Back in 2014, I had a procedure called an endoscopy — the doctor threaded a scope with a camera on the end of it through my mouth, down my esophagus, and into my stomach. He was looking for the cause of some strange symptoms I’d been having for about a year.
- I would often get hoarse after eating or drinking something and have to clear my throat.
- A few times food got caught in my esophagus, which is pretty freaky. Things like raw vegetables or peanut butter. All I could do was stay calm and take deep breaths and within a few minutes, all would be clear.
- Without warning and usually when I was resting I would sometimes get a sharp, sharp pain in the middle of my chest. The first time it happened, I had a cardiac workup to make sure it wasn’t a heart attack.
The endoscopy and the sharp eye of Dr. Doug Howell, now a retired gastroenterologist, revealed the cause of my symptoms. Acid. “It’s due to leakage of stomach acid because of what’s called an incompetent lower esophageal sphincter,” said Dr. Howell.
A sphincter is a circular band of muscle. When we swallow the one in the lower part of the esophagus relaxes so that food and liquid can pass down into the stomach. Then it’s supposed to close so that stomach acid doesn’t flow back up into the esophagus. My valve doesn’t close properly. As Dr. Howell put it, “Your sphincter has failed you, Diane.”
The persistent leakage of acid caused some esophagitis (inflammation) in the lower part of my esophagus, which made it narrower. There’s a name for the narrowing: Schatzki ring. “Everybody has a ring,” Dr. Howell explained. “It’s usually wide enough so that nothing ever gets caught. If it gets a little bit damaged, a little bit inflamed, it tends to narrow and catch your food.”
During the procedure, he stretched the Schatzki ring with a balloon. So far, knock on wood, I have not had further problems with food sticking. If it begins happening again, I might have another stretching procedure.
The constant hoarseness was also due to acid flowing back into my esophagus as were the sharp pains I got on occasion. “The cause of an esophageal spasm is usually acid reflux,” explained Dr. Howell. “Acid goes up the esophagus, which is unable to protect itself because the valve is no longer working. The remainder of the esophagus goes into an intense spasm to protect you from the acid getting all the way up your esophagus into your throat. It’s sort of a protective reflex.”
The most reassuring information he gave me was that I didn’t have cancer or a precancerous condition. The name for what I did have is gastroesophageal reflux disease (GERD). Everybody experiences reflux. When it happens a lot, or symptoms and/or complications occur, it’s considered GERD — an extremely common disease in this country — affecting nearly 30 million people. I didn’t have any of the common risk factors. Just the luck of the draw.
Common risk factors for GERD
- Hiatal hernia
- Connective tissue disorders, such as scleroderma
Being hoarse and other GERD symptoms
Here’s a list of common symptoms:
- Burning sensation in the chest (heartburn), sometimes spreading to the throat
- Sour taste in the mouth
- Chest pain
- Difficulty swallowing
- Dry cough
- Hoarseness or sore throat
- Regurgitation of food or sour liquid (acid reflux)
- Sensation of a lump in the throat
- Nausea after eating
Nearly everybody gets heartburn from time to time. If your symptoms are severe or you have to take over-the-counter medications for heartburn more than twice a week, you should see your doctor.
Stomach acid that persistently leaks into the esophagus can lead to a precancerous condition called Barrett’s esophagus. The lining of the esophagus becomes damaged and increases the risk of a type of esophageal cancer called adenocarcinoma. Dr. Howell says adenocarcinoma of the esophagus is the number one most rapidly increasing cancer in our society.
Known risk factors for adenocarcinoma of the esophagus
- Barrett’s esophagus
- Obesity (which increases the risk of GERD)
Some people might opt to take an over-the-counter PPI or proton pump inhibitor, which prevents the stomach from producing acid. Because using it long-term may reduce the absorption of important nutrients, vitamins, and minerals and increase the risk of bone fractures and some infections, I decided to carefully weigh the risks and benefits, and start with some lifestyle changes instead.
The Mayo Clinic offers a list of lifestyle changes that might help reduce GERD symptoms:
- Maintain a healthy weight. Excess pounds put pressure on your abdomen, pushing up your stomach and causing acid to back up into your esophagus.
- Avoid tight-fitting clothing. Clothes that fit tightly around your waist put pressure on your abdomen and the lower esophageal sphincter.
- Avoid foods and drinks that trigger heartburn. Common triggers such as fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine may make heartburn worse. Avoid foods you know will trigger your heartburn.
- Eat smaller meals.
- Don’t lie down after a meal. Wait at least three hours after eating before lying down or going to bed.
- Elevate the head of your bed. Place wood or cement blocks under the feet of your bed so that the head end is raised by six to nine inches. Raising your head with additional pillows is not effective.
- Don’t smoke. Smoking decreases the lower esophageal sphincter’s ability to function properly.
