October 20th, 2010
09:43 AM ET
Every weekday, a CNNHealth expert doctor answers a viewer question. On Wednesday, it's Dr. Otis Brawley, a chief medical officer.
Last week, Dr. Brawley answered a question about whether Jessie from North Carolina has symptoms that could indicate gallbladder problems. This week, he offers another theory for what could be causing her pain.
Question asked by Jessie, North Carolina
My mom, grandma and older sister have all had their gallbladders removed. For the past month, I have been getting nauseated and/or experiencing pain in my upper belly after many meals. It seems as though I can tolerate little of any type of fat. The only thing that makes my discomfort manageable is Mylanta and Zantac. Are my symptoms and family history indicative of gallbladder problems? My doctor didn't immediately think so.
The symptoms you describe could be due to stones in the gallbladder and they could be due to peptic ulcer disease. However, your symptoms are classic for gastro-esophageal reflux disease or GERD.
GERD is a very common condition in which stomach contents including the acidic fluid secreted by the stomach and necessary for digestion are moving back up into the esophagus. In very bad cases people can actually have acidic stomach contents come back up into their mouth.
More commonly the acidic fluid goes to the lower to mid esophagus. It can cause a chemical burn and discomfort. Patients usually describe their symptoms as chest pain, heartburn, nausea, sour stomach, or indigestion. Some will describe the pain as in the mid-upper stomach.
Long-term reflux can result in esophagitis (an inflamed esophagus). This increases sensitivity to acidic stomach contents and foods. It can also cause scarring of the esophagus and increase risk of esophageal dysfunction and esophageal cancer.
GERD sufferers often report increased reflux and the pain after large fatty or spicy meals. Indeed, high fat foods are a real problem especially when eaten quickly.
Other foods that stimulate reflux are chocolates, alcohol, coffee, teas, and carbonated drinks, especially colas. The pain can often be relieved by eating bland low-fat food or by taking an antacid, particularly one that coats the raw burned areas of the esophagus.
Abdominal obesity is a major risk factor for GERD as the stomach is compressed by abdominal fat forcing acidic fluid up the esophagus.
Couch potatoes are at special risk for GERD and walking after eating a meal may prevent reflux by stimulating digestion.
Strategies to decrease reflux include avoiding foods that cause it. One can reduce the volume or size of meals and spread food intake out over several meals. It is also best to avoid food and drink for at least three hours before bed.
By lying down, the stomach is tipped sideways and the fluid can go up the esophagus. You might envision lying down as if one were pouring fluids from the base of a bottle (the stomach) up a long neck bottle (the esophagus). Some find comfort in propping the head of their bed on six-inch blocks.
Extra pillows do not help prevent reflux. Indeed, it may worsen GERD as it puts a bend in the torso which can squeeze the stomach, pushing its contents up the esophagus.
Physicians will sometimes suggest use of liquid and tablet antacid medications. People with more severe forms of reflux may benefit from oral medications such as the H2 blockers. Examples are cimetidine, ranitidine or the proton pump inhibitors such as lansoprazole and omeprazole.
Please note that many worry that the long-term effects of H2 inhibitors and proton pump inhibitors are not well defined.
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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.