Heartburn????

i have just been diagnosed with gilberts syndrome, but i have to have further tests because i am also suffering with heartburn, i am only 17 and am very fit, im a discus thrower at quite a high level so i train every day and eat a healthy diet, but i always have heartburn the doctor said this isnt normal for somebody of my age, could this be linked with gilberts syndrome or what else could be the cause, i am on tablets for it but it seems to me getting worse.

Gilbert's syndrome is a harmless condition unrelated to reflux and heartburn. As you probably know, it is the job of the liver to take the product of hemoglobin breakdown called bilirubin and combine it to another molecule, a process called conjugating the bilirubin to help eliminate it from the body. Because you don't do this normally, the unconjugated bilirubin levels rise in your blood, possibly even to the point of being visible as a yellowish cast t the skin called jaundice. Other causes of jaundice might be threatening, so until we know it's only Gilbert's syndrome, there might be some concern. But once the problem is identified, you never have to think about it again.

Reflux is a problem of the junction between the end of the swallowing tube, the esophagus, and the stomach. There is a sphincter there called the lower esophageal sphincter (LES) that normally prevents the backflow (reflux) of stomach acid into the lower esophagus. When the LES fails to prevent reflux, you are said to have gastro-esophageal reflux disease, or GERD, and the symptom caused by stomach acid's abnormal presence in the esophagus is called heartburn (technical name pyrosis). This problem is not known to be related to Gilbert's or the liver in any way.

Heartburn is common, but not normal at any age. It is no more ominous in a 17 year old than anyone else. It does need to be taken care of, however, as reflux can do more harm than merely cause heartburn. With time, the histology of the lower esophagus can change to resemble the stomach, a process called metaplasia and in this location named a Barrett's esophagus. The problem is that a small fraction of these become malignant (cancer) if ignored.

Also, chronically bathing the lower esophagus in acid leads to inflammation of the esophagus (esophagitis) which can lead to two more serious complications: [1] painful spasm of the esophagus, so-called diffuse esophageal spasm (DES), and [2] scarring of the esophagus with contraction and stricture formation which can narrow the esophagus and mage it difficult to pass some foods. Trouble swallowing is called dysphagia.

All of this can be avoided with medications that prevent reflux. The best at this are the PPI's (proton pump inhibitors) like Prilosec (over the counter) or Nexium, Protonix, Prevacid and Aciphex. Less effective than the PPIs, but still decent, are the H2-blockers like Zantac (ranitidine), Pepcid (famotidine) and Axid. Most H2-blockers are over the counter. The PPIs are once a day and last all day. The H2-blockers are good for 12 hours and should be taken at night.