Dear doctor;

I keep getting heart burn every often especially when sleeping at night. Is this a sign of some ailment?

Ninsiima, 26.

Dear Ninsiima,

Heartburn at night usually occurs due to reflux of acid from the stomach into the esophagus (food pipe) while sleeping. Acid is produced in the stomach to serve as a protective cover for the stomach. Reflux of acid in the esophagus usually occurs when the lower esophageal sphincter is not closed easily. During supine position as in sleeping, it becomes easy for the acid to pass to the esophagus.   Chronic reflux can lead to inflammation of the esophagus. Over a prolonged period it can cause scarring of the esophagus. This can cause cancer of the esophagus in some cases. Certain types of foods can cause direct irritation of the esophagus causing heart burn like spicy foods, citrus fruits, processed juices, among others.

Night burn can simply be due to indigestion, that is, food which is eaten is not digested properly. It  often occurs due to drinking soda beverages or alcohol, more so if one takes it while sleeping. Fatty foods like chocolates, chips, etc, which are not easily digested can also cause it. Obesity, wearing tight night clothes, smoking, taking sleeping pills, some anti inflammatory drugs, are other causes for night burn. It can also occur due to certain diseases like hiatal hernia (where part of diaphragm herniates), diabetes, scleroderma, among others.

Prevention lies in avoiding alcohol, sodas, fatty and spicy foods. Taking small frequent meals is better than taking one heavy meal at a time. Preferably one should take dinner early in the evening, so there is enough time for the stomach to digest it before sleeping. If the problem is much, taking drugs that neutralise acid of the stomach like omeprazole and Ranitidine would help. Night burn is mostly a functional disorder and improves with changes in food habits and life style factors. However if the problem continues, it is better to get tests for diabetes and esophagitis done. A simple blood test and upper gastrointestinal endoscopy is needed.