Travelers Medical Guide

esophagus, which causes a burning sensation in the center of the chest and esophagus. The esophagus cannot tolerate the acid as well as the stomach can, resulting in inflammation and pain. Heartburn is often worse following large meals, after eating certain foods or when bending forward, straining or lying flat (especially after meals or in the morning). Reflux is common, especially in pregnant women, obese people, people who eat spicy foods or eat late at night and people who drink lots of alcohol.

Symptoms: The most common GERD symptom is a burning sensation in the center of the chest that typically moves up the esophagus toward the back of the throat. It is often associated with belching, nausea, a chronic dry cough, a sour or bitter taste in the back of the mouth, discomfort when swallowing and occasionally hoarseness. The abdominal pain is usually worse after meals and is associated with a sensation of fullness or bloating, but this is not true for everyone. Over time, this leaking of acidic fluids into the esophagus can lead to permanent damage. GERD is diagnosed primarily based on history, except in extreme circumstances in which a procedure called endoscopy is performed in a doctor’s office.

Treatment: The best treatment for GERD is avoidance of foods and habits that can worsen reflux. Once symptoms start, the treatments are primarily associated with lifestyle. They include the following: (1) elevating the head of the bed at least 6 inches to allow gravity to assist in preventing leakage of acidic stomach contents upward, (2) eating smaller meals at least three to four hours before lying down or going to sleep, (3) avoiding late-night snacks and alcohol before bedtime, (4) limiting foods that may worsen reflux, (5) refraining from smoking, (6) wearing loose-fitting clothing to reduce abdominal pressure (which may increase reflux) and (7) maintaining a healthy weight.

Medications that may help reduce acid reflux include over-the-counter antacids, but some antacids may cause side effects such as constipation, diarrhea and decreased absorption of other medications, so chronic use is not recommended. Other antacids include H2 blockers and proton pump inhibitors. These are effective medications, but they work gradually and may not be best for people who want immediate relief of acute symptoms.

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