Reflux-ology

Gastro esophageal reflux disease is widespread yet still quite mysterious.

Can’t tolerate tomatoes? No more coffee for you — it doesn’t matter if it’s decaf or regular. Citrus fruits are off your list of favorite foods. Onions and garlic are okay once in a while. You can say a definite no to fatty and fried foods. Nothing too spicy! The real heartbreaker is not enjoying a glass of wine (might as well drink acid) and saying goodbye to chocolate!

This list of forbidden foods may look all too familiar to many of you; it certainly does to me!

More than 25 million Americans experience GERD (gastro esophageal reflux disease) symptoms every day. Reflux can occur in people of all ages, including children and babies. It is most common in people who are overweight, eat poor diets, have emotional stress and have a sedentary lifestyle. Pregnant women, especially those in their third trimester, can suffer from GERD, as can people who have asthma or diabetes. People with hiatal hernias and people over the age of 40 are also more likely to develop GERD. All in all, that covers much of the population!

Gastro esophageal reflux occurs when the lower esophageal sphincter (LES) opens spontaneously for varying periods of time or does not close properly. When the LES muscle relaxes or is very weak, the acid contents of the stomach can back up (or reflux) into the esophagus, causing inflammation. This typically brings heartburn, a burning pain in the lower part of the chest, behind the breastbone and in the mid-abdomen. Some people also experience regurgitation, a sensation of food coming back into the mouth, along with an acidic or bitter taste.

Other symptoms may include a chronic cough, asthma-like symptoms, non-cardiac chest pain, burping, nausea after eating or drinking, stomach discomfort and bloating. Among GERD sufferers, then, there are varied sets of symptoms and discomforts. Some may experience no symptoms at all. GERD is most bothersome after large meals, when bending over and while lying down at bedtime; it’s not pretty.

GERD can also be associated with another chronic condition called reflux laryngitis, laryngopharyngeal reflux, or GERD with throat and voice complications — the terminology seems to be in flux. The symptoms may include hoarseness, constant throat clearing, cough, sore or burning throat, difficulty swallowing and a lump-in-the-throat sensation. The esophagus is guarded by two ring-like sphincter muscles that close to prevent passage of, or back-up of, the stomach contents. When the upper sphincter isn’t closing, reflux occurs in the throat.

Reflux can also enter the sinuses and lungs and is then associated with post-nasal drip, chronic cough and asthma.

Given that lifestyle factors are a leading cause for the increasing prevalence of reflux, strategies to alter them probably hold the best promise for relief of symptom. If you smoke, stop. Lose weight. Eat small, frequent meals; this will put less of a strain on your stomach and esophagus. Wear lose fitting clothes around your waist. Watch when you eat and don’t lie down within three hours after eating; avoid late night meals. Sleep with your upper body at a 30% incline in your bed. Raising your mattress works best; extra pillows will not help.

Preventing acid reflux means knowing which foods can trigger heartburn problems and which are low-risk. The list is long:

• Citrus and tomato based foods: These increase the production of stomach acid
• Fatty and fried foods: Enzyme production has to increase in order to break down the fatty content, and fat takes longer to digest
• Alcohol
• Caffeine: coffee and tea
• Peppermint
• Garlic and onions
• Chocolate
• Vitamin C supplements
• Calcium citrate supplements

Other tips include eating small meals more often during the day to prevent the stomach from becoming too full and chewing gum after dinner to stimulate saliva production, which helps the stomach neutralize acid.

If you’ve been diagnosed with reflux, there are several options outside of lifestyle changes. Over-the-counter antacids such as Maalox, Rolaids and Mylanta can relieve mild symptoms of reflux. H2 blockers, over-the-counter and prescription strength, can provide short-term relief of GERD by preventing production of stomach acid. Proton Pump Inhibitors (PPIs) are prescription medications to block stomach acid production more effectively than H2 blockers. There may be a rebound reflux effect when PPI’s are discontinued and stomach acid may return worse than before, although this may subside after several months. The last resort is surgery.

There are many unanswered questions surrounding this disease and the various treatments. Is malabsorption of vitamins and minerals due to decreased acid production? Can long-term treatment use have adverse effects, such as vitamin B-12 deficiencies? Studies have shown this to be the case. Also, an article in JAMA* 2006 reports a higher incidence of hip fractures with long term usage in high doses due to decreased calcium absorption. Are there natural remedies that work?

More research is needed and I, for one, will be waiting.