I have a small hiatal hernia, and if I eat late at night I find that I have nasty heartburn and acid reflux. My wife tells me I can get esophageal cancer if I am not careful. What do you advise?
Gastroesophageal reflux disease, sometimes called GERD, is very common, affecting between 14 to 20 percent of adults. The disease is a little vague in its definition, because diagnosis is based on self-reported chronic heartburn.
What happens is that acid from the stomach, which is hydrochloric acid, washes back up the esophagus, or gullet. This takes place especially in the lying-down position, and more so if one is overweight or if the stomach is full.
The condition is seen most frequently in those with a hiatal hernia, where the stomach pushes through the diaphragm into the thorax.
Interestingly, endoscopic findings—that is, what is seen internally using a narrow tube called an endoscope—do not always show the most serious findings in those complaining of severe symptoms. Reflux of acid can cause chest pains that mimic a heart attack or gall bladder disease. The acid can lead to scarring and narrowing, as well as a condition called Barrett’s metaplasia, which can lead to cancer of the esophagus. The esophagus can be checked and biopsied in a routine endoscopic procedure, and your doctor will advise you about this.
It makes sense to reduce fatty foods and highly spicy, irritating foods.
Elevating the head of the bed may reduce the reflux.
You mention eating late at night. An early and light evening meal, taken at least four hours before retiring, is a wise adaptation.
Weight loss could also help.
There is considerable evidence to show that the blocking of acid production by the stomach results in reduction of symptoms. There are two groups of medications used to help with this. One group is called proton pump inhibitors; the other, histamine receptor antagonists. Proton pump inhibitors result in a clearance of esophagitis better than the histamine receptor blockers, but both are effective in most patients. The problem is that this is a chronic condition, and prolonged use of medication may be required. If one can decrease weight, sleep with the head of the bed up three to four inches, and eat early in the evening, medication might be avoided.
Surgery has not proved to be an unqualified success, and its utilization has decreased markedly since 1999.
In summary, evening consumption of citrus fruit, tomatoes, onions, carbonated drinks, or spicy foods is discouraged. Fatty foods, coffee, tea, and caffeinated beverages, along with chocolate and mint, tend to cause gastric reflux.
Smoking cessation, weight reduction, and alcohol cessation all help reduce this problem.