The biggest change for me was to avoid the foods and beverages that seemed to trigger my hoarseness. In particular, I gave up minty things, which I consumed more than I realized — Mentos, Altoids, mints, tea — I like them all, but apparently, peppermint relaxes the valve that has failed me. Giving them up definitely made a difference. Caffeine can also trigger it, but I really enjoy that early morning cup of coffee, so didn’t give that up.
As for other things on the list, I would have to say rather than avoid, I don’t overindulge, but I do indulge on occasion, which means I still contend with hoarseness and having to clear my throat, but no sharp pains in my chest (have to knock on wood, again). I now have a prescription for a medication called Famotidine, which I take as needed.
If you are interested in alternative treatments, talk to your doctor about what may be safe for you. Options may include:
- Herbal remedies. Some used for GERD symptoms include licorice, slippery elm, chamomile, and marshmallow. Some herbal remedies can have serious side effects, and/or may interfere with medications. Ask your doctor about a safe dosage before beginning any herbal remedy.
- Relaxation therapies. Techniques to calm stress and anxiety may reduce signs and symptoms of GERD.
- Acupuncture. One small study reported that acupuncture helped people with heartburn that persisted despite medication.
I’d rather not have GERD, but I’m glad to know what was causing my strange symptoms. If you have it too and want to pass along some advice, please do.
Digestive enzymes are a natural treatment for GERD. A calcium defiency can cause a hiatal hernia. Taking protonic pump inhibitors can cause osteoporosis and long term use makes the body dependant on them. They also stop all acid production and your body needs the acid to break down food, medications and supplements for absorbtion.
In the long run, no. I’ve already begun a conversation with my primary care doctor about the issues you mentioned. I appreciate your information very much.
I have wrestled with GERD for 30 years, and only recently discovered an alternative approach – one that gets directly at the cause – at least for some, perhaps many. Another purpose of stomach acid is to kill bacteria. While we need beneficial flora in our intestines, bacteria isn’t supposed to survive in our stomach. But if you develop low stomach acid, you can have bacterial overgrowth in your stomach – and it’s a catch 22 – the more bacteria gets a foothold, the more it can impede stomach acid production. With the stage set, you eat food that the bacteria feed on (they love sugar and carbs especially), and as a result the bacteria give off methane (their waste product), which actually pressurizes your stomach – and it has no choice but to push up through the esophageal sphincter, causing GERD. With this possible scenario, taking PPIs to stop stomach acid production would be counterintuitive – you’d stop acid production, so your esophagus won’t be damaged by acid, but the bacterial overgrowth would just get worse, and when you stop the PPIs, you are worse off than when you started taking them. The answer – for me at least – was to take a stomach acid/enzyme supplement. I took Betaine HCL with Pepsin, and the improvement was astounding for me. It restored a healthier level of acid in my stomach, which kills off the bacterial overgrowth that was causing the problem to begin with. I still have flareups – probably because I haven’t truly cleaned up my diet – but flareups are quickly corrected by taking the supplement for a few meals in a row. I hope this helps – something else to research at least.
Bob, thank you for this information. I’m glad you’re feeling so much better and I’m definitely going to do some research.
I am waiting for a referral to have an endoscopy soon as my doctor now believes that the cough, “Minnie Mouse” voice and shortness of breath I have been experiencing for weeks now may be caused by GERD. They’ve ruled out everything else they could think of. I was put on a PPI and my doctor also suggested a DGL Licorice supplement. I too don’t experience real “heartburn” very often, but have had chest pains for a while now. An ear nose & throat doctor looked at my voice box and said that there was a lot of irritation and inflammation that was consistent with acid reflux. Although it will be nice to finally have a diagnosis, GERD doesn’t sound “fun”. I’m still trying to find a way to raise the head of my bed to help reduce the “gravity” flow issue at night. Good luck to everyone who suffers from this condition.
Good luck Wendy. I’m doing some research on the digestive enzymes the other commenters mentioned, so stay tuned.
The sell “bed risers” in a variety of heights many places and of course at Amazon. They can cost from $15 to $40+ for a set of four. You usually only put two at the top of the bed and none at the bottom or you can put two different sizes if you like to store things under your bed. I hope that this helps.
Thank you for the information!
You should always do research for reliable and safe alternatives. Drugs, over the counter and prescription, have a systemic affect which is not always optimal.
Thank you for posting this article on GERD. I also suffer from it for more years than I can count. When an MD put me on ppi’s I was glad to be free of the heartburn. But then I found about how bad it was so I started reducing the dose gradually. It took a lot of diligence but I kicked it eventually. I have the hoarseness too so next time I visit my doctor, I’m going to mention seeing a gastroenterologist. It is important that we take care of health.
Thanks for your comment, Jo. I’d love to know what the gastroenterologist has to say.