You knew better. You shouldn’t have eaten the greasy fried chicken along with the fried onion rings and spicy dipping sauce at lunch.  Eventually it comes back to haunt you in the form of  heartburn, acid reflux or GERD.  Whichever form it takes, it makes life unpleasant leading to feelings of stress, irritability and pain.

It all begins with the esophagus

The esophagus is a tube about 8-10 inches in length connecting the pharynx to the stomach. Its purpose is to pass food you’ve swallowed to the stomach.  Wavelike muscular contractions in the esophagus called peristalsis help move the food towards the stomach. As the food approaches the opening to the stomach, it has to pass through a ring of muscle called the lower esophageal sphincter (LES).  Normally the valve of the LES opens inward allowing food into the stomach and will then close tightly so the contents of the stomach don’t backflow up into the esophagus.  If the LES doesn’t close properly, contents in the stomach can enter back up into the esophagus.  The lining of the esophagus is not protected from the strong acidic contents of the stomach which can cause a burning sensation in your chest.

Heartburn, acid reflux and GERD – how are they different?

Heartburn is a burning sensation felt in the center of your chest near the heart, caused by a backflow of stomach acid into the esophagus.  The pain can be mild to severe causing a burning or tightening sensation in the chest and is sometimes mistaken for a heart attack.  

Other symptoms experienced might include:

·      Sour taste/burning in the mouth

·      Coughing, wheezing, sore throat or hoarseness

·      Difficulty swallowing

·      Burping and indigestion

·      Feeling like food you just ate is “stuck” in your throat

·      Lying down makes the feeling worse

Heartburn is quite common with more than 60 million Americans experiencing it at least once a month.

Acid Reflux is when the LES muscle is weak and doesn’t close properly, allowing acid from the stomach to move backward into the esophagus.  This acid causes a burning sensation which is heartburn.  

GERD or gastroesophageal reflux disease is a chronic form of acid reflux.  If you experience acid reflux more than twice a week or have swelling in the esophagus and the pain in not relieved by antacids or other over-the-counter medication, it is diagnosed as GERD.  If GERD is left untreated, acid from the stomach can damage the lining of the esophagus causing bleeding, ulcers and scarring.  Another consequence of GERD is Barrett’s esophagus which is caused by frequent exposure of cells lining the esophagus to acid from the stomach causing changes to the cells increasing the risk of esophageal cancer.  

Avoid the “burn” with these dietary and lifestyle modifications

·      Avoid large meals – When you eat a lot of food at one time, it increases the likelihood of reflux.

·      Reduce total fat intake – Fried foods and foods high in fat can weaken the LES muscle in addition to staying too long in the stomach as they take longer to digest.

·      Certain foods and beverages can weaken the LES muscle – 

*Chocolate – It contains methylxanthine which can cause relaxation of smooth muscle reducing LES pressure.

*Coffee- Either with or without caffeine, it may promote GERD but this depends on individual tolerance.  It can also increase the acid content in the stomach.

*Peppermint, spicy foods. carbonated beverages, citrus juices and tomato products – These substances may weaken the LES muscle and may irritate a damaged esophageal lining but again, depends on individual tolerance.  They can also increase acid content in the stomach.

·      Chew non-mint gum – This increases saliva production, increases peristalsis helping to move the stomach contents into the small intestine more quickly and decreases acid in the esophagus.  

·      At the end of a meal, drink a small glass of water. This washes down and dilutes stomach acid that could backflow into the esophagus.

·      Drink beverages that don’t promote heartburn – water, mineral water, noncitrus juice, decaffeinated tea, and nonfat or lowfat milk.

·      Increase fiber – The more fiber you eat, the less likely you’ll experience heartburn.  Include more fruit, vegetables, whole grains, beans, nuts and seeds.

Other nondietary modifications to try:

·      Lose weight if overweight – Excess weight can press against the stomach and increase the pressure going up toward the LES.

·      Avoid wearing clothing fitting tightly around the abdominal area.

·      Don’t smoke – This can increase the amount of acid secreted by the stomach and interfere with the function of muscles helping keep acid down.

·      Stay upright for at least 2 hours after eating – Lying down can lead to the stomach contents splashing up toward the LES.  Let gravity pull the stomach contents towards the bottom of the stomach.

·      Avoid exercise for at least 2 hours after eating – Exercise can jostle stomach contents making heartburn worse.

·      Avoid eating 3 hours before bedtime and elevating the head of your bed 6-8 inches by putting blocks of wood or bricks under the bedposts may prevent heartburn.  Simply stacking extra pillows under your upper body will probably not get quite the same effect.  

Paying attention to your body and how it feels after you eat can help you be aware of any symptoms of these conditions.  Try dietary or lifestyle treatments first to see if they relieve the symptoms but if they don’t, seek help from your physician to avoid more serious complications.