Beyond Food: What Triggers Heartburn and GERD?

In gastroesophageal reflux disease (GERD), the LES does not close properly allowing the stomach contents to leak back or reflux into the food pipe and irritate it.

Heartburn is the burning sensation in the chest due to backflow or reflux of the acidic stomach contents into the food pipe (esophagus). Heartburn is a major symptom of gastroesophageal reflux disease or GERD. The food pipe or esophagus is a tube that connects the mouth to the stomach. The lower end of the esophagus has a muscular valve called the lower esophageal sphincter or LES. The LES guards the reflux of stomach contents into the food pipe. In gastroesophageal reflux disease (GERD), the LES does not close properly allowing the stomach contents to leak back or reflux into the food pipe and irritate it.

Certain foods and drinks have been recognized to trigger heartburn. They include spicy and fatty foods, alcohol, coffee (including decaf), tomatoes, chocolate, and carbonated beverages.

Besides certain foods, several other factors may cause heartburn. They include:

• Overeating
• Sleeping or lying down right after a meal
• Smoking
• Rigorous exercise especially after a meal
• Obesity or being overweight
• Hiatal hernia (a condition in which the stomach bulges up into the chest through an opening in the diaphragm, the muscle that separates the two areas)
• Certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), blood pressure medications, and medications used to treat asthma, heart diseases, anxiety, depression, and cancer
• Stress and anxiety

Multivitamins, especially the ones containing zinc, iron, or calcium, can aggravate the symptoms of GERD including heartburn. To avoid heartburn caused by multivitamins:

• Avoid taking multivitamins on empty stomach
• Take multivitamins with food
• Do not take multivitamins right before exercise
• Try the easy-to-digest forms of multivitamins, such as chewable tablets, powders, and dissolvable forms
• Avoid mega doses of multivitamins, such as the once a month or once a week dose
• Take smaller daily doses of multivitamins
• Try meeting your daily nutrient needs through a diet

The treatment for heartburn involves:

• Lifestyle and home remedies:
  • Eat small meals
  • Eat your food slowly
  • Avoid certain foods and beverages, such as spicy and oily foods, citrus, tomato, mint, garlic, chocolate, tea, coffee, carbonated drinks, and alcohol
  • Do not lie down right after eating
  • Do not snack close to bedtime
  • Maintain a healthy weight
  • Do not smoke
• Medications:
  • Antacids to neutralize stomach acid
  • H2 blockers to decrease acid production
  • Foaming agents coat the stomach to prevent reflux
  • Proton pump inhibitors reduce the amount of acid the stomach makes
  • Prokinetics help strengthen the lower esophageal sphincter (LES); they empty the stomach faster and reduce acid reflux
• Surgery: If the medications do not provide lasting relief and the symptoms are severely interfering with everyday activities, your doctor may recommend surgery options, which include:
  • LINX device placement: The procedure involves surgically placing a ring (LINX device) around the outside of the lower end of the esophagus.
  • Fundoplication: The procedure creates an artificial valve using the upper part of the stomach.