’Tis the season for heartburn.
Dr. Mark Pochapin, the Sholtz-Leeds Professor of Medicine and director of the Division of Gastroenterology and Hepatology at NYU Langone Health, said he often sees patients around 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 foul.
How can someone distinguish between heartburn, acid reflux and GERD?
Acid reflux is a condition in which acid from the stomach backflows 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 hallmark 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 a burning or bitter taste in the mouth, sore throat, chronic cough, hoarse voice, ear pain, asthma-like symptoms or even non-cardiac chest pain. One or more of these symptoms may be present. Acid reflux can also occur silently, with no symptoms at all. The symptoms vary by person.
What causes acid reflux?
Usually, stomach acid stays in the stomach thanks to gravity and a valve called the lower esophageal sphincter, which tightly seals off the esophagus. Acid reflux can occur as the result of a number of different underlying causes and contributing factors.
These can include dietary, motility, neurologic, medication or structural anatomical issues, such as a hiatal hernia, that can prevent the valve from working properly, allowing stomach acid to escape back into the esophagus. Factors such as being pregnant, being overweight, smoking, taking certain medications, eating a large meal and ingesting certain foods and beverages can also contribute to the occurrence of acid reflux.
What are some common triggers for acid reflux that people should be aware of?
Different foods and beverages can trigger 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 can include eating a large meal or lying down after a meal.
When we eat too much, we can overfill the stomach and force contents back up into the esophagus. Lying down takes away the natural protective barrier of gravity, also contributing to reflux of contents back up into the esophagus. Smoking is also a risk factor and potential trigger for acid reflux.
How is GERD diagnosed?
GERD is typically diagnosed through a clinical exam and medical history, done with your doctor. In many cases, your doctor may prescribe a trial of a histamine-2 receptor antagonist or proton pump inhibitor medication to reduce the acid and determine whether this alleviates symptoms.
In some cases, your gastroenterologist may perform other tests, such as an upper endoscopy to view the lining of your esophagus for signs of inflammation or other damage, or if needed, additional pH, manometry or other testing to better determine the amount and underlying cause of your reflux.
How should GERD be treated?
It’s important to see your health professional for frequent or persistent symptoms, for a full evaluation, accurate diagnosis and treatment plan. Treatment can include modifying your diet to cut out foods that trigger symptoms, eating smaller meals, stopping meals at least two to three hours before bedtime and potentially sleeping on a wedge pillow or other incline to elevate the head and neck area.
Weight management can play a role too, as excess weight can contribute to reflux. Medications are also available, both over the counter and by prescription, to neutralize or reduce stomach acid, helping to ease symptoms and heal and prevent damage to the esophagus.
In some cases, endoscopic and surgical options are available to alleviate related symptoms.
What dietary modifications are recommended for someone prone to acid reflux?
First, we recommend you keep a diary to track the foods and beverages you consume with the symptoms you have. Because these dietary triggers can vary by individual, the first step is to identify the trigger foods for you. In this way, you can begin to limit or even eliminate these triggers from your diet.
It may also be helpful to eat smaller meals more frequently than to eat a large meal — and to avoid eating for at least two to three hours before bedtime. One of the other things that I recommend is, after people eat, to take a walk. Walking helps with motility, 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 underlying motility, neurologic or structural anatomical issues, which your gastroenterologist can help diagnose. Acid reflux can cause a variety of symptoms and exacerbate other conditions, such as lung disease or ear/nose/throat conditions.
Chronic, persistent acid reflux, if not treated, can also lead to more serious conditions such as esophagitis and, for some people, even progress to Barrett’s esophagus or esophageal cancer. This is why an accurate diagnosis and treatment are so important — to alleviate your symptoms but also to heal and prevent additional 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 these if possible even during the holidays. But many of us experience heartburn over the holidays due simply to the amount of festive food and drinks that we tend to consume. It’s so tempting to eat a nice big holiday meal and then lie right down for a nap, but all that food can cause pressure on the stomach and the lower esophageal sphincter.
Should we portion control?
Portion control is essential to try to help us feel better when we eat great food over the holidays. Eating smaller portions, giving a little bit more time to digest between meals and getting up and walking will help empty the stomach and make us feel better overall.
Is it beneficial to adjust eating times 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 just a little bit smaller, allow time between the portions and not eat so late. Give time for the stomach to empty so when we do get in bed, we don’t have a full stomach pushing up and allowing acid to backflow and cause damage to the esophagus.
What are the potential complications of untreated GERD?
Untreated GERD over time can cause esophagitis, which is an inflammation of the lining of the esophagus. If not treated, esophagitis can cause narrowing from scarring that could cause food to get stuck in the esophagus, so when someone eats, they feel like the food isn’t moving down. That’s 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 during the holidays. Even apart from reflux, excess alcohol intake is a risk factor for many disease processes and is not healthy for us overall.
Drinking water and staying hydrated is always a good idea. Overall, it’s great for your health and may even help with eating those smaller portions during the holidays. If you suffer from GERD, you may just want to avoid drinking too much fluid right before bedtime.
Dr. Mark Pochapin is the Sholtz-Leeds Professor of Medicine and director of the Division of Gastroenterology and Hepatology at NYU Langone Health. He specializes in advanced endoscopy and preventing, detecting and diagnosing gastrointestinal cancers.
