Feel the Burn?

Jeff Ringhofer didn’t know that his very occasional heartburn was serious until, unable to swallow a Chicken McNugget, he wound up in the emergency room some years back. Then 39, Ringhofer traveled extensively as a vice president of marketing for a former employer, often eating dinner right before turning in for the night. “Your eating schedule is all screwed up, you eat a meal late at night with a couple cocktails, lay down to sleep, and you can’t because it’s all coming back at you,” he says.

Ringhofer learned that he had gastroesophageal reflux disease (GERD), frequent regurgitation of stomach acid that occurs when the lower esophageal sphincter, the muscle valve between the esophagus and stomach, doesn’t stay closed. Repeated exposure to stomach acid had damaged the lining of his esophagus, not only making it harder to swallow, but also greatly increasing his chances of developing esophageal cancer. (Ringhofer’s condition, called Barrett’s esophagus, increases cancer risk to 30 to 125 times that of the general population. It’s found in about 5 percent of GERD patients.)

Reflux twice a week might be cause for concern; daily reflux definitely is.

Once seen as innocuous, heartburn is occurring in more people and with greater severity than it used to. Doctors estimate that between 15 million and 30 million people in the United States experience reflux symptoms often enough—twice or more weekly—to be diagnosed with GERD. And GERD is strongly associated with a spike in esophageal cancer—the incidence of which is increasing faster than that of any other cancer in the U.S.—and a rise in cases of asthma and bronchitis.

But isolating specific causes of GERD is tough. Although people have had heartburn for “thousands of years,” says Dr. Ronald Soltis, a gastroenterologist at the University of Minnesota, “understanding the mechanism is still an evolving part” of treating GERD. Diet, genetics, other medications, other medical conditions, and even bacteria may all play a role.

Gut Busting

Our big, fat appetites are likely one reason why GERD is more common today, says Dr. Robert Ganz, a GERD specialist at Minnesota Gastroenterology, P.A., in St. Paul. Many recent studies have linked obesity with an increased incidence of GERD and of esophageal cancer.

“Overeating and being obese is probably the main issue,” Ganz says. “We don’t realize the extent to which we overeat, and that contributes to gastric distension.” A continually overstretched stomach weakens the lower esophageal sphincter over time, he says. First described in the 1930s, GERD was uncommon until the 1970s. (It’s probably no coincidence that Alka-Seltzer’s “Plop, plop, fizz, fizz” jingle debuted in 1979, becoming one of the most popular in history.) “Since then, the incidence of reflux has gone up like a hockey stick,” Ganz says. “It’s up 600 percent since then.”