Acid reflux – that familiar burning pain in the chest under the breastbone – is a common complaint.

While occasional heartburn is nothing to worry about, persistent episodes are a red flag that should prompt you to seek medical attention, says Dr. Lawrence Cohen, the director of the division of gastroenterology at Sunnybrook Health Sciences Centre in Toronto.

Here's what you need to know about acid reflux.

1. Acid reflux occurs when stomach contents flow back into the esophagus.
Food, acid, bile and other secretions back up into the esophagus instead of going out the duodenum, the short portion of the small intestine that connects to the stomach. The problem might be a faulty lower esophageal sphincter (the gatelike mechanism that opens and closes to help us swallow). Or stomach ulcers or tumours may be to blame.

2. Acid reflux is more common among the overweight and those over 40.
The mechanism that prevents acid reflux deteriorates as you age. Excess weight puts extra pressure on the stomach and diaphragm, forcing open the lower esophageal sphincter and allowing stomach contents to back up into the esophagus.

Acid reflux is also more common among females. Women who are pregnant may be at increased risk because of the greater pressure being put on the stomach and a higher production of the hormone progesterone, which relaxes the esophageal sphincter.

3. Smoking cigarettes and drinking alcohol may increase your chances of getting acid reflux.
These habits tend to relax the lower esophageal sphincter. Other risk factors include:

• Drinking coffee and eating mints after a meal (again, they relax the esophageal sphincter);

• Eating fatty foods (since it takes the stomach longer to digest fat, the emptying of the stomach is delayed, causing stomach acid to build up and back up into the esophagus); and

• Lying down soon after eating.


Page 1 of 2 – Find out what you can do to treat acid reflux on page 24. Lifestyle changes are the most effective way to reduce – even eliminate – acid reflux.
Here are some tips to do that:

• If you're obese, lose weight.

• Control your intake of caffeine and alcohol.

• Eliminate other heartburn triggers (common ones include fried foods, spicy foods,
garlic, onions, tomatoes, peppermints, chocolate and carbonated beverages).

• Wear loose-fitting clothes to reduce pressure on your abdomen.

• Avoid bending over for long periods soon after eating.

• Wait at least two hours after eating before going to bed, and try elevating the head of the bed about four to six inches.

• Don't smoke, not even an occasional after-dinner puff.

5. Check with your doctor if you have persistent acid reflux symptoms.
Chronic reflux can lead to changes in the lining of the esophagus that, in rare cases, can become cancerous, says Cohen. He adds that if you've had reflux symptoms for five years, or you're 45 or older and had a recent onset of persistent acid reflux, you should speak with your doctor about undergoing a gastroscopy (an easy examination of the inside of the stomach using a thin flexible tube equipped with a tiny light and camera).

Get relief
A range of over-the-counter medications are available for the symptomatic relief of occasional acid reflux. They include:

• Antacids, such as Tums, Rolaids, Maalox, Gaviscon and Gastrocote, neutralize stomach acid but won't heal the damage it causes. Overuse can cause diarrhea or constipation. Also, the bismuth in Pepto-Bismol can turn the tongue and stool black.

• Histamine (H-2) receptor blockers, such as Tagamet HB, Pepcid AC and Zantac 75, reduce the production of acid. They should be taken about 30 minutes before a meal or bedtime. Side-effects include dizziness, diarrhea and headache.

For more effective therapy, there are prescription acidsuppressing medications, such as proton pump inhibitors and H-2 receptor blockers.

Surgery to "tighten" the lower esophageal sphincter to prevent reflux may be an option for some young patients, who face an anticipated lifelong acid reflux problem with its accompanying complications.

(GERD – gastroesophageal reflux disease – is an umbrella term for chronic reflux. GERD usually requires prescription-strength drugs and sometimes surgery.)


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This story was originally titled "Acid Reflux" in the December 2008 issue. Subscribe to Canadian Living today and never miss an issue!