Heartburn and GERD
Heartburn or acid indigestion, is a burning sensation caused by irritation of the esophagus, the hollow, muscular tube that carries food and fluids from the mouth to the stomach. If it occurs 2 or more times a week, and/or is associated with complications, it is diagnosed as Gastroesophageal Reflux Disease (GERD). The esophagus becomes irritated when food and fluids mixed with acid in the stomach, backs up into the esophagus. The stomach can tolerate the acidic blend but the esophagus doesn’t have the same protective mechanisms, so stomach contents can injure it.
Normally, stomach contents are brought to the small intestines, but a backward flow of stomach contents can occur if the valve between the esophagus and stomach becomes displaced upward and loses its support from the surrounding diaphragm. This displacement of the valve, – a hiatal hernia, is caused by excess pressure in the abdomen from pregnancy or abdominal obesity. The unsupported valve allows reflux to easily occur, especially with lying down after eating.
Overeating can also physically push food back through the valve. Bending over after eating can also have this effect. Some medications and foods can weaken the valve and allow stomach contents to back up into the esophagus and irritate the tissues. Medications that can weaken the valve include aspirin, ibuprofen, the high blood pressure and heart drugs calcium channel blockers and beta blockers, the asthma medication theophylline, nitrates and nitroglycerin used for angina, and anticholinergics like medications for incontinence.
Foods and fluids that can have this effect on the valve include spicy foods, and acidic foods such as tomatoes, grapefruit and other citrus fruits. Other foods or fluids that can worsen reflux: chocolate, coffee, tea, carbonated drinks, peppermint, garlic, and yellow onions. Fatty foods delay stomach emptying and thus worsen heartburn. Drinking alcohol also can result in reflux. Smoking stimulates the release of stomach acid and the nicotine in it weakens the valves.
Heartburn can be prevented and the frequency of it decreased by avoiding eating for three hours before going to bed, eating smaller meals, and raising the head of the bed 8 to 10 cm with blocks so that gravity prevents food from backing up. If you need to lie down after eating, try lying on your left side so your stomach is lower than your esophagus, making reflux less likely. Avoid wearing constrictive clothing. Also, cut back on fatty, spicy or acidic foods – especially later in the day. If you are taking a medication that can cause heartburn, discuss this with you doctor.
Although antacids can give relief from heartburn, they contain ingredients that can cause problems for those with high blood pressure, heart arrhythmias, kidney disease, certain intestinal problems, chronic heartburn or appendicitis. Those pregnant and breast feeding also should discuss heartburn treatment with their doctor. Occasional heartburn is uncomfortable, but frequent heartburn can be dangerous. Over time, repeated episodes of reflux can cause bleeding of the esophagus or tissue changes that can lead to cancer. Chest or upper abdominal pain may be from a heart attack. If the pain radiates to your arms or shoulders, this is more likely to be from a heart attack. A heart attack needs immediate attention and anyone possibly having a heart attack must be brought to an emergency room by ambulance.
Reference: “Gastroesophageal Reflux,” by J. Pilgrim and J. Parks-Chapman in Nursing Course, 1/12/2018.