Burn Baby Burn: Heartburn and Reflux
On occasion, you may experience burning or discomfort behind the lower breast bone, which is likely heartburn. Usually heartburn (also called dyspepsia) is temporary, and responds to an over-the-counter medication and avoiding foods or alcohol that triggers such symptoms. However, if this becomes an ongoing problem or interferes with your sleep or what you are doing, then you should consider seeing your healthcare provider (Mayo, August 2014).
When the acids from the stomach flows up through the esophagus (the pipe from the mouth to the stomach), we refer to this as reflux, or specifically gastroesophageal reflux, better known as GERD. Over time this can cause erosion or damage to the lining of the esophagus. The inflammation from the acid can cause narrowing of the esophagus, and it may be noticed as a discomfort when swallowing solid foods. It can also cause cell changes in that area that are precancerous called Barrett’s esophagus, which is much more serious (Mayo, July 2014).
The symptoms of GERD occur when the sphincter at the top of the stomach does not close after the passage of food or fluids, which is how the sphincter should function. (Another cause of GERD is a hiatal hernia when the stomach is pushed upward weakening the sphincter. This is often seen with obesity, but can occur in other situations as well (Mayo, July 2014). Common symptoms of GERD are: heartburn, burping, cough that mimics asthma, backwash of acidic fluid, ear pain and throat irritation (Marks, 2016). The diagnosis of GERD is usually made by the healthcare provider listening to your experience of symptoms and examining you. If there is the possibility of ulcers, a test can be done to see if the bacteria called heliobacter pylori (H. pylori) is present because this is treated more aggressively with antibiotics and acid blockers combined. For those with resistance to treatment, or continued or severe symptoms, there may be the need to see a gastroenterologist (doctor who specializes in the stomach and colon) for further evaluation.
Foods and beverages that are known to trigger GERD include: caffeine, chocolate, peppermint, fatty foods, spicy foods, fried foods, garlic, onions, tomatoes, carbonated drinks and citrus drinks. Keeping a food diary may help you to identify what affects you (ASGE, 2014).
The treatment of GERD should start with lifestyle changes including avoiding caffeine which can cause the sphincter to relax, allowing the backwash, to stop smoking, and dietary changes. Antacids can be taken if this is not a frequent problem. Another class of over-the-counter treatment choices include H2 (histamine 2) blockers, such as ranitidine. A medication called proton-pump inhibitor(PPI) is often prescribed, but it must be taken on an empty stomach to work properly. The PPI works by reducing the acid that is produced in the stomach. Chronic use of PPIs has risks that you must know about. There are risks of: osteoporosis, reduced absorption of vitamin B12, they may cause low levels of magnesium, and may lead to clostridium difficile infection of the colon (Marks 2016). In recent studies, there has also been some concerns of long-term, high dose PPI use being related to kidney damage, but gastroenterologists have mixed thoughts about the interpretation of the studies. It is suggested that you talk to your healthcare provider about what treatment is right for you, and how long you can continue such a medication (American, 2016).
Another valuable resource is www.drgourmet.com, which offers free dietary information on GERD and other medical conditions. Dr. Timothy Harlan (chef turned doctor), helps patients understand that food IS medicine.
Lifestyle changes are recommended in both treatment and prevention of reflux include not just dietary changes, but the following:
avoid caffeine, alcohol, tobacco and stress
Avoid eating large meals, especially late at night
Avoid lying flat for an hour or more after a meal
Walking for 15-30 minutes after a meal aids in digestion
Chewing gum after a meal may increase the saliva you swallow, and reduce the acid that is in the stomach and esophagus as well
Raise the head of your bed by 6-8 inches
American Gastroenterology Association (April 2016). How to talk with patients about PPIs and chronic kidney disease. Retrieved on 3/6/17 from www.gastro.org/news_items/how-to-talk-with-patients-about-ppis-and-chronic-kidney-disease.
ASGE American Society for Gastrointestinal Endoscopy (2014). Diet and gastroesophageal reflux disease (GERD). Retrieved on 3/6/17 from www.asge.org/docs/default-source/about-asge/newsroom/doc-gerd_infographic_final.pdf.
Marks, J. (Oct 2016). GERD (Acid Reflux/Hearburn). Retrieved from www.medicinene.comgastroesophageal_reflux_disease_gerd/article.htm on 3/6/17.
Mayo Clinic Staff (July 2104). GERD. Retrieved on 3/6/17 from www.mayoclinic.org/diseases-conditions/gerd/basics
Mayo Clinic Staff (Aug 2014). Heartburn. Retrieved from www.mayoclinic.org/diseases-conditions/heartburn/basics
University of Virginia Health System (2014). Diet tips for gastroesophageal reflux disease. Retrieved on 3/6/17 from http://med.virginia.edu/ginutrition/wp-wontent/uploads/sites/19/2014/04/GERD-12-19-2014.pdf.