With an abundance of tasty holiday treats on the horizon, party-goers are bound to suffer some heartburn. But for some, that heartburn will indicate a much more serious disorder — gastroesophageal reflux disease, a digestive disorder characterized by a burning sensation in the mid-chest, coughing and sometimes hoarseness of voice — that afflicts about five million Canadians

Although most people consider heartburn a minor inconvenience, chronic sufferers of GERD can lose hours of sleep every night. A study published this past September by the American Journal of Gastroenterology found that those suffering from GERD and nighttime heartburn slept significantly better once their symptoms were controlled with prescription medications.

“The research gives corroborative evidence that proper treatment not only can improve your heartburn, but can also improve your sleep and, therefore, your productivity at work,” says the study’s lead author, Dr. David Johnson.

Heartburn occurs when the natural acids in the stomach creep up into the esophagus, the tube leading from the mouth into the digestive tract. Ordinarily, a valve called the lower esophageal sphincter muscle keeps the acid in the stomach, where a thin layer of mucous prevents irritation to the stomach lining. In heartburn patients, however, this valve remains open. Because the esophagus does not benefit from the same protective mucous layer as in the stomach, the acid causes a burning sensation, which often mimics a heart attack or angina.

“There are some heartburn sufferers whose symptoms definitely make them miserable,” says Dr. Flavio Habal, a gastroenterologist at Toronto General Hospital. “They get up at night because they can’t sleep, they can’t eat certain foods or they are in pain every time they eat a meal. That is significant. Other people only experience heartburn after a big meal; then it’s gone.”

Experts are not sure why some people suffer from heartburn and others do not. It is possible that some people are born with weaker esophageal sphincter muscles or ones that don’t completely close.

Certain foods are also culprits. For instance, fried and fatty foods decrease gastric emptying, causing the stomach to remain full and begin to swell. As the stomach distends, it fills with fluid, causing food to move up into the esophagus.

Other foods promote heartburn because they weaken the esophageal sphincter muscle, allowing acid to travel up out of the stomach. Alcohol, mint and chocolate have all been linked to weakened sphincter muscles. And some foods are considered off-limits to heartburn sufferers because they increase acid production in the stomach. Coffee, tea, cola and cocoa all have this effect.

Contrary to popular belief, stress itself doesn’t cause heartburn. Rather, it’s how a person deals with stress that matters. “If you eat more, drink more and smoke as a reaction to stress, then, yes, it could lead to heartburn,” says Habal.

If left untreated, GERD can lead to inflammation of the esophagus (esophagitis), which causes scarring and obstruction in the esophagus. As a result, patients have trouble swallowing food and often vomit after meals.

There is evidence that suggests that those with long-standing reflux — with or without common symptoms, such as a burning sensation — can develop a more serious condition called Barrett’s esophagus, which affects about 10% of chronic GERD patients. Repeated exposure to stomach acids “tricks” the lower esophagus into thinking it is the stomach, causing the cells of the esophagus to change to mimic those in the stomach. Barrett’s is considered a pre-malignant condition and is associated with higher risk of esophageal cancer.

Many people find relief from temporary bouts of heartburn with over-the-counter medications such as Rolaids, which work to neutralize acid in the stomach. More serious cases of GERD may depend on prescription medications that decrease acid production in the stomach. Called “proton pump inhibitors,” these drugs are the mainstay of heartburn treatment and they work almost immediately, says Habal.

Those with less serious cases of heartburn may be able to keep their symptoms in check with the following tips:

> Shed excess pounds. Carrying around extra weight increases intra-abdominal pressure, which pushes stomach acids up into the esophagus. Lowering your body weight will decrease the pressure. “One of the first things we tell [overweight] patients is to lose weight,” says Habal. “It’s one of the most effective ways to manage heartburn.”

@page_break@> Avoid foods that trigger heartburn. Keep track of foods that trigger pain, and eliminate those foods from your diet.

> Don’t eat before bedtime. Lying down increases the probability of stomach fluids creeping up into the esophagus. Avoid eating before going to sleep. If you must eat, have something small. IE