continuing symptoms during your next endoscopy appointment, which forms part of the usual monitoring. Extra medication, such as the anti-acid drug ranitidine, may be recommended.