Pharmacy shelves are full of medications for reflux "heartburn." Most of us know the symptoms: a burning sensation in the chest with belching, sour stomach fluid coming up into the mouth — or worse yet, awakening suddenly choking on burning acid in the airway. These symptoms are very common, affecting 40 percent of Americans monthly and 18 percent of Americans weekly.
In addition to annoying symptoms, untreated reflux could eventually cause death due to esophageal cancer. One of the most deadly cancers, it currently strikes about 14,000 Americans every year. But the numbers are growing rapidly. Research shows that the increase in reflux and cancer is directly related to the nation's increase in obesity.
There is a correlation between increased weight and heartburn, and another correlation between weight loss and improvement of heartburn symptoms. In 1991, 15 percent of Americans were considered obese and 30 percent were considered overweight. Today 30 percent are obese with 60 percent overweight.
WHAT IS HEARTBURN OR REFLUX?
The stomach normally produces acid to aid in the digestive process. The problem is not the acid itself but when the acid comes up, or refluxes, into the esophagus. To understand the nature of acid reflux it's helpful to understand a little bit of human anatomy.
We are able to breathe because the rib cage and diaphragm function like a bellows. The diaphragm is a sheet of muscle separating the chest cavity from the abdominal cavity. In the middle of this muscle is a hole, or hiatus, that allows the esophagus to join with the stomach. When you inhale, your diaphragm contracts and expands the chest cavity, allowing air to flow into your lungs. As your rib cage expands, it decreases chest pressure and increases abdominal pressure.
Reflux can happen because gases and fluids tend to flow from high-pressure areas, like the abdomen, to low-pressure areas, or the chest. When you inhale, the pressure can force acid up from the stomach into the esophagus and even up into the mouth or airway.
Of course, our bodies are naturally designed to keep this from happening. Acid reflux occurs only when something goes wrong. Factors that allow reflux include:
1. TLESR, or transient lower esophageal sphincter relaxation. The lower esophageal sphincter is a weak ring of muscle that closes off the bottom of the esophagus from the top of the stomach, preventing acid from rising. But sometimes the sphincter relaxes when it shouldn't.
2. Delayed acid clearance. When sleeping, we stop producing saliva, which helps clear acid from the esophagus. Saliva also contains growth factors that heal the esophagus from the damaging effects of acid.
3. Reduced resistance to injury. Once your esophagus or stomach are injured — for instance, if you have an existing ulcer — the injured tissue loses its protective defenses and is much more susceptible to further injury.
4. Delayed stomach emptying. Food and acid can sometimes sit in the stomach longer than usual.
5. Sleep apnea. The partial blockage of your airway can cause your chest to expand harder than normal. This pulls more acid into your esophagus.
6. Hiatal hernia. This condition occurs when a portion of your stomach protrudes into your chest cavity through the hiatus. It forces the lower esophageal sphincter open and basically brings the food and acid up into your chest.
In the long term, acid reflux can lead to ulceration or stricturing (narrowing) of the esophagus, which makes it difficult to swallow. It can also lead to Barrett's esophagus, a mutation in the lower esophageal tissue that can eventually develop into esophageal cancer.
Cigarette smoke and alcohol, especially in combination, can worsen esophageal injuries. The theory is that the esophagus is protected from toxins in cigarette smoke by a mucus lining, as well as the swallowing of saliva, which washes acid out of the esophagus. Alcohol dissolves the mucus layer and also dissolves the smoke toxins so they are absorbed directly through the esophageal surface. If you have acid reflux, smoking and drinking can greatly increase your risk of complications, including the development of esophageal cancer.
If you have acid reflux, avoid the following:
1. Eating large volumes of food
2. Eating less than three hours before bedtime
3. Caffeine, including coffee and soft drinks
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