Almost everyone gets heartburn once in a while. That burning sensation in the middle of your chest is most commonly caused by acid reflux, the overflow of acidic stomach contents into the esophagus. And it’s especially common around the holidays, since overeating, eating rich foods and drinking alcohol can all trigger the condition.
Dr. R. Tomás DaVee, a gastroenterologist with UTHealth Houston and Memorial Hermann, sees the number of patients reporting heartburn symptoms spike around this time every year. “From Thanksgiving through New Year’s Day, I see people having a lot more issues with reflux,” Dr. DaVee says. “Many of them are people who have had issues for a while, but it gets worse during the holidays, and someone in their family says, ‘Hey, you’re not doing great; you need to get this checked out.’”
While occasional reflux can usually be managed by lifestyle changes, chronic reflux — known medically as gastroesophageal reflux disease (GERD) — affects about 20 percent of Americans, according to the National Institutes of Health. And it can lead to more serious problems if left untreated.
“On average, most people have been having acid reflux for about two years by the time they come see me — some people much longer,” Dr. DaVee says. “It often starts out kind of mild, but slowly, over time, it becomes twice a week or three times a week, and the symptoms are getting worse, and they’re popping antacids like candy.”
Chronic reflux can damage the lining of the esophagus and cause a condition called Barrett’s esophagus, which increases the risk of developing esophageal cancer. White males over age 50 have a higher risk of developing Barrett’s esophagus or esophageal cancer, as do people who are overweight or obese, who have sleep apnea, or who smoke or drink alcohol regularly. Dr. DaVee encourages anyone with known risk factors to see a gastroenterologist.
“Anyone who’s having frequent reflux — twice or more per week — or severe symptoms that impact their quality of life or their sleep, should be evaluated,” he says. “Anyone with a family history of esophageal cancer, Barrett’s esophagus, or symptoms like anemia, trouble swallowing or unintentional weight loss, those are some of the warning signs we look for.”
For those with mild, intermittent heartburn symptoms, doctors will usually recommend lifestyle modifications, Dr. DaVee says. Those can include eating smaller meals and not eating within two to three hours of bedtime, since lying down increases the chances that food will back up into the esophagus. Other recommendations include dietary changes: less meat and refined carbs, more fruits and vegetables.
Certain foods and even some medications can relax the valve at the base of the esophagus, making it easier for food to find its way back into the esophagus. Alcohol and caffeine are two common culprits, but anything flavored with real peppermint oil, including tea and candies, can also relax the valve. “We actually use peppermint oil as a treatment for spasms of the gastrointestinal system,” Dr. DaVee says.
Anatomical abnormalities can also lead to reflux. The two most prevalent are a loose lower esophageal sphincter — the valve between the esophagus and the stomach — and a hiatal hernia, in which the top of the stomach protrudes up into the chest cavity.
“For people with risk factors or more severe symptoms, we will do an endoscopy and comprehensive testing to evaluate the health of their esophagus and figure out the root cause of their symptoms, including a loose valve or a hiatal hernia,” Dr. DaVee says. “If it’s a problem with the esophagus not functioning properly or the stomach not emptying correctly, treatments can include medications for acid suppression as well as everything from an endoscopic procedure to tighten the valve to hiatal hernia repair.”
And while over-the-counter medications, such as histamine-2 blockers and proton pump inhibitors, can be very useful in the short term, they aren’t meant to be used long term without a physician’s oversight. “A lot of those medications are only FDA-approved for use for eight weeks, and they can sometimes cause serious problems if you take them for too long,” says Dr. DaVee. “If you’ve had symptoms for a while, or if you suddenly develop acid reflux over the age of 50 and you’ve never had symptoms before, you should get checked out.”
For more information, visit www.memorialhermann.org/services/conditions/heartburn-gerd.