Do you often get “heartburn” and if so, what can you do about it?

Heartburn is a burning feeling in the upper central abdomen and may also be felt in the neck or throat.  It is usually caused by regurgitation of stomach acid (i.e. gastric reflux) from the stomach into the esophagus. “Reflux” means to flow back or return, so gastroesophageal reflux is the return of the stomach’s contents back up into the esophagus.

Heartburn

In normal digestion, the lower esophageal sphincter (LES) opens to allow food to pass into the stomach and closes to prevent food and acidic stomach juices from flowing back into the esophagus. Gastro-esophageal reflux occurs when the LES is weak or relaxes due to some other cause, allowing the stomach’s contents to back up into esophagus.

While “heartburn” is usually associated with GERD, in a very small percentage of people, it may be the sign of something more serious.  In just over half of one percent of people, feelings of “heartburn” may be a symptom of ischemic heart disease.

Gastroesophageal reflux disease (GERD) is a digestive disorder that affects the LES and many people, including pregnant women experience “heartburn” or “acid indigestion” caused by GERD. The severity of GERD depends on LES dysfunction as well as the type and amount of fluid brought up from the stomach and the neutralizing effect of saliva.

Doctors believe that some people suffer from GERD due to a condition called hiatal hernia. A hiatal hernia is where the stomach and the section of the esophagus that joins the stomach slide up into the chest through an opening (hiatus) in the diaphragm.  The diaphragm is the muscular wall separating the chest cavity from the abdomen. This is the most common type of abdominal hernia. In most cases, heartburn caused by GERD can be relieved through diet and lifestyle changes.

In March 2013, the AmericanCollege of Gastroenterology published new updated guidelines for the diagnosis and management of gastroesophageal reflux disease (GERD) based on a systematic reviews and meta-analyses of previously published studies, as well as clinical trial data. The outcome was 54 pragmatic recommendations that were graded to prioritize their strength, as well as the weight of the evidence supporting each recommendation. Not surprising, weight loss came made the “top 10” of the 54 recommendations.

Weight reduction in GERD matters. A cohort study from Norway called the HUNT study and published in the same issue as the American College of Gastroenterology’s new GERD Recommendations looked at the effect of weight reduction in more than 100,000 patients with GERD. A reduction of 3.5 units in a person’s body mass index (BMI) resulted in less likelihood of reporting GERD symptoms or using GERD-related medications.

What can you do?

You can reduce by GERD-related symptoms and improve response to medication taken for GERD by:

  • eating fewer calories and less fat
  • being more active; exercising about 30 minutes a day, 5 days a week
  • losing weight; often 10 – 15% of body weight is enough

How Our Dietitian can Help

Nutrition to You’s Registered Dietitian can help you make changes to your diet to enable you to reduce your weight and the likelihood of needing to take GERD-related medications.

References

American College of Gastroenterology Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease, March 2013,  http://gi.org/wp-content/uploads/2013/03/ACG_Guideline_GERD_March_2013.pdf

Kato H, Ishii T, Akimoto T, Urita Y, Sugimoto M (April 2009). “Prevalence of linked angina and gastroesophageal reflux disease in general practice”. World J. Gastroenterol. 15(14): 1764–8.

Web MD – Gastroesophageal Reflux Disease (GERD)- http://www.webmd.com/heartburn-gerd/guide/reflux-disease-gerd-1