Fire in the Hole

They say the way to a man’s heart is through his stomach. But by the look of the Tulsa World headlines this morning there is no longer a gender bias. To add insult to injury, our enlarging dimensions  becomes a source of chest pain as well. Now, chest pain definitely gets your attention (as well as the health care professionals around you), but when you know it’s coming from your stomach it’s a constant source of frustration. In medicine, we call this noncardiac chest pain (NCCP), meaning we’ve ruled out the heart as one of the sources of pain (if the heart hasn’t been ruled out, then do not go past Go but get thee to a physician pronto!).

When we have NCCP one of the most common causes is gastroesophageal reflux disease (GERD). When we have GERD we could easily think we’re having a heart attack—intense pain in the chest that travels to the neck, arms or back. It may start after a meal, or when we lie down, or after heavy exercise or stress. Sometimes the pain lasts only briefly, or may last all day long and even for several days. Intense squeeze pain for some and burning pain for others. No wonder we pass the Pepto Bismol around the table as fast as Grandmother’s cranberry salad.

Interestingly, there is no agreement on one cause for this pain. Gastric acid, or bile, literally running uphill may damage the esophageal lining. Some speculate it could be physical stretching of the esophagus resulting in spasm that activates pain fibers. Any way you slice it, modern medicine is more than happy to come to the rescue. Pharmaceutical companies continue to develop, produce and most importantly sell more solutions than “Carter’s got pills.” There are more myachinggutazoles being produced almost endlessly that, when effective, cause us to dip in the medicine jar for more. One popular purple pill earned it’s makers over $5.6 billion last year. No wonder they advertise right after the pizza commercials.

If we want to be pill-less we can elevate the head of our beds about six inches. Sleeping slightly downhill allows the gastric acids to drain normally without much of a sensation that we’re going to end up on the floor. Certain foods like chocolate, alcohol, caffeine, and peppermints relax the esophagus one-way valve allowing bile to head upstream. Reducing those in the diet (okay, maybe not chocolate) may help with symptoms. Not all experts would agree however that these steps are effective. What they do agree on is weight loss for those overweight or obese. The more abdominal fat we gain, the higher chance of significant gastric reflux and heartburn. The increased abdominal fat squeezes the stomach, which acts like a water filled balloon and sends contents in all directions. Losing the belly fat can sometimes dramatically reduce or completely eliminate GERD without pills, effectively putting out the fire in the hole. And seeing chest pain completely disappear while finally being able to touch our toes is a beautiful thing too.

About Steve P. Sanders

A general internist writing and sharing ideas and art.

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