Dear Dr Nina: How do I stop getting heartburn after I eat?
Ask the Doctor...
Q I am in my 50s and have recently developed heartburn after I eat. It doesn't happen all the time, but it's frequent enough.
I also sometimes feel nauseous in the mornings when I get up, but this passes after an hour or so. Overall, I am in general good health, although I am about half a stone overweight, but I'm concerned the heartburn might be a symptom of something more serious. I haven't changed my diet, so I don't know why I'm getting heartburn. What do you recommend I do about it?
Dr Nina replies: In a healthy individual, there is a band of muscle at the bottom of the oesophagus that stays closed unless allowing the passage of food. This sphincter keeps acid in the stomach where it should be. Reflux occurs when acid that is normally contained in the stomach manages to flow upwards into the oesophagus.
The lining of the stomach is designed to cope with an acidic environment, but the lining of the oesophagus is not, and it becomes irritated and inflamed, leading to discomfort. This may be felt as soreness in the throat or chest, a sensation of acid coming back into the mouth or soreness in the upper abdomen. If there is pressure in the abdomen, such as with pregnancy and obesity, the pressure from the lower abdomen into the chest can push acid back up.
Symptoms lasting more than a month, new symptoms in anyone aged over 55, those experiencing associated weight loss or anaemia, and those with a family history of stomach problems need further investigation, and onward referral should be sought in this group. If you feel food sticking when swallowing or if you feel you get full very easily, it is essential to see a doctor, as these symptoms are particularly worrying. The most common investigation is a gastroscopy, which involves passing a camera on a fine tube along the oesophagus and into the stomach to look for any erosion, damage or ulcers. If a hiatus hernia is diagnosed, it is likely that long-term treatment with tablets that block acid production will be required. If there is no acid, any gastric inflammation can heal and there will be no further irritation to the oesophagus.
Over time, acid can damage the lining of the oesophagus, leading to erosion (Barrett's oesophagus). This chronic irritation can permanently damage the lining of the oesophagus over time and can increase the risk of cancer in the lower part of the oesophagus. Those who have been diagnosed with Barrett's oesophagus require regular surveillance to watch for changing, potentially cancerous cells.
It is estimated that over half of the stomach ulcers worldwide are caused by helicobacter pylori. This is a bacterium that can survive in the stomach. It can weaken the mucus coating that lines the stomach wall, allowing an ulcer to develop. Not everyone who has this infection develops ulcers or symptoms and it may be present for many years before an ulcer occurs. Other symptoms suggestive of infection may be acid reflux, nausea, and bloating or bad breath.
To avoid simple reflux, eat smaller portions. Maintain a healthy weight, try to include plenty fruit and veg and drink plenty water to keep the gut moving, and avoid the discomfort and bloating that constipation can bring. Eating mint or drinking peppermint tea after a meal can be soothing and refreshing. Don't eat late at night before going to bed. Acid reflux is usually worse lying down. Alcohol is well known to irritate the gut. Spirits are particularly irritating. Smoking relaxes the oesophageal sphincter, making heartburn worse.
Given your age and symptoms, a visit to the doctor is required.
⬤ If you have any queries, email firstname.lastname@example.org