Asthma & GERD
Gastroesophageal reflux occurs when the acidic contents of the stomach flow back up into the esophagus. This stimulates a reflex that may cause asthma to worsen. Symptoms of heartburn and breathing difficulty at night can indicate gastroesophageal reflux.
Everybody has some reflux. Abnormal amounts of gastroesophageal reflux can cause gastroesophageal reflux disease, or GERD. This occurs when the valve of smooth muscle between the esophagus and the stomach does not function properly. This muscle band is called the lower esophageal sphincter.
A physician diagnoses GERD from a history of signs and symptoms. He or she may order tests, such as a barium swallow test, esophageal pH probe study, or endoscopy, to help diagnose this condition.
Each time you eat, stomach acids are released. Normally, the lower esophageal sphincter acts as a guard to prevent stomach acids from backing up into the esophagus. An increase of the pressure in the stomach or relaxation of the muscle tone of the valve may cause reflux to occur.
Elevate the head of the bed five to six inches. Lying down flat presses the stomach’s contents against the lower esophageal sphincter.
Factors that can cause an increase in pressure are a full stomach, obesity, lying down, bending forward, pregnancy, and tight clothing. Factors that loosen the muscle tone of the valve include pregnancy, nicotine, alcohol, coffee, tea, chocolate, mint, and fatty foods.
Symptoms of gastroesophageal reflux disease include heartburn, sour taste in the mouth, pain occurring in the middle of the chest or stomach, chronic cough, choking sensation, increased trouble breathing while asleep, swallowing problems, sore throat, recurrent pneumonia, and chronic sinusitis.
Medications that may be prescribed to help this condition include proton pump inhibitors, H2 antagonists, and promotility agents. Proton pump inhibitors are acid-suppressing medicines that are used most commonly for people with symptomatic GERD. These include Prilosec® (omeprazole), Nexium® (esomeprazole), Prevacid® (lansoprazole), Protonix® (pantoprazole), Aciphex® (rabeprazole), and Dexilant® (lansoprazole)
H2 antagonists are acid-suppressing medicines that are used to treat mild GERD. These include Tagamet® (cimetadine), Zantac® (ranitidine), Pepcid® (famotidine), and Axid® (nizatidine). A promotility agent is a medicine that moves the food through the stomach more quickly, such as Reglan® (metoclopramide).
Occasionally, surgery may be recommended to help eliminate GERD.
Your doctor may suggest certain lifestyle, dietary, or physical changes to help prevent acid reflux. If you are overweight, talk with your healthcare provider about losing weight. Obesity increases abdominal pressure, which can then push stomach contents up into the esophagus. According to some statistics, approximately 35 percent of overweight people experience heartburn.
If you smoke, quitting smoking is important. Nicotine relaxes the esophageal sphincter. Smoking also stimulates the production of stomach acid. Your healthcare provider may have ideas to help you quit.
Relax. While stress hasn’t been linked directly to heartburn, it is known that it can lead to behaviors that can trigger heartburn.
Limit citrus and tomato products (if they cause pain), strong spices, caffeinated and decaffeinated coffee and tea, carbonated drinks, fatty foods, chocolate, mint, and alcohol. Eat smaller, more frequent meals rather than three large ones. A full stomach can put extra pressure on the lower esophageal sphincter, which will increase the chance that some of this food will reflux into the esophagus. Avoid food or liquids for two to three hours before bedtime. Lying down with a full stomach can cause stomach contents to press harder against the lower esophageal sphincter, increasing the chances of refluxed food.
Elevate the head of the bed five to six inches. Lying down flat presses the stomach’s contents against the lower esophageal sphincter. With the head higher than the stomach, gravity helps reduce this pressure. You can elevate your head in a couple of ways. You can place bricks, blocks, or anything that’s sturdy securely under the legs at the head of your bed. You can also use a wedge-shaped pillow to elevate your head.
Avoid bending forward at the waist. This will squeeze the stomach, forcing food up against the lower esophageal sphincter. Avoid wearing tight-fitting clothing. Clothing that fits tightly around the abdomen will squeeze the stomach, forcing food up against the lower esophageal sphincter, and cause food to reflux into the esophagus. Clothing that can cause problems include tight-fitting belts and slenderizing undergarments.
This article was originally published in Coping® with Allergies & Asthma magazine, May/June 2011.