What to do to extinguish the fire
By Deborah Jeanne Sergeant
Heartburn or acid reflux, the feeling of lava crawling up your esophagus, occurs in 20% of people older than 60 and 30% of those older than 70, according to the National Institutes of Health.
People tend to lose muscle tone as they age, including the lower esophageal sphincter. When working normally, this structure helps keep stomach acid where it belongs.
Older adults’ slower digestion and propensity for taking medications that relax the lower esophageal sphincter also raise their risk of acid reflux. Health issues that raise risk also tend to present in middle to older adulthood, including Type 2 diabetes, Parkinson’s disease and Alzheimer’s disease.
“As we get older, acid reflux tends to happen more and more,” said Christopher J. Norman, geriatric nurse practitioner, Ph.D. candidate and associate medical director at PACE CNY. “Heartburn happening repeatedly is gastroesophageal reflux disease” (GERD).
He explained that age-related thinning of the lining of the esophagus exacerbates acid reflux. But acid reflux can be minimized both with lifestyle changes and medication. Norman said that quitting smoking and vaping can help, as can losing weight.
He added that other strategies to combat the burn include avoiding eating three to four hours before lying down so food has more time to pass farther along in the digestive system. Gravity can help keep stomach acid down.
“When you’re digesting food, that acid is very active,” Norman said. “If you have a large meal, don’t lie down. If you’re lying down, especially on your back, you’re more likely to have that acid. Instead, sit down on a recliner at a 30- to 45-degree angle, not flat on your back. You’re letting gravity move things along as well.”
It may also help to avoid alcohol or coffee, especially late at night.
“If you are prone to coffee after dinner, switch to tea or decaffeinated coffee,” Norman said. “These are less inflammatory.”
He also noted that medications, including over-the-counter medicine like aspirin, can contribute to acid reflux. People experiencing acid reflux should discuss their medication with their providers.
Diet can worsen acid reflux.
Laurel Sterling registered dietitian and global educator for Carlson Laboratories in Canastota, said that eating smaller, more frequent meals can help, along with minimizing irritating foods, including, fried foods, tomato sauce, spicy foods, orange juice, garlic, onion and others such as alcohol, chocolate, mint and caffeine “as these relax the lower esophageal sphincter,” Sterling said.
She also suggested trying digestive enzymes with meals or papaya enzymes after meals.
Lifestyle changes can help reduce acid reflux, but that does not mean eschewing medication. Over-the-counter preparations such as Tums or Pepcid can help in mild to moderate cases. Doctors can prescribe medications such as proton pump inhibitors (PPI) such as Nexium (esomeprazole), Prilosec (omeprazole), Protonix (pantoprazole), and Prevacid (lansoprazole).
Most cases cannot be resolved with lifestyle changes alone, according to gerontologist Sharon Brangman, faculty member at SUNY Upstate Medical University and a distinguished service professor, chairwomn of geriatric medicine and director of the Upstate Center of Excellence for Alzheimer’s Disease.
“Some over-the-counter antacids that sometimes help,” Brangman said, “but most importantly, speak with your doctor. Some think it’s acid indigestion but It’s really heart disease. Chest pain can feel like indigestion but you’re at risk for a heart attack. Don’t self-diagnose. Speak with a primary care provider.”
For people experiencing chronic reflux, an endoscopy can help monitor for precancerous changes in the esophagus.