DEAR DOCTOR,

I often get heartburn when I eat certain foods, especially in the night, making it very hard for me to sleep. How can I effectively deal with this? Should I just avoid these foods altogether?

SIMON

DEAR SIMON, 

What is your current age? How long have you been having heartburn in the night and how frequent is it? Is it always after eating some specific foods or on occasion?

Most common cause of heart burn is dyspepsia. Consuming alcohol, caffeinated products like tea, coffee or cocoa in the evening before sleeping can cause burning pain in chest. Similarly, substances like peppermint, garlic, onions fatty or very spicy food can also cause heartburn and interrupt sleep. It can also be due to a heavy meal taken late in the evening. Apart from these, some drugs like painkillers and steroids irritate the mucosa (inner lining of stomach and food pipe), resulting in heartburn. There may be associated nausea and or vomiting. Best way to avoid this is to follow certain measures. Avoid taking heavy meals, alcohol, tea, coffee, or other heartburn causing substances in the evening prior to sleeping. Take the evening meal at least two to three hours before sleeping. Instead of one heavy meal, take small frequent meals, two to three times each day. This helps in better digestion and also neutralises acid produced by mucosa of the stomach, thus preventing heartburn. Keeping the head elevated while sleeping, sleeping in left lateral position, helps to reduce acid reflux in the night, thus preventing burning chest pain. Food taken should have high fibre content which aids in digestion. Avoid taking drugs causing heartburn, unless necessary.

Allergy to some food substances can also cause heartburn as one of the manifestations. Mostly, it is protein rich foods like beans, peanuts, which are implicated in causing allergy. Foods containing chemicals as preservatives or colouring/ flavouring agents also cause allergy in susceptible persons. One can judge for oneself what foods are causing problem and avoid them. Obesity can also cause heartburn in supine position. Reducing excess body weight by suitable diet and physical exercise would help prevent this.

Hiatus hernia is a medical condition where   part of the stomach pushes through the diaphragm (large muscle separating the chest and abdomen). Heartburn after lying down is one of the manifestations. Inflammation of the inner lining of oesophagus or stomach or breach in the protective inner lining is yet another cause of heartburn after sleeping. Any of these conditions can be diagnosed by upper gastro intestinal (G.I) endoscopy. Here, the upper part of the alimentary system is directly visualised by putting a tube connected to a small camera, inside the gut via throat. After diagnosis, treating the cause cures heartburn.

It is also important to have adequate sleep and relax. Stress by itself can cause digestive disturbances and heartburn.

Dr. Rachna Pande is a specialist in internal medicine

rachna212002@yahoo.co.uk