‘Tis the season of heartburn.
Dr. Mark Pochapin, Sholtz-Leeds Professor of Medicine and director of the Division of Gastroenterology and Hepatology at NYU Langone Health, said he often sees patients during the holidays suffering from heartburn, indigestion or an upset stomach.
Just in time for Thanksgiving, Pochapin gets to the bottom of acid reflux, heartburn, and gastroesophageal reflux disease (GERD), sharing tips and tricks for stuffing yourself without feeling sick.
How can one tell the difference between heartburn, acid reflux and GERD?
Acid reflux is a condition in which acid from the stomach backs up into the esophagus. GERD is the name of a chronic condition that causes frequent symptoms or damage to the esophagus as a result of acid reflux. The main symptoms of GERD are heartburn and regurgitation.
What are some other symptoms that can be caused by acid reflux?
In addition to heartburn and regurgitation, chronic acid reflux over time can cause symptoms such as burning or bitter taste in the mouth, sore throat, chronic cough, hoarseness, ear pain, asthma-like symptoms, or even pain. non-cardiac chest. One or more of these symptoms may be present. Acid reflux can also occur silently, with no symptoms at all. Symptoms vary by person.
What causes acid reflux?
Normally, stomach acid stays in the stomach thanks to gravity and a valve called the lower esophageal sphincter, which tightly closes the esophagus. Acid reflux can occur as a result of a number of different underlying causes and contributing factors.
These can include dietary, mobility, neurological, medication, or anatomical structural issues, such as a hiatal hernia, that can prevent the valve from working properly, allowing stomach acid to leak back into the esophagus. Factors such as being pregnant, being overweight, smoking, taking certain medications, eating a large meal, and consuming certain foods and beverages can also contribute to acid reflux.
What are some common triggers for acid reflux that people should be aware of?
Different foods and drinks can cause acid reflux for different people. Examples of common dietary triggers for acid reflux are caffeine, tomato-based products, fatty or spicy foods, chocolate, peppermint, and alcohol. Other triggers may include eating a large meal or lying down after a meal.
When we eat too much, we can fill the stomach and force the contents back up into the esophagus. Stretching removes the natural protective barrier of gravity, also contributing to the reflux of contents back into the esophagus. Smoking is also a risk factor and potential trigger for acid reflux.
How is GERD diagnosed?
GERD is usually diagnosed through a clinical examination and medical history taken with your doctor. In many cases, your doctor may prescribe a trial of a histamine-2 receptor antagonist or a proton pump inhibitor medication to reduce acid and determine if this relieves symptoms.
In some cases, your gastroenterologist may perform other tests, such as an upper endoscopy to look at the lining of the esophagus for signs of inflammation or other damage, or if necessary, additional pH, manometry, or other tests to better quantify and root cause. of your reflux.
How should GERD be treated?
It is important to see your healthcare professional for frequent or persistent symptoms, for a complete evaluation, accurate diagnosis, and treatment plan. Treatment may include modifying your diet to cut out foods that cause symptoms, eating smaller meals, withholding meals at least two to three hours before bedtime, and potentially sleeping on a wedge pillow or other prone to raised head and neck area.
Weight management can also play a role, as excess weight can contribute to reflux. Medicines are also available, both over-the-counter and prescription, to neutralize or reduce stomach acid, helping to relieve symptoms and heal and prevent damage to the esophagus.
In some cases, endoscopic and surgical options are available to relieve associated symptoms.
What dietary modifications are recommended for someone prone to acid reflux?
First, we recommend keeping a diary to track the foods and drinks you consume with your symptoms. Because these dietary triggers can vary from individual to individual, the first step is to identify trigger foods for you. That way, you can begin to limit or even eliminate these triggers from your diet.
It may also be helpful to eat smaller meals more often than one large meal—and to avoid eating for at least two to three hours before bed. One of the other things I recommend is, after people eat, take a walk. Walking helps with mobility, helps empty the stomach and move things along in the digestive process.
Is acid reflux a symptom of a more serious condition?
For some people, acid reflux may stem from other motility, neurological, or structural anatomical problems, which your gastroenterologist can help diagnose. Acid reflux can cause a variety of symptoms and worsen other conditions, such as lung disease or ear/nose/throat disease.
Chronic, ongoing acid reflux, if left untreated, can also lead to more serious conditions such as esophagitis and, for some people, progression to Barrett’s esophagus or esophageal cancer. This is why an accurate diagnosis and treatment is so important – to relieve your symptoms, but also to heal and prevent further damage to the esophagus.
Are there specific foods commonly found in holiday meals that should be avoided by those with GERD?
If you have GERD and know your trigger foods, it’s best to limit them if possible even during the holidays. But many of us experience heartburn during the holidays simply because of the amount of festive food and drink we tend to consume. It’s very tempting to eat a nice party meal and then lie down for a nap, but all that food can put pressure on your stomach and lower esophageal sphincter.
Should we be portion controlling?
Portion control is key to helping us feel better about eating good food during the holidays. Eating smaller portions, giving yourself a little more time to digest between meals, and getting up and walking will help empty your stomach and make you feel better overall.
Is it helpful to adjust your eating schedules or habits during the holiday season to manage acid reflux?
One of the best ways to feel better and reduce the risk of reflux or heartburn is to try to make those portions a little smaller, allow time between portions, and not eat so late. Allow time for the stomach to empty, so when we go to bed, we don’t have a full stomach pushing up and allowing acid to back up and cause damage to the esophagus.
What are the possible complications of untreated GERD?
Untreated GERD over time can cause esophagitis, which is an inflammation of the lining of the esophagus. If left untreated, esophagitis can cause narrowing from scarring that can cause food to get stuck in the esophagus, so when someone eats, they feel like food isn’t moving down. This is called dysphasia. It can also progress when chronic acid reflux causes the lining of the esophagus to change, leading to the development of Barrett’s esophagus and, in a small percentage of cases, esophageal cancer.
How should people with GERD handle alcohol consumption during the holidays? Does hydration play a role?
If alcohol is one of your triggers, then you may want to limit it while on vacation. Even aside from reflux, excessive alcohol intake is a risk factor for many disease processes and is not healthy for us in general.
Drinking water and staying hydrated is always a good idea. Overall, it’s great for your health and can even help with eating those smaller portions while on vacation. If you suffer from GERD, you may simply want to avoid drinking too many liquids before bed.
Dr Mark Pochapin is Sholtz-Leeds Professor of Medicine and director of the Division of Gastroenterology and Hepatology at NYU Langone Health. it specialized in advanced endoscopy and the prevention, detection and diagnosis of gastrointestinal cancers.
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