Health Options Alan Titchenal  & Joannie Dobbs                   Wednesday, May 12, 1999

Heartburn linked to many causes

What health condition is more common in pregnant women, senior citizens, athletes, those carrying too much weight, and people over 50? Heartburn or gastroesophageal reflux disease (GERD).

In the United States , more than 10 percent of adults have symp­toms daily and 30-40 percent have it periodically. Most of us have experienced mild heartburn at some time. Generally the symptoms are mild and do not require treatment.

The pain of heartburn usually occurs in the chest area but sometimes can radiate into the neck and arms and can last for minutes or hours. Some individuals also notice a sour or unpleasant taste in their mouths.

Although it is commonly called heartburn, GERD has nothing to do with the heart. The cause of heart­burn is a reflux of stomach juices up into the esophagus (the tube that carries food from the mouth to the stomach). Because stomach digestive juices are very acidic, repeated back flow from the stomach up into the esophagus can cause irritation, inflammation, and sometimes, even ulcers in the esophagus. This irritation is sensed most commonly as a pain in the chest, thus the popular name heartburn.

The lining of the stomach is designed to be protected from the strong acids it produces, but the wall of the esophagus is not protected. Normally a muscular sphincter or valve between the stomach and the esophagus closes tightly to prevent the acidic stomach contents from going back up.

However, when there is a buildup of pressure in the stomach, it can force the valve open. The caustic stomach acid is forced up into the esophagus, actually "burning" it. Repeated reflux can weaken the valve and result in more frequent incidents of heartburn.

Many factors can cause a buildup of stomach pressure or weakening of the esophageal valve. Gravity is the reason bending over or lying down too soon after a large meal causes stomach pressure to push acid against the esophageal valve. Excess abdominal fat can tend to push stomach acid upward. Even exercise can cause reflux, especially after a meal.

Both the size and composition of meals have been implicated in causing heartburn. Foods most fre­quently thought to cause heartburn are spicy foods, fatty foods, acidic fruits like oranges, alcoholic beverages, coffee, and chocolate. This is not based on scientific evidence but rather on reports of patients who frequently experience heart­burn. Therefore all or none of these foods may affect you.

Emotional stress can increase stomach acid production and also foster a habit of constant nibbling, creating the perfect environment for GERD.

Various medications increase GERD. These include some anti-inflammatory drugs, antidepres­sants, calcium channel blockers, asthma medications, and pro­gestins, used in oral contraception and hormone replacement thera­pies.

Here are some tips to keep your esophagus healthy:

1. Keep meals at a moderate size.
2. Stay upright for at least two hours after eating.
3. Eat foods that agree with you.
4. Exercise to maintain a health­ful weight.
5. Don't exercise too soon after a meal and avoid high fat snacks before exercise.
6. Be happy.
7. Inform your doctor of heart­burn symptoms, especially if you are taking medications.