In the last two to three years I’ve been having severe gastric reflux—even antacids can’t seem to ease the trouble. How does one develop such a problem, and why are some people with cystic fibrosis more susceptible to this condition than others? Is stomach surgery necessary, and does this operation really work?
What you are talking about is gastroesophageal reflux, which is the backflow of stomach acid up into the esophagus (the passage that connects the throat to the stomach). It is not unusual to have some reflux, but it is abnormal to have too much. Because the gastric fluid backflow is acidic, it irritates the more sensitive lining of the esophagus. This causes a burning sensation around the sternum (the upper front of the chest) and sometimes even in the throat. This irritation can also cause spasms in the esophagus: the pain feels like a tightening similar to that of angina (heart-related chest pain).
People with cystic fibrosis have a problem with reflux more often than the general population. Chronic coughing, which increases pressure in the stomach, can induce reflux. The problem can also be caused by a malfunction of the gastroesophageal sphincter (the muscle located at the stomach opening, which expands to let food through, then contracts to keep it in the stomach). Several factors influence the contraction of the sphincter: smoking, alcohol, coffee and chocolate can all weaken the contraction of the sphincter. Bronchodilator drugs such as theophylline and salbutamol (Ventolin) have the same effect.
How do you treat reflux? First, some basic advice: avoid big meals and eating before you go to sleep, raise the head of your bed and avoid factors that weaken the contraction of the sphincter. No need to discuss smoking, since we all know about its toxic effects on the respiratory system. You should not stop using bronchodilators, however, when they are needed in respiratory treatment. As far as medication goes, your first choice should be an antacid, which neutralizes acidity and can be effective when the problem is minor.
Antacids don’t work for long, however, and when the problem is more severe, products that reduce stomach acid production can be taken. Antihistamines such as ranitidine (Zantac) are effective; omeprazole (Losec), which belongs to another category of medications, is even better. If this treatment is insufficient, it can be combined with medications that accelerate the emptying of the stomach (e.g., Motilium or Prepulsid). These measures will control most cases of gastroesophageal reflux. Surgery is a final option and isn’t often resorted to; it is effective but risky, especially for patients suffering from serious lung diseases.