Heartburn and gastrointestinal reflux


It’s difficult to find reliable statistics to how common gastrointestional refux is in Brazil, but the International Foundation for Functional Gastrointestinal Disorders recently estimated that in the United States, 44% of the population notices heartburn symptoms at least once a month, and 7% notice symptoms daily.

This is actually a huge, complex, and controversial subject, but today we will just cover the big picture that hopefully will point you towards relief if you have the problem!

Why does reflux or heartburn occur?

Normally there is a valve-like barrier at the connection between the bottom end of the esophagus as it enters the stomach, and this “valve” (in the diagram, at the area “cárdia”) keeps stomach acids from entering the esophagus. If there is a problem with this valve (usually temporary or intermittent), acid can enter the esophagus and damage the lining of the esophagus. At times the acid can rise as far as the throat, mouth, and back part of the sinuses.

What are the symptoms?


Chest pain

Cough (typically a “dry cough”)


Swallowing difficulty (often feeling of something “stuck in the throat”)

Sore Throat

Bad breath and acidic damage to the teeth

Respiratory symptoms from asthma, sinusitis, pneumonia, or lung scarring

Many people may only have symptoms in the throat and larynx area, such as cough or hoarseness, and not notice heartburn at all.

Prevention and treatment of reflux 

Keep your weight under control. If you are overweight, abdominal fat pushes on the stomach which pushes stomach acids upwards into the esophagus and even higher up. Overweight people who are able to lose their “big belly” often find their reflux symptoms disappear.

Avoid tight clothes (and belts) around your waist. These can push on the stomach forcing acids upwards.

If you smoke, quit.  Smoking relaxes the sphincter between the stomach and esophagus, so acid can more easily enter the esophagus.

Avoid big meals, and avoid eating for two or (preferably) three hours before bedtime.  If you have reflux, it’s best to eat more frequent, smaller meals throughout the day rather than a couple big meals. Big meals require more acid production for digestion. And if you wait a few hours between eating and bedtime, your stomach has time to clear out the food and acid.

Elevate your head.  When you lie down, for a nap or sleep, it’s much easier for acid to travel upwards from your stomach into the esophagus. Avoid lying down after meals, and at nighttime, many people get relief from elevating the head of bed a minimum of 15 to 20 cm. If you take this measure, it’s important that you do it correctly, and not just use more pillows (which can aggravate the problem if it flexes your body at your abdomen). Put the entire head of the bed up on bricks, or buy a special wedge you can find at mattress stores.

Avoid trigger foods. Some people get worse with alcohol, greasy foods, citrus or tomato-based foods, mints, caffeine, or chocolate.

Cut your stress.  Stress can be a trigger in many people, and you might consider more walking or aerobics to help this—both to help cut your stress and keep your weight under control.


If lifestyle measures don’t help, antacids might help after meals and before bedtime. The first-line of stronger medications are the H2 blockers such as ranitidine (Zantac), but to be effective, these need to be taken before a meal. You might try this if you are expecting to eat a large meal or any of your “trigger” foods. The third category of medications, the most potent, are the “proton pump inhibitors” (such as omaprozole), but if you have to resort to this medication, you should see a doctor for a proper diagnosis.

Be aware that heartburn may not be a result of acid reflux— it could be something else, even something more serious, so for any doubts see your doctor or a gastroenterologist, who might suggest further testing.

However most people with reflux and heartburn can effectively manage their problem with simple  lifestyle changes, even avoiding medications in most cases!

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Esta postagem também está disponível em: Portuguese (Brazil)

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