A muscular ring called the lower esophageal sphincter (LES) separates the esophagus from the stomach. Normally, the LES works something like a gate. The muscle relaxes when you swallow, opening the passage between the esophagus and stomach and allowing food to pass into the stomach. When the sphincter tightens, it closes the passage, keeping food and acidic stomach juices from flowing back into the esophagus. In people with acid reflux (gastroesophageal reflux disease or GERD), the LES relaxes when it shouldn't or becomes weak and doesn't close tightly. Either problem allows the contents of the stomach to rise up into the esophagus. The LES is controlled by various nerves and hormones. As a result, foods, drugs, and certain emotions such as anxiety or anger can impair its function, causing or worsening acid reflux. The following factors are under your power to change:
- Certain foods. Coffee, tea, cocoa, cola drinks, and other caffeine-containing products loosen the LES and stimulate gastric acid production. Mints and chocolate, often served to cap off a meal, can make things worse by relaxing the LES. Fried and fatty foods contribute to heartburn. Some people say that onions and garlic give them heartburn. Others have trouble with citrus fruits or tomato products, which irritate the esophageal lining.
- Eating patterns. How you eat can be as important as what you eat. Skipping breakfast or lunch and then consuming a huge meal at day's end can increase pressure in the stomach and the possibility of reflux. Lying down soon after eating will make the problem worse.
- Smoking. Smoking can irritate the entire gastrointestinal tract. In addition, frequent sucking on a cigarette can cause you to swallow air. This increases pressure inside the stomach, which encourages reflux. Smoking can also relax the LES.
- Overweight and obesity. Being overweight or obese increases the odds of having GERD and experiencing heartburn. Actually, any weight gain increases the risk of frequent GERD symptoms. In addition, eating larger meals distends the stomach, pushes the contents up toward the esophagus and loosens the LES.
- Certain medications. Some prescription drugs can add to the woes of heartburn. Oral contraceptives or postmenopausal hormone preparations containing progesterone are known culprits. Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn) can irritate the stomach lining. Other drugs—such as alendronate (Fosamax), used to prevent and treat osteoporosis—can irritate the esophagus. And some antidepressants, bronchodilators, tranquilizers, and calcium-channel blockers can contribute to reflux by relaxing the LES.
To learn more about GERD and heartburn, read Controlling Heartburn from Harvard Medical School.
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