Heart Burn: Dos and Donts

About 60 percent of all adults experience some type of acid reflux, and irritation of the esophagus caused by the acid that comes up from the stomach. Here, DR ANDREA RAJNAKOVA of Andrea’s Digestive, Colon, Liver and Gallbladder Clinic explains the causes and symptoms of reflux, and what we can do about it.

Causes and Symptoms of Heart Burn

“Acid reflux usually happens when the junction between the gullet and the stomach doesn’t function normally,” says Dr Andrea. “During swallowing, food passes down the throat, through the oesophagus and into the stomach. Normally, a muscle valve at the end of the oesophagus, called the lower oesophageal sphincter, opens to allow food into the stomach, then closes again. When this muscle doesn’t close tightly enough, stomach acid can reflux, or wash back, into the oesophagus causing damage to its lining.”

This irritation creates troublesome symptoms including a burning sensation in the gullet, which is the most typically experienced symptom of reflux. However, Dr Andrea notes that, while most people experience heartburn pain during reflux, others feel nothing at all – it just depends on the person. Other symptoms of reflux can include burping, belching, sour or bitter tastes in the mouth, coughing at night, dry throat, sore throat, hoarseness in the morning, or worsening asthma.

Longstanding reflux can result in complications such as oesophagitis, an inflammation of the esophagus that may be associated with ulcers (breaks in the lining of the esophagus) and stricture, the narrowing of the swallowing tube as a result of long-lasting inflammation. Another possible complication is Barrett’s Oesophagus, which may occur when longstanding inflammation leads to changes in the cells of the lower esophagus. “Patients with Barrett’s Oesophagus have higher risk of oesophageal cancer compared to the general population,” notes Dr Andrea.

Heart Burn Detection and Diagnosis

“In the simplest case, when the duration of symptoms is short and reflux improves after medication, no diagnostic tests are required,” says Dr Andrea. “However, if the symptoms are longstanding and don’t improve with medication, further investigation is mandatory.”

A gastroscopy allows for the inspection of the gullet and stomach, and can detect inflammation in the lower esophagus. During the procedure, tissue samples can be obtained for further testing to assess the severity of reflux and rule out Barrett’s esophagus. Another assessment is 24-hour pH monitoring, which tests the acidity of the esophagus; it’s a complementary test for gastroscopy but it cannot replace the procedure.

Treatment Options

Luckily, reflux is a condition that can be resolved. Dr Andrea says that medications like proton pump inhibitors can be prescribed to reduce acid secretion in the stomach, while antacids, many of which are available over-the-counter, can neutralize gastric acid. In addition to medication, Dr Andrea says that lifestyle and dietary modifications are key to the treatment and prevention of acid reflux.

Lifestyle Habits

“In today’s hectic lifestyle, many of us are affected by stress and stress-related health problems, which can manifest in different ways”, says Dr Andrea. “One of the most common ways stress manifests is by causing digestive problems – affecting the stomach, oesophagus and bowel. The problems may be brought about by stress itself, irregular meals, inappropriate food selection or gulping the food due to lack of time”.

In addition to avoiding stress, Dr Andrea suggests adopting the following lifestyle habits, whenever possible, to help minimize the amount of acid refluxing from the stomach:

• Eat five small meals rather than three large meals a day
• Eat meals slowly, while chewing properly
• Avoid oily foods, fried foods, heavy meals and overeating
• Refrain from eating two to three hours before bedtime
• Lose weight (if you’re overweight)
• Quit smoking
• Elevate the head of your bed by 15 to 20 centimeters

Dietary Changes

It’s also important to avoid the very foods that are known to worsen acid reflux, as they relax the muscle responsible for stomach closure, allowing stomach acid to reflux into the esophagus.

Foods and beverages to be avoided during reflux episodes include:

• Chocolate Sweet desserts
• High-fat foods
• Curry and other spicy foods
• Citrus fruits and citrus juices
• Garlic and spring onions
• Tomatoes or tomato-based products
• Alcohol, especially on an empty stomach
• Coffee and tea on an empty stomach

Why is reflux especially common during pregnancy?

Acid reflux is experienced by 45 to 80 percent of pregnant women due to hormonal and mechanical changes – after all, a growing baby in the uterus causes pressure on the stomach. According to some statistics and epidemiological studies, 52 percent of pregnant women first experience reflux in the first trimester, 24 to 40 percent in the second trimester, and nine percent experienced in the third trimester.

Dr Andrea says that making lifestyle changes is important for pregnant women with reflux. “I’d advise pregnant patients to elevate the heads of their beds, avoid getting into bent or stooped positions, eating small, frequent meals, and refraining from ingesting foods within three hours of bedtime.” She adds that, while the outcome for pregnant patients with acid reflux is positive, the condition tends to recur with subsequent pregnancies.