It was a heavy lunch: cheeseburger, onion rings, a dash of hot sauce on both, followed by a slab of Aunt Betty’s deep dish apple pie. After the meal you squeeze behind the steering wheel of the pickup and suddenly it hits, that piercing hot sensation of heartburn. Pop a couple of antacids, however, and the discomfort goes away. Whew!
But what if the sensation never went away?
Gastroesophageal reflux disease, or GERD, is a digestive disorder that occurs when stomach acid repeatedly flows back into the esophagus, the tube that connects the mouth to the stomach. Stomach acid is just that, an acid that breaks down food in the stomach. Fortunately, the stomach has a tough inner lining to protect it. But the esophagus doesn’t.
In normal digestion, the lower esophageal sphincter opens up to allow food to move into the stomach. Then it closes to keep that food and stomach acid from flowing back into the esophagus. When the sphincter is weak or relaxes, the stomach’s contents can flow up into the esophagus. People who have GERD run the risk of serious damage to the tissues in the esophagus due to continual bathing in stomach acid. GERD is estimated to affect about 20% of adults and 10% of children in the U.S., according to the Cleveland Clinic.
While the lower esophageal sphincter naturally begins to weaken as one ages, there are other specific conditions which may cause GERD.
A hiatal hernia occurs when the top of the stomach pushes up through the hole in the diaphragm where the esophagus passes through. It squeezes in next to the esophagus, compressing them both and trapping acid. Hiatal hernias are very common. They usually occur gradually, and they can just as gradually worsen.
Pregnancy is a common cause of acid reflux. The pressure and volume in the abdomen can push, stretch and weaken the muscles in the diaphragm that support the lower esophageal sphincter. The condition typically will correct itself after birth.
Obesity increases the pressure and volume in the abdomen, which affects the lower esophageal sphincter much the same as pregnancy does. Being obese for many years can weaken the diaphragm muscle permanently. It’s also a common contributing factor to developing a hiatal hernia.
Smoking relaxes the lower esophageal sphincter, whether you are doing the smoking or simply inhaling secondhand smoke. Smoking triggers coughing, which opens the sphincter. Smoking also slows down digestion and causes the stomach to produce more acid.
GERD symptoms may be worse at night or while lying down; after a large or fatty meal; after bending over; or after smoking or drinking alcohol.
If heartburn seems to be happening more than several times a week, you should take steps to avoid it. Too much acid in the esophagus too often is unhealthy. It can lead to esophagitis, inflammation in the lining of the esophagus. Chronic esophagitis can cause chronic pain and complications, like ulcers in the esophagus. The esophagus may also develop scar tissue to protect it from chronic inflammation due to stomach acid. The scar tissues will make it narrower, which will make it hard to swallow, eat or drink. Stomach acid also may aggravate existing asthma or cause asthma-like symptoms in people without any preexisting respiratory conditions.
Some people can reduce acid reflux with lifestyle adjustments, like changing their eating habits, reducing alcohol and tobacco use, and losing weight. But for some, medicines to reduce stomach acid are necessary.
Certain actions can help you manage acid reflux on your own:
- Eating smaller meals. Larger meals expand your stomach and put pressure on the lower esophageal sphincter. Smaller meals digest faster and don’t stimulate the stomach to produce so much acid.
- Eating dinner earlier. Gravity plays a role in keeping acid down, so it’s a good idea to eat several hours before reclining in the living room or going to bed.
- Sleeping on your left side. This positions the lower esophageal sphincter in an air pocket above your stomach contents. Lying on your back or the right side submerges the valve.
- Quitting smoking and drinking.
Thanksgiving is right around the corner, so keep these tips in mind later in the month when you find yourself at a table loaded with good things to eat!