Dear Alice,

I'm having this problem called gastric reflux. That is, when I lie down to go to sleep at night, the fluid in my stomach tends to flow back into my lower throat region. Because the fluid is very acidic, my throat is always feeling sore, and I can't speak loudly or for long because of this. This is really annoying. The doctor told me not to eat within two to three hours before going to bed, so I gave up the habit of eating snacks before bed. I eat my dinner at eight and go to bed at twelve, which seems to be a long enough time. But it didn't help. I tried everything. For some days I jogged before sleeping, in the hope that it will 'shake the food deeper down'. And I tried using a high pillow too. It helped a bit but the posture is very uncomfortable and I often slip down when asleep. The problem has existed for months. What should I do?

— Signed, The cow

Dear The cow,

It sounds like you're all too familiar with the signs and symptoms of gastric reflux. This is a condition in which stomach acid flows back (reflux) up into the throat (via the esophagus) and can cause horrible heartburn. While having a bout of reflux here and there can happen to anyone, experiencing it with some frequency (two or more times a week) may result in a diagnosis of gastroesophageal reflux disease or GERD. The frequent acid reflux can also irritate the lining of the esophagus, causing inflammation. In turn, this irritation can lead to narrowing of the esophagus (causing a person to have difficulty swallowing), ulcers, and even a slightly increased risk of esophageal cancer. In addition to what you’ve already tried, there may be a few additional actions you can take to bring some relief.

It sounds as if you're already doing lots of good things to help decrease the acid reflux (such as avoiding large meals before bed, allowing a few hours to digest after eating before lying down, and elevating your upper body to have gravity help keep the acid down while you sleep). Here are some more ideas for you to consider:

  • Instead of using a high pillow, you might try propping up your whole bed with a couple of cinder blocks under the posts at the head of your bed.
  • Avoiding tight fitting pants and bending over for extended periods after eating can reduce the pressure on your stomach.
  • If you're overweight, losing five to ten percent of your body weight could tremendously decrease the symptoms of GERD.
  • If you're a smoker, quitting smoking can help.
  • Certain foods, including fatty foods, spicy foods, chocolate, caffeine, onions, tomato sauce, carbonated beverages, alcohol, and peppermint or wintergreen flavorings, can exacerbate reflux. Identifying which foods bother you and avoiding them may keep the acid at bay.
  • You may try eating smaller meals more frequently, such as eating six smaller meals as opposed to three larger meals in a day.
  • Over-the-counter medicines may also provide some relief:
    • Antacids (brand names include: Maalox, Mylanta, Rolaids, or Tums) can neutralize stomach acid to provide some quick relief.
    • H2-receptor blockers (brand names include: Tagamet, Pepcid, or Zantac) can reduce the production of stomach acid. These medicines don't work as fast as antacids, but they tend to provide longer relief.
    • Proton pump inhibitors (brand names include: Prilosec or Nexium) can block acid production and allow time for the damaged esophageal tissue to heal. However, this type of medication is meant for short-term use only (unless it’s prescribed for long-term use).

There are stronger prescription medications and less-invasive procedures that may also help reduce the discomfort associated with GERD, so you may want to consider making another appointment with your health care provider if you have:

  • Heartburn that a) occurs several times a week, b) returns soon after an antacid medicine wears off, or c) wakes you up at night
  • Difficulty swallowing
  • Regurgitated blood
  • Stool that is black (seeing black in your bowel movements could indicate bleeding somewhere in the digestive tract)
  • Symptoms that persist even though you're taking prescription medications

Again, if you’re not getting the relief you're looking for with lifestyle adjustments and over-the-counter medications, then it may be time to seek out some additional medical advice. To learn a bit more about acid reflux and GERD, both Mayo Clinic and the National Institute of Diabetes and Digestive and Kidney Diseases have even more information.

Here’s hoping you find some relief soon!

Alice!

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