What to do to extinguish the fire
By Deborah Jeanne Sergeant
Heartburn or acid reflux, the feeling of lava crawling up your esophagus, occurs in 20% of people older than 60 and 30% of those older than 70, according to the National Institutes of Health.
People tend to lose muscle tone as they age, including the lower esophageal sphincter. When working normally, this structure helps keep stomach acid where it belongs.
Older adults’ slower digestion and propensity for taking medications that relax the lower esophageal sphincter also raise their risk of acid reflux. Health issues that raise risk also tend to present in middle to older adulthood, including Type 2 diabetes, Parkinson’s disease and Alzheimer’s disease.
Also called gastroesophageal reflux disease (GERD), acid reflux has many causes which can be mitigated.
“You should review your medications with your physicians,” said physician Jason Gutman, service line division head of gastroenterology at Rochester Regional Health. “Some patients are put on medications long-term that they no longer need and some of these can affect risk” for acid reflux. “If you smoke tobacco or marijuana or vape, you should stop. These can relax the sphincter muscles. Avoid alcohol. Avoid wearing tight fitting garments, which can increase reflux. Chewing gum can be helpful as it increases saliva because it neutralizes acid that’s coming up.”
Gutman added that other strategies to combat the burn include avoiding eating two to three hours before lying down so food has more time to pass farther along in the digestive system. If symptoms worsen at night, “sleeping on the left side decreases incidence,” he added.
Gravity can help keep stomach acid down. Try elevating torso by using risers under the bedposts at the head of the bed or sleeping with a foam wedge or pillows under the torso. Gutman also said that losing weight can help alleviate symptoms.
For people experiencing chronic reflux, an endoscopy can help monitor for precancerous changes in the esophagus.
Diet can worsen acid reflux.
Sarah Cook, registered dietitian for University of Rochester Endocrinology at Highland Hospital, said that eating smaller, more frequent meals can help, along with minimizing irritating foods, including peppermint and spearmint, caffeine, alcohol and greasy or spicy foods.
“Opt for blander foods,” Cook said. “Things that are higher fat tend to remain in our stomachs longer as well, like fried meat, ice cream, milkshakes, whole milk, doughnuts, French fries and more processed deli meats like sausage, salami. These have the ability to stick around and your stomach for longer and create more of a problem.”
She added that some people also report that highly acid fruits and vegetables such as citrus fruits and tomatoes can trigger more acid reflux. But this can be a personal experience.
“It depends upon the person,” Cook said. “Some try taking out or at least limiting certain foods to see if it helps. Sometimes a food journal is helpful.”
Trying these lifestyle changes does not mean eschewing medication. In fact, it can augment their effectiveness.
Physician Andrew J. Quinn, of Thompson Health Gastroenterology, encourages taking both dietary and lifestyle changes before and along with managing acid reflux with medication, as these “can be just as beneficial as medications in certain patients.”
Over-the-counter preparations such as Tums or Pepcid can help in mild to moderate cases. Doctors can prescribe medications such as proton pump inhibitors (PPI) such as Nexium (esomeprazole), Prilosec (omeprazole), Protonix (pantoprazole) and Prevacid (lansoprazole).
“While milder, infrequent symptoms are not too concerning, if acid reflux symptoms are a daily experience, more severe, and do not respond to over-the-counter antacids then this is reason to seek medical attention regarding the issue,” Quinn said. “Other concerning symptoms that if occur with the GERD would prompt medical evaluation and some of these are: difficulty swallowing, weight loss, pain with swallowing, persistent vomiting, decreased appetite, history of gastrointestinal cancer in a first degree relative, vomiting blood or coffee ground color material or a first-degree relative with Barrett’s esophagus.”