Everybody gets some form of heartburn from time to time, but as we get older, it often seems to be more frequent and more severe. Reflux esophagitis refers to a backup of stomach contents into the lower esophagus, where the stomach acids produce a burning sensation. It is commonly known as GERD, or gastroesophageal reflux disease.
In case it has been awhile since you took anatomy, the esophagus is a long tube leading from the mouth to the stomach. Its function is obvious. The upper 3 inches are designed to open when we swallow and close tightly between swallows. The tube gets a workout, because most swallowing is unconscious and occurs at times when we are not even eating. In fact, it happens about 2,500 times a day.
As food goes down the tube, it is moved along by muscular contractions with a little help from gravity. The lower end of the esophagus has another special muscular ring that relaxes when we swallow and closes in between. It serves as a valve to prevent the contents of the stomach from returning to the esophagus. In older people, obese people, pregnant women and individuals with stomach hernias, this lower muscle ring gets weak. Then, when the stomach is full and contracts while trying to move its contents down into the intestine, some of the digestive acids and food go up through the weak muscle into the esophagus instead of into the intestines where they belong.
The esophagus was never meant to be bathed in acid, so if this happens often enough, the irritation can become severe and can cause almost continuous pain. Usually, however, the symptoms are annoying but mild. There are some things you can do to prevent acute heartburn and some lifestyle changes you can make that may help to keep it from becoming chronic:
- Try not to lie down right after eating a meal. Lying down makes it easier for food and acid to be pushed back into the esophagus. Eating light meals early in the evening will usually help. Eating more frequent smaller meals during the day is better than one or two really large meals.
- If pain occurs, sit or stand for a while to take advantage of gravity. If it is really heartburn, the pain should go away in a few minutes.
- If you have developed chronic heartburn and it always occurs when you are in bed, try elevating the head of your bed by about six to 10 inches. This is easy to do if you live in a big city: Just put last year's phone books under the top legs of the bed.
- Avoid foods that decrease muscle tone (and weaken that lower muscle ring). These include fat, chocolate, alcohol and probably coffee. Citrus fruits and tomatoes also may aggravate the condition and should be avoided, especially before bedtime if you are having problems.
- Avoid tobacco. (This comes under the heading of good advice under any circumstances.)
- If you are troubled with heartburn, try over-the-counter antacids or some of the newer acid blockers. Do not take these drugs regularly for more than two weeks without consulting your doctor. If you have any other underlying problems, consult your doctor before taking any medications.
- If the sensation persists and is severe, especially if it does not respond to conservative treatment, seek medical advice as soon as possible. Better to be embarrassed in the emergency room than end up in the coronary care unit. The symptoms are very similar to those of a heart attack, and you can't be blamed for not knowing the difference.
- If you are obese, try to lose weight. This will take pressure off the muscle at the base of the esophagus.
For some people, one of the unwanted side effects of changing to a diet high in fiber (lots of fruits, vegetables, beans, legumes and whole grains) is the possibility of experiencing intestinal gas. The trouble begins when complex sugars (oligosaccharides) in these foods stay undigested until they get into the large intestine, where they are attacked by bacteria and, well you know what happens then. There are a few things you can do to reduce the formation of intestinal gas.
- When you soak dry legumes (beans), throw out the water they have soaked in. Cook the beans fully to make their sugars more digestible. If you are using canned beans, drain and rinse them before using.
- Try to gradually increase your consumption of high fiber foods and eat a variety of them.
- Try some of the over-the-counter preparations that can be taken before or after eating or are sprinkled on your food. Some work, some don't, but they are relatively inexpensive and probably harmless for most people.
