Feeling it in the gut

Ever notice that unpleasant stomach burn…. Even after a pleasant meal? Dyspepsia, sour stomach, heartburn, reflux, GERD (gastroesophageal reflux disease)….not identical terms but all do describe a common symptom of belly discomfort.
During the holidays our diets may change and reflect more ‘indulgent” foods: candy, chocolate, alcohol, and just plain abundance, which can lead to more stomach discomfort and more visits to the doctor or to the emergency room.
Having a bad reaction in your gut is not always due to dietary indiscretion, though. Let’s take a look at some of the common and some of the more concerning causes for stomach discomfort.
First, what is going on here? Our stomach contains acid–which can eat through many common materials–but is protected by a specialized lining. We need the acid to break down our food and absorb its nutrients. But if the stomach lining is breached that same benefit can turn into a detriment.
The esophagus (food tube) travels from the mouth through the chest beneath the breast bone next to the heart on its way to the stomach. When it is irritated it can cause left-sided chest pain, often a burning sensation, giving rise to the term “heartburn.”
At the base of the esophagus there is a sphincter, a band of muscle, which keeps the stomach and its acid secure. It opens at the reflex of swallowing to allow the chewed food to come in. But that sphincter can loosen or not completely close—sometimes a result of the type of food eaten. A loose sphincter allows acid to rise into the esophagus and irritate it, cause it to spasm or even allow the acid and undigested food to reflux back into the mouth. The result: cough, shortness of breath, chest pain, burning sensations, difficulty swallowing. Any one of any age can suffer these symptoms.
Besides the discomfort it causes, a worse danger is the change that can occur over time: if the esophagus is constantly exposed to acid, the cells lining it can alter and ultimately lead to cancer. For children reflux can appear as asthma, night time coughing, even pneumonia. In infants problems with feeding, regurgitation, irritability and poor growth may result.
What to do?
One plan is to avoid trigger foods. Some foods and compounds are classically known to irritate the stomach lining or to loosen the securing sphincter: alcohol, tobacco and caffeine are the big three. Chocolate (which also contains some caffeine) can trigger symptoms in some people, as can mint, spicy foods, citrus such as tomatoes and oranges and even potatoes, eggplant and garlic. For some people fatty or fried foods serve as a trigger.
Another is to avoid tight clothing, especially garments and belts that restrict the abdomen and can add undue pressure on the stomach sphincter. Overweight is a trigger; even a little weight loss can reduce symptoms significantly. Avoiding lying down within 2 hours of a meal and even raising the head of the bed on a 4 to 6 inch block for a slight incline can reduce symptoms.
For some people the source is anatomic, such as a hiatal hernia (malposition of the stomach) and may require surgical intervention.
Treating immediately symptoms with acid blockers can help in the short term, but longer term solutions are more desirable. We do, in fact, need our stomach acid for food digestion, and chronic suppression brings on other problems.
Seek better dietary choices, weight loss if indicated…and seek help if you still have symptoms despite your efforts. Beware—-and bon appetit!

Dr Hoffman

Dr. Rebecca Hoffman is a Family Practitioner and works at Kaiser Permanente in Salmon Creek, which is in Vancouver, Washington. Interests include using diet and healthy living to stay healthy and attending to mental health and its physical manifestations. Personal interests include hiking, jogging, music (she plays the harp), dance, theater, storytelling and writing. She lives with her husband and two daughters.

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