Shedding a few extra pounds can improve acid reflux symptoms

Go to the doctor to get relief for your heartburn and the first thing she’s likely to say, if you’re overweight, is that you need to shed a few pounds. That’s because studies have suggested a strong link between obesity and a tendency to develop gastroesophageal reflux.

Heartburn symptoms do seem to improve when people cut calories. But no one really knows why extra pounds can lead to heartburn or why weight loss can improve symptoms.

Some doctors argue that symptoms of gastroesophageal reflux disease, or GERD, are the result of a big bulging tummy, that gravity pushes? especially at night? against the stomach. That extra weight increases the pressure put on the lower esophageal sphincter, the valve connecