“I always read the last page of a book first so that if I die before I finish I’ll know how it turned out.”
― Nora Ephron, Heartburn
DO YOU GET HEARTBURN? Stomach contents heading back into the esophagus (gastroesophageal reflux) are not unexpected. For many, these episodes are fleeting and do not cause symptoms or injury to the esophagus.
Gastroesophageal reflux becomes a problem when it causes significant damage to the esophagus or symptoms.
Today we look at the physiology of gastroesophageal reflux, causes, symptoms, diagnosis, and potential non-medical interventions for management.
We’ll end with the observation that those who sleep on their left side have less potentially harmful stomach acid than others.
What is reflux (GERD)?
At your stomach’s entrance is a functional valve, a muscle ring known as the lower esophageal sphincter (LES). Usually, the LES closes after food passes through it.
If the sphincter does not entirely close (or it opens too frequently), stomach acid can move backward into your esophagus. With this retrograde acid flow, one can experience symptoms such as burning chest discomfort or heartburn.
If your symptoms of acid reflux occur more than twice weekly, you may have gastroesophageal (acid) reflux disease.
Reflux: Common risk factors
A common cause of acid reflux is a hiatal hernia. This condition happens when the upper stomach and the lower esophageal sphincter slip above the diaphragm (the muscle separating your stomach from the chest). If you have a hiatal hernia, acid can more easily move up into your esophagus, causing acid reflux disease.
Other risk factors for acid reflux disease include:
- Being overweight or obese
- Consuming large meals or lying down right after eating
- Eating certain foods, for example, such as spicy or fatty foods. Some get heartburn from citrus, tomato, mint, garlic, or onions.
- Drinking beverages such as alcohol, carbonated drinks, coffee, or tea
- Being pregnant
- Taking certain medicines (aspirin, ibuprofen, certain muscle relaxers, and some blood pressure medicines are examples)
Reflux (GERD): Symptoms
The Mayo Clinic (USA) explains that common symptoms of gastroesophageal reflux disease (GERD) include:
- Chest pain
- Heartburn (a burning sensation in your chest, typically after eating). Heartburn can be worse at night.
- Swallowing difficulty
- Regurgitation of food or sour liquid
- Lump in your throat sensation
This burning can occur anytime but is often worse after eating. For many, heartburn gets worse when they recline or lie in bed, making getting good sleep a challenge.
The Mayo Clinic offers that you should seek immediate medical care if you have chest pain (especially if you also have shortness of breath or jaw or arm pain). These may be symptoms of a heart attack.
Make an appointment with your doctor if you have severe or frequent GERD symptoms. Also, check-in with your healthcare provider if you use over-the-counter medications for heartburn more than twice weekly.
The perils of GERD
Did you know that more than 75 percent of individuals with asthma have GERD? Those with asthma are twice as likely to have GERD as those without the condition.
Gastroesophageal reflux disease may worsen asthma symptoms, and asthma drugs can worsen GERD. But treating GERD often helps to relieve asthma symptoms. The mechanism of action is not clear.
GERD (chronic acid reflux) can be dangerous or even life-threatening. It’s not the GERD per see that is the issue; instead, chronic GERD can promote:
- Esophagus inflammation (esophagitis). Stomach acid can irritate and inflame the esophagus lining, culminating in heartburn, chest pain, bleeding, or challenges swallowing.
- Barrett’s esophagus. About ten percent of those with chronic GERD develop this condition. Here, the long-term damage from acid hitting the esophagus lining can cause cells to be abnormal; when this occurs, we call it Barrett’s esophagus, a risk factor for esophagus cancer.
- Esophagus cancer. Adenocarcinoma is a cancer type that typically develops in the lower esophagus. Squamous cell carcinoma more commonly affects the middle and upper esophagus.
- Strictures. The damaged esophagus sometimes becomes scarred, resulting in narrowing of the structure. Strictures can make drinking or eating challenging.
GERD and sleep position
Medicines can help with GERD. Many can benefit from lifestyle interventions. For example, try sleeping on your left side. This position appears to be the best sleeping one for people with GERD, as it reduces reflux episodes. On the other hand, sleeping on your back can make reflux more likely.
An old-school trick is to raise the head of the bed. Propping it up (not just putting more pillows under your head) by at least six inches may reduce your reflux when you are lying down.
You can find some more intense interventions for GERD here:Treatment for GER & GERD | NIDDKYour doctor may recommend that you make lifestyle changes and take medicines to manage symptoms of gastroesophageal…www.niddk.nih.gov.
GERD — my take
If you have symptoms of GERD, please discuss them with a healthcare provider. Having a good weight can help us dodge acid reflux. In addition, don’t eat overly large meals or lie down immediately after eating.
Be careful with spicy or fatty foods, citrus, tomato, garlic, mint, and onions. I try to avoid peppermint in the evening but have no trouble with it during other times of the day.
I don’t drink alcohol but do consume e risk-increasing coffee and tea. I am sure you are not surprised that I don’t smoke. Finally, be careful with the medicines such as aspirin, ibuprofen, certain muscle relaxers, and some blood pressure medicines.