AOPA Pilot Magazine - March 2011 - 34

FLYWELL

BY DR. JONATHAN SACKIER

Heartburn and the art of aircraft maintenance

be sedated, so have no worries. A GI series in which X-rays are taken after a barium drink may show areas of narrowing, hiatal hernia, or obvious reflux. Incidents of reflux are measured over 24 hours by placing a thin esophageal probe connected to a mini-computer clipped to your belt. Pressures in the valve and esophagus are measured with a probe to define what therapy is best for you. Initially, address those things that are under your control—stop smoking, lose weight, wear loosefitting clothes, avoid attack-triggering foods and dollars [a real number, my son assures me] and we’re out of stock for six months.” But there’s another kind drinks (a food diary really helps), elevate the head Dr. Jonathan of heartburn. of your bed, don’t get horizontal directly after eatSackier is a Heartburn is often a manifestation of gastroing, or bend at the waist to pick up objects. Stress U.K.-trained esophageal reflux disease (GERD) when stomach or weight reduction with acupuncture or yoga may surgeon and active contents wash up into your gullet or mouth. The help, and some swear by naturopathic therapies private pilot. acronym “GERD” sounds like the noise made when such as chamomile, slippery elm, or licorice. gastric contents flow up the esophagus! The stomIf simple antacids fail, over-the-counter (OTC) ach has a special lining to withstand the environment within, medicines that reduce gastric acid such as cimetidine (one of but the esophagus does not—that’s why symptoms are expe- several “H2 receptors”) may help. Acid may also be blocked rienced as acid inflames and erodes the wall. These include with OTC “proton pump inhibitors” such as omeprazole or burning sensations behind the breastbone or neck, bitter taste lansoprazole. If these don’t do the trick, your doctor has stronin the mouth, constant sore throat, chronic dry cough, vom- ger versions available and may add another class of drug that iting, problems swallowing, and sometimes—especially in enhances esophageal propulsion. children—asthma, as acid enters the lungs. If drugs don’t work, symptoms dominate your life, or you Chest pain always merits a visit to the doctor, but if GERD want freedom from medication, there are surgical options. is on the radar, consider going early because this condition is Often done under laparoscopic guidance—the scope-througheasier to treat early. Many people try over-the-counter medica- the-belly-button routine—in which surgeons create a new tions such as antacids. If these initially stop all symptoms but valve by wrapping the top of the stomach around the lower they return, go to your doctor, as GERD may be progressing or esophagus, hiatal herniation is fixed if present. In good hands, something more sinister is lurking. the results are impressive; use resources such as the American The lower end of the gullet has a complex valve to allow food College of Surgeons website to find a qualified surgeon near down and prevent stomach contents from seeing the light of you (www.facs.org). Less invasive alternatives still being evaluday. If this fails, sometimes in conjunction with hiatal her- ated include cinching together where stomach and esophagus nia, GERD can follow. The “hiatus” is a gap in the diaphragm meet or using radiofrequency energy to induce lower esophathrough which the esophagus passes from the chest to join geal controlled scarring. the abdominally located stomach. If circumstances allow, the Before embarking on any treatment journey, avail yourself of stomach can take a trip north to a different climate inside the the benefits of the AOPA Medical Services Plan to help obtain chest—a hernia (see “Fly Well: Hernias are Like Troublesome less expensive drugs and navigate FAA regulations (www.aopa. Neighbors,” November 2010 AOPA Pilot). org/info/certified/medical/index.html). Other issues causing heartburn are obesity, pregnancy (the Left untreated, GERD can get really troublesome, beyond its enlarged uterus raises pressure inside the abdomen), smoking irritating symptoms. Constant exposure to acid causes esopha(it really mucks up everything), diabetes (so lay off the sodas), geal scarring and narrowing, interfering with swallowing—or and some rarer conditions with damaged connective tissue or painful bleeding ulcers can form. Eventually, as the gullet lining Zollinger-Ellison syndrome, in which the stomach makes too attempts to deal with all this aggravation, Barrett’s Esophagus much acid because of gut or pancreatic tumors. can develop—not a good thing as this can become cancerous. When you go to your doctor he or she will ask seemingly If your heartburn only occurs after a $100 hamburger or odd questions and prod and poke to ensure your symptoms are opening your maintenance bill, no problem—but if it’s more not due to something else, because GERD has few obvious signs. regular, see your doctor. Now, if someone can just help me with Referral to either a gastroenterologist or a surgeon with an inter- my sprogulator problem…. est in GERD and diagnostic tests will follow, beginning with an endoscopy or a look-see with a flexible telescope first; you will E-mail the author at jonathan.sackier@aopa.org. 34 • MARCH 2011

ou might experience heartburn when, during aircraft maintenance, you are told, “The left sprogulator needs replacing; it will cost a gazillion

AOPA PILOT •

http://www.facs.org http://www.aopa.org/info/certified/medical/index.html http://www.aopa.org/info/certified/medical/index.html

AOPA Pilot Magazine - March 2011

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