“JOSH,”AGE 45, was just beginning to experience some of the aggravating physical complaints common to middle age. Having packed on more than a few extra pounds, his BMI of 29 placed him well within the ranks of the overweight and right on the cusp of obesity. Once-simple activities like climbing the stairs left him out of breath, his knee joints ached, and lower-back pain frequently prevented him from getting restful sleep.
Josh was also vexed by another problem: Severe heartburn was becoming an almost nightly ritual. Oftentimes, a nagging dry cough would accompany the burning sensation, and he would occasionally awake suddenly with a sour taste in his mouth after having regurgitated a small amount of stomach fluid. On some nights, propping his upper body with several pillows prevented these symptoms, and popping antacid tablets offered temporary relief, but the root problem persisted. A visit to his primary care physician revealed that Josh had gastroesophageal reflux disease, or GERD.
This reflux occurs because the circular band of muscle located at the lower end of the esophagus—called the esophageal sphincter—functions abnormally.
When it’s doing its job as it should, the esophageal sphincter remains closed until food or liquid flows down to the stomach. Then, it relaxes just long enough to allow the food or liquid to pass and closes again. But if this band of muscle relaxes abnormally or becomes weakened, stomach acid, and possibly bile, can travel the wrong way and back up into the esophagus, causing heartburn. In addition to heartburn, GERD can cause a host of unpleasant symptoms, such as hoarseness or sore throat, a dry cough, difficulty swallowing or a sensation of swelling in the throat, regurgitation of food or stomach acid, and even chest pain.
Over time, persistent acid reflux can also lead to the formation of scar tissue and consequent narrowing of the esophagus, ulceration and bleeding of the esophagus, precancerous changes to the esophageal lining, and other complications.
According to experts at Yale Medicine (yalemedicine.org), risk factors for GERD include:
• Weight gain, being overweight or obese
• Family history of GERD
• Hiatal hernia (a condition in which the top of the stomach at the esophageal junction bulges into the chest)
• Smoking or inhaling secondhand smoke
• Eating fatty foods
• Drinking alcohol, coffee, or carbonated beverages
• Lying down within three hours of eating
• Taking certain medications such as some antidepressants, calcium channel blockers (high blood pressure medications), sedatives, and some medications used to treat asthma.
As Josh’s doctor explained, his excess body weight was likely a major contributing factor to his problem. Essentially, his abdominal fat was applying pressure to the stomach and diaphragm, causing the lower esophageal sphincter to open when it shouldn’t.
Some lifestyle changes were definitely in order for Josh. Under his doctor’s supervision, he began a weight-loss program based on exercise and nutrition and gradually shed 20 pounds over the course of two and a half months. In the process, he also shed most of his symptoms and began to enjoy much more restful sleep. He still experiences occasional heartburn, but he can usually manage it with over-thecounter medications.
In addition to encouraging Josh to shed excess pounds, his doctor recommended the following lifestyle modifications to help reduce the frequency of his heartburn symptoms:
• Eat smaller meals and avoid eating for at least three hours before going to bed.
• Avoid foods or beverages that seem to trigger GERD symptoms, for example fried foods, fatty foods, garlic and onion, tomato sauce, alcohol, and caffeine.
• Avoid wearing tight-fitting clothes.
• Avoid smoking.
• Elevate the head of the bed, either by placing a wedge between the mattress and box springs or by placing wood or cement blocks under the feet of the bed.
Certain over-the-counter and prescription-strength medications, such as proton-pump inhibitors, can be helpful in managing GERD symptoms, but be sure to consult with your physician before taking any medication to ensure it will be both safe and effective for you and won’t have any harmful interactions with other medications you may be taking.
Like Josh, most GERD sufferers find symptom relief with medications and lifestyle modification. However, if this conservative approach is not effective, your doctor may recommend one of various surgical procedures to prevent stomach acid from flowing into the esophagus. ✲
