The question: Large meals keep me awake at night with heartburn. Help!
Heartburn, or as it is more officially known, Gastro-Esophageal Reflux Disease (GERD), produces a variety of symptoms that may include: chest pain or burning, belching, a sore throat, an acid or bitter taste, coughing, hoarseness and bad breath. These are due to acid reflux — that is, acid from your stomach which is backed-up into your esophagus, where it causes irritation and the symptoms we commonly call heartburn or indigestion.
Acid is usually blocked from the esophagus by a constricting sphincter muscle at the entrance to the stomach. This muscle sometimes becomes weakened as we age. Body position (lying down or bending over) or eating a large meal may push acidic stomach fluids into the esophagus. Certain foods, like citrus juice, alcohol, pepper, caffeine, peppermint and carbonated beverages, may also contribute to GERD. Increased abdominal pressure due to obesity and pregnancy can similarly result in acid reflux.
GERD should be properly diagnosed and treated as it not only results in discomfort, but may make you at increased risk for bleeding, narrowing of your esophagus or even esophageal cancer. Diagnostic tests may include an endoscopy with a fiber-optic scope to look into your upper digestive system, a measure of the acidity in the esophagus and stomach or X-rays that look at the motion of the esophagus as you swallow solids and liquids.
Treatment includes modifying your diet to eliminate contributing factors like caffeine and acidic and spicy foods. It also includes modifying your habits to reduce your meal size and eliminate tobacco and alcohol. If you are bothered by clear-cut symptoms of acid reflux, a trial of one of the common over-the-counter acid blocking products is usually worthwhile prior to seeking advanced relief. For stubborn symptoms, stronger medication to decrease or block the amount of acid secreted by the stomach may be prescribed by your physician after an evaluation to look for complicating factors.