By Les Reiss, MD
Mounds
of cookies, platters of cold cuts, cups of eggnog and glasses of wine -- it’s
the holiday season. At this time of year, when we’re not shopping, it seems
like we’re eating and drinking. The stress of the holidays, combined with
over-indulgence at the table is the perfect recipe for that painful, burning
sensation in the upper abdomen known as heartburn.
While
it might be difficult to avoid all holiday-related stress, certain foods and
drinks are more likely to bring on heartburn than others. These include:
coffee, chocolate, peppermint, alcohol, fried foods, fatty foods, sugary foods
and citrus fruits and juices. In addition, heartburn can be exacerbated by the
use of tobacco, sudden weight changes, lying down, bending over and, of course,
stress.
It’s
true that certain foods and activities often help initiate a bout of heartburn,
however the condition is really caused by a muscle called the lower esophageal
sphincter (LES). The job of the LES is to maintain a constant pressure at the
lower end of the esophagus in order to keep it closed -- and keep stomach
juices in the stomach where they belong. Weakness in the LES, or undue upward
pressure caused by a large meal can cause it to open slightly, allowing a
reflux of stomach contents to re-enter the esophagus, causing the pain and sour
taste associated with heartburn.
You
needn’t worry too much if you experience heartburn occasionally. Most people
do. In fact, about 20 percent of all adults have heartburn at least once a
month. Heartburn that occurs about once a month is considered mild. A frequency
of once a week is considered moderate. Daily heartburn is considered severe.
Heartburn often increases during pregnancy when the stomach is pressed upward
and pressure on the LES becomes greater.
Many
people successfully treat their heartburn symptoms without seeing a health
professional. There are home treatment measures, lifestyle changes and
non-prescription medications that can be very useful. Some home treatment
measures include diet changes: avoid foods that are fried, fatty or high in
sugar content; decrease consumption of alcohol, coffee (even decaf), chocolate
and peppermint; and increase intake of fresh fruits (non-citrus) and
vegetables. Also, eat smaller, more frequent meals, and avoid eating right before
going to bed. Eliminate excessive bending, lifting, abdominal exercises and
tight belts. Lifestyle changes such as losing weight, stopping smoking and
decreasing stress can also help decrease heartburn.
If
home treatment and lifestyle changes aren’t enough to eliminate heartburn from
your life, you may want to try non-prescription medications. These come in two
forms: antacids and acid blockers. Antacids neutralize stomach acid and work
faster than their acid blocker counterparts. A liquid antacid works more
quickly than an antacid in tablet form. Their effect lasts for about one to two
hours. Antacids have side effects.
These can include diarrhea or constipation. Antacids can interfere with the
absorption of other medications, so you should check with a health professional
if you are taking any prescription medications.
Acid
reducers, now available over the counter, were previously only available with a
prescription. These medications decrease the amount of acid that the stomach
makes. Acid reducers generally provide relief for longer periods of time than
antacids. However, they take longer to work. Like antacids, acid reducers can
change the way other medications affect you, so check with your health
professional before taking one.
Most
often, heartburn is a mild condition that can be safely treated at home.
Sometimes, however, it becomes more serious and requires the attention of a
health professional. If your symptoms occur frequently (more than twice a week)
and last longer than four weeks, an evaluation by your physician is warranted.
Frequent heartburn that is not lessened by home treatment or lifestyle changes
might be a condition known as gastro esophageal reflux disease, or GERD. With
GERD, a persistent inflammation of the lining of the esophagus occurs and can
lead to other health problems such as swallowing difficulties, bleeding, weight
loss or a persistent cough (from acid being regurgitated into the lungs).
There
are a number of treatment methods for GERD. In addition to the home treatments,
lifestyle changes, antacids and acid blocking medications outlined previously,
other prescription medications, which increase the strength of the LES muscle,
are available. Endoscope surgery to strengthen the LES muscle may also be
considered in some cases.
In
general, heartburn is a fairly common condition for most adults and usually
isn’t a serious health concern. Taking it easy on the stress and enjoying
everything in moderation should help you to keep your heartburn in check,
leaving you free to enjoy the holidays this year.
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Dr.
Reiss is a board certified family practice physician at Raiter Clinic in
Cloquet.