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Heartburn| Is it a heart related disease?

Heartburn: Is is a heart related disease?

Health experts from US Preventive Services Task Force released a guideline indicating that a low-dose of aspirin can help people in their 50s to reduce the risk of heart-related diseases.

The updated set of recommendations aim to add new information on the use of aspirin for preventive measures against certain types of heart diseases and cancer. The last published recommendation by the task force was released in 2009. It detailed that low-aspirin can help men aged 45 to 79 and aged 55 to 79 for women.

“In this recommendation, we try to provide additional guidance about who is most likely to achieve benefits from aspirin. We think for people taking aspirin to prevent cardiovascular disease, there is an additional benefit for colorectal cancer protection. We’re not recommending you take aspirin for colorectal cancer if you’re not at high risk for cardiovascular disease,” explained Dr. Doug Owens, a member of the task force and a professor of medicine at Stanford University.

Heart-related diseases include high blood pressure and high cholesterol. But what about heartburn?

Is heartburn a heart-related disease?

Heartburn is a burning sensation around the lower chest. It occurs due to acidic digestive juices that are washed back into the esophagus. Common causes of heartburn include bad eating habits such as overeating, hurried eating, not chewing the food well; excessive intake of oily foods, spicy foods, citrus fruits, chocolates, mints, and tomato products; smoking; being overweight; alcohol, coffee, and tea intake; tight clothing around the abdomen; lying down, bending over, squatting, and carrying heavy objects right after eating; weakened muscle that controls the opening of the lower end of the esophagus; and even pregnancy.

Common heartburn symptoms include burning sensation in the upper abdomen that moves up into the chest and sometimes up to the throat, belching, bitter or sour taste in the mouth, wheezing or choking sensation when asleep, discolored teeth, and chronic cough. It is important to pinpoint the cause of the symptoms because these symptoms can also be associated with heart and gastrointestinal problems.

There is no cure for heartburn but actions can be taken to alleviate the condition and lessen the risk. You may take antacids, but do take note that antacids can have side effects. You may also improve eating habits and reduce intake of foods that causes heartburn such as chocolates, oily foods, spicy foods, mints, tomato products, among others. Reducing weight and living an active lifestyle is also recommended. Quit smoking and learn how to manage stress properly. Avoid wearing tight clothing that squeezes the abdomen. Avoid lying or bending down immediately after eating. Lastly, elevate your upper body when sleeping.

If the condition still grows worse, it is best to consult your doctor.

GERD| Study finds LINX should be first line of therapy

GERD| Study finds LINX should be first line of therapy

Torax Medical announced completion of a landmark study confirming the long-term results of the LINX® Reflux Management System in controlling reflux-related symptoms and eliminating dependence on acid suppression medications called proton pump inhibitors (PPIs). Findings from the clinical study demonstrated that the LINX procedure normalized the amount of acid in the esophagus, while safely and effectively relieving heartburn and regurgitation, and improving quality of life without the need for PPIs. The LINX device was approved by the FDA in early 2012 and is currently the only medical device approved by the FDA to be safe and effective for the treatment of gastro-esophageal reflux disease (GERD). Authors of the clinical study, published this week in a leading medical journal; [Clinical Gastroenterology and Hepatology (] concluded LINX should now be considered a first-line anti-reflux therapy for appropriate patients.

All patients included in the LINX study had pathologic levels of acid in their esophagus, had compromised quality of life from their reflux disease and were refractory to continuous PPI therapy (median duration of treatment with PPIs was 5 years). The study’s efficacy endpoints for success at 5 years, restored quality of life and reduced PPI dependence, were both met.

Robert Ganz, MD, FASGE, Chief of Gastroenterology, Abbott Northwestern Hospital and Associate Professor of Medicine, University of Minnesota commented, “This study demonstrates the LINX procedure provides significant and durable improvement in heartburn, regurgitation, PPI independence and quality of life. Patients can now have a relatively simple procedure to restore their sphincter function and avoid the invasiveness required in fundoplication procedures. In my view, LINX represents the next generation of anti-reflux treatment.”

GERD| After 5 years…

85 percent of patients were free from daily dependence on PPIs
Bothersome heartburn was reduced to 11.9% from 89% at baseline
Bothersome regurgitation was reduced to 1.2% from 57% at baseline
Because medications are less effective at managing regurgitation, the near elimination of regurgitation in this clinical study after LINX represents an extraordinary benefit for patients with this life-altering symptom. Importantly, no new safety risks emerged during the 5-year follow-up period. If needed, the device can be removed and the rates for reoperation were less than the expected range for other anti-reflux procedures at 5 years. Overall, patients in this clinical study achieved significant clinical benefits from the LINX procedure; these benefits are now shown to be sustained at 5 years.

GERD|The Disease

Gastro-esophageal Reflux Disease (GERD) is a chronic, often progressive disease resulting from a weak lower esophageal sphincter that allows harmful gastric fluid to reflux into the esophagus, resulting in both pain and injury to the esophageal lining. Symptoms of GERD include heartburn and regurgitation, often associated with chronic sleep disruption, and may also include persistent cough, excessive throat clearing, hoarseness and a feeling of a “lump” in the throat. Acid reflux medications, such as Prevacid®, Nexium®, and Prilosec®, affect gastric acid production, but do not repair the sphincter defect, allowing continued reflux. The FDA has issued a series of statements on possible side effects of long-term PPI use including: possible fracture risk, low magnesium levels, and clostridium difficile-associated diarrhea. More recently, a study out of Stanford University published in the journal PLOS ONE showed PPI use may increase the risk of heart attack.1 Anti-reflux surgery called Nissen fundoplication reconstructs a new reflux barrier using a portion of the patient’s stomach which is wrapped around the lower portion of the esophagus. GERD is associated with a pre-cancerous condition known as Barrett’s esophagus, which increases the risk of esophageal cancer.

GERD|The LINX Reflux Management System

LINX is a small implant comprised of interlinked titanium beads with magnetic cores. The magnetic attraction between the beads augments the existing esophageal sphincter’s barrier function to prevent reflux. The device is implanted using a standard minimally invasive laparoscopic procedure and is an alternative to the more anatomically disruptive fundoplication, commonly used in surgical anti-reflux procedures. The LINX Reflux Management System is indicated for those patients diagnosed with GERD as defined by abnormal pH testing, and who continue to have chronic GERD symptoms despite maximum medical therapy for the treatment of reflux.

LINX does require a surgical procedure and is associated with potential risks, contraindications and life style modifications. For more information on LINX, including a statement of risks, please visit

GERD and Proton Pump Inhibitors: Are PPI’s Safe?

GERD and Proton Pump Inhibitors

Proton pump inhibitors have become one of the most heavily prescribed types of medications in the United States. The names of these medications have become familiar even to people who don’t have reflux. Protonix, Nexium, Dexilant, Aciphex and others have become almost as familiar to folks as Pepsi and Coke.
The fact that they are so ubiquitous leads many patients and doctors to assume that they are harmless. Research in this area is beginning to lead many patients and physicians to re-think this assumption and the risk/benefit of long-term usage of these medications.

To be fair, these medications provide an enormous benefit to many patients. Their ability to block the production of acid in the stomach allows ulcers to heal and greatly reduces the symptoms of gastro-esophageal reflux or GERD. These medications make people feel better and they do not want to stop taking them because GERD symptoms rapidly return when the medications are stopped in about 80% of patients. Despite the fact that the FDA has advised that no more than three 14-day courses be used on any given patient in a one year period most people take them on a daily basis for years. Subsequently we are seeing unanticipated side effects.


Although many of the documented side effects are mild many patients are starting to question the wisdom of long-term use. Recent news has begun to highlight some of the more dramatic risk factors, particularly heightened cardiac risks. Some have suggested the increased risk of heart attack among PPI users is up to 21%.

Proton pump inhibitors may increase heart attack risk.
The New York Times (6/11, Bakalar) “Well” blog reports that research published in PLOS One suggests that “proton pump inhibitors…may increase the risk for heart attack.”
The Washington Post (6/11, Bernstein) “To Your Health” blog reports that “after combing through 16 million electronic records of 2.9 million patients in two separate databases,” investigators “found that people who take the medication to suppress the release of stomach acid are 16 percent to 21 percent more likely to” experience a heart attack. Nicholas J. Leeper, an author of the study, “said the Food and Drug Administration ‘should be aware of these findings,’ but agreed that only a large, prospective clinical study…could establish whether the drugs are actually causing more heart attacks.”
On its website, CBS News (6/11, Seidman) reports, however, that “analysis of patients using another type of antacid drugs called H2 blockers…did not show this increased risk.”

This is a tremendously important issue as PPI’s account for BILLIONS of health care dollars being spent every year just in the USA. They are often being taken in a manner that is contrary to FDA recommendations and they may be putting many patients at risk for problems they may not be aware of. I personally see patients every month who are seeking surgical control of their reflux so that they can avoid the possible consequences of long term PPI use.

Is GERD Causing Your Cough?

GERD, heartburn, hernia


Is GERD causing your cough?

There are many reasons one may have a cough and GERD could be one of them. “Coughing is a protective mechanism your body uses to clear the airway,” explains Dr. Kevin Gillian, MD at The Virginia Heartburn and Hernia Institute in Lorton, VA. But what causes a cough? It turns out that it could be a multitude of things ranging from allergies to acid reflux to GERD. It’s impossible to always pinpoint the cause of a cough by how it sounds and for a persistent cough; you should always visit your physician. However, there are some key differences in coughs that may give you clues as to what’s going on.

Postnasal drip

This can be either a wet or a dry cough. Mucus dripping down your throat (due to either allergies or a cold) tickles your nerve endings and triggers coughing.

Other symptoms of a cough caused by postnasal drip may include; increased coughing at night and a tickly feeling at the back of your throat. If postnasal drip is caused by allergies, itchy eyes and sneezing may accompany the coughing.

If you suspect your cough is being caused by allergies, an over-the-counter antihistamine may help. If your coughing is caused by a residual cold, natural remedies like saline washes and steam could help relieve congestion, If your symptoms do not improve in 7 -10 days, see your doctor to rule out a sinus infection, which might require antibiotics.


A dry cough that ends with a rattle or wheeze may be caused by asthma. Asthma is a condition that is marked by airway restriction. This can cause difficulty breathing as well as wheezing and coughing.

Other symptoms of a cough caused by asthma may include increased coughing at night and while exercising.

If you think you may have asthma, you will need to see your doctor for diagnosis and treatment of this potentially dangerous condition. If your doctor suspects that you have asthma, he will most likely order a spirometry, a lung function test. . There are two types of medications to treat asthma; quick-relief drugs (bronchodilators, which make it easier to breathe) and drugs you take daily to keep asthma under control.


A chronic, hacking cough that produces a lot of mucus, particularly in the morning may be indicative of COPD (chronic obstructive pulmonary disease). COPD includes chronic bronchitis and emphysema. The main cause of COPD is smoking.,

Other symptoms of COPD may include decreased coughing as the day progresses; shortness of breath, especially with physical activity; wheezing, fatigue, and chest tightness.

If your doctor suspects COPD, he will usually recommend lung function tests such as spirometry and a chest x-ray. The disease is treated with meds like bronchodilators and inhaled steroids. If diagnosed with COPD, it is imperative to stop smoking. In extreme cases, you may need oxygen therapy

Medication-related cough

A group of drugs known as ACE inhibitors are commonly prescribed to treat high blood pressure. In about 20% of patients, they can cause a dry cough. A medication related cough usually begins a few weeks after starting these medication..

If your ACE inhibitor is causing your cough, talk to your doctor. If your cough is mild, your doctor may switch you to a different ACE inhibitor. If the cough is severe, your doctor may want to switch you to another type of blood pressure medication entirely, such as an angiotensin receptor blocker or ARB.


GERD (gastroesophageal reflux disease) causes a dry, spasmodic cough. GERD characterized by acid from your stomach backing up into your esophagus. GERD is the second most common cause of chronic cough, causing about 40% of cases, according to a 2006 review published in Nature.

Symptoms of a cough caused by GERD include increased coughing when you’re lying down or eating. Approximately 75% of GERD patients that have a chronic cough caused by GERD have no other symptoms. However, if there are other symptoms present they usually include heartburn, hoarseness and globus ( lump in the throat sensation).. Normally heartburn is an innocuous condition. However, “if chronic heartburn is left untreated, it can lead to Barrett’s esophagus, which is a precursor to gastroesophageal cancer” says Dr. Gillian.

To determine if your cough is caused by GERD, your doctor may order an x-ray of the upper GI tract and/or an endoscopy. Coughing caused by GERD is often not fully controlled by medications and lifestyle adjustments. Minimally invasive laparoscopic operations ike the Nissen Fundoplicaion and LINX procedure control reflux and thus can stop the cough or significantly improve it.

The evaluation of chronic cough from GERD and the surgery to correct it is available at the Virginia Hernia and Heartburn Institute