Dear Doctors: I’m a 44-year-old man and a bit overweight. I’ve been having trouble with what I thought was heartburn, but my doctor says it’s GERD. She prescribed medication, but I wonder what else I can do that might help.
Dear Reader: Your doctor has diagnosed you with a form of heartburn known as gastroesophageal reflux disease, or GERD.
Though often referred to as acid reflux, GERD is more severe.
Heartburn refers to a painful burning sensation that spreads through the chest, typically behind the breastbone. It can be accompanied by a sour taste at the back of the mouth or throat.
These symptoms occur because some of the acidic contents of the stomach have moved up into the esophagus. That’s the tube that connects the mouth and throat to the stomach. Unlike the lining of the stomach, the inner tissues of the esophagus are delicate, leaving them vulnerable to damage from stomach acid.
The one-way flow of food from the esophagus to the stomach relies on a flexible ring of muscle known as the lower esophageal sphincter. It relaxes to let food and drink pass into the stomach but otherwise remains tightly closed, protecting the esophagus from stomach acids.
Heartburn is the result of an occasional breach of this barrier.
With GERD, the lower esophageal sphincter repeatedly fails to constrict adequately. This results in esophageal injury from stomach acid.
Left untreated, it can cause esophageal ulcers, a precancerous condition known as Barrett’s esophagus and an increased risk of esophageal cancer.
Risk factors of GERD include older age, being overweight, smoking, being sedentary and the size and timing of meals.
The medications your doctor has prescribed will lower stomach acid production and give the esophagus time to heal.
But the behavioral changes you’re asking about are important as well.
Most important is reaching a healthy weight. Carrying extra pounds is a significant risk factor for GERD.
Your doctor has also likely counseled you against smoking and exercise regularly.
Remain upright as you eat and afterward. Lying down puts pressure on the already-weakened lower esophageal sphincter. It’s also beneficial to stop eating two to three hours before bedtime.
Stress increases stomach acid production, so meditation, yoga and tai chi can help. Getting good sleep also is important. There is some evidence that sleeping on a wedge, elevating the torso, can offer relief. For side sleepers, lying on the left side rather than the right can help.
Dr. Eve Glazier and Dr. Elizabeth Ko are internists at UCLA Health.
