Heartburn, Acid Reflux and GERD
By: Kenneth Ripp, M.D.
The late night dinner at the Mexican restaurant sounded like such a great idea, and the spicy food was served just as you like it. But now, 30 minutes after returning home, you need to get to sleep and there’s just one thing keeping you from falling off into dreamland: heartburn.
Normally, when we eat, our food passes down through the esophagus and into the stomach. At the entrance to the stomach is a valve, made up of a ring of muscle, called the lower esophageal sphincter (LES). Normally, the LES opens to allow food into the stomach and then closes as soon as food passes through. If the LES doesn’t close completely, or if it opens too often, acid is released into the esophagus. This is known as acid reflux. Acid reflux causes the symptoms of what is commonly known as heartburn.
If acid reflux occurs more than twice a week, you may have acid reflux disease, which is also called gastroesophageal reflux disease, or GERD.
There are a number of risk factors for acid reflux. One is a hiatal hernia. A hiatal hernia occurs when the upper part of the stomach and LES bulges above the diaphragm – a muscular wall that sits above the stomach. Within this bulge, or hernia, is stomach acid, which causes heartburn.
Other risk factors for acid reflux include:
• Eating large meals
• Lying down right after a meal or snack
• Bending over shortly after eating
• Being overweight
• Certain foods including citrus, tomato, chocolate, mint, garlic, onions, spicy and fatty foods
• Certain beverages including alcohol, carbonated drinks, coffee and tea
• Certain medications including aspirin, ibuprofen, certain muscle relaxers and blood pressure medications
While heartburn can cause intense pain that feels like it is near your heart, acid reflux has nothing to do with a heart attack. There are ways to differentiate between pain from heartburn and heart attack.
Heartburn typically begins soon after eating a meal and is characterized by a burning sensation in the chest. It intensifies when you bend over or lie down. The pain is often accompanied by a sour taste (acid) in the mouth. Coughing and sudden hoarseness are also symptoms of heartburn.
Pain associated with a heart attack is often accompanied by a tightening and crushing pain in the center of the chest. The pain often spreads out to the left arm, back, jaw and shoulder.
If you are unsure whether your pain is heartburn or heart attack, seek medical attention immediately.
If you have acid reflux symptoms two or more times per week and over-the-counter medications don’t bring relief, you should make an appointment to see your doctor. Often acid reflux and GERD can be treated successfully with diet and lifestyle changes.
This may include keeping a heartburn diary, to track which foods, if any, serve as common triggers to your symptoms. Avoiding those foods can help you avoid heartburn.
Other lifestyle changes to consider:
• Eat smaller meals
• Eat at least two to three hours before going to bed or lying down
• Quit smoking
• Never exercise on a full stomach
• Put blocks under the head of your bed to raise it at least four to six inches
• Avoid tight belts and tight clothing
• If you are overweight, take steps to lose weight
• Ask your doctor if any medication you are taking could be triggering your acid reflux symptoms
Medications are available to treat acid reflux. Antacids are available over the counter. In addition, your physician may prescribe other medications. This could include foaming agents – which coat your stomach to prevent reflux, H2 blockers to decrease acid production and proton pump inhibitors – which reduce the amount of acid your stomach makes.
Don’t combine more than one type of antacid or other medications without prior approval from your physician.
In severe cases of GERD medication and lifestyle changes do not alleviate symptoms and the disease continues to interfere with everyday life. In these instances, surgery may be considered. This procedure is considered a last resort for treating acid reflux disease.
In most cases, the last resort isn’t needed because diet and lifestyle changes help the majority of people successfully manage their acid reflux symptoms. If you experience acid reflux, one of the best things you can do to help yourself is to pay attention to what triggers your symptoms and then avoid those triggers. It sounds simple, but it is likely this one step can help you lessen your heartburn and perhaps even make it a thing of the past.
Dr. Ripp is a board certified family practice physician at Raiter Clinic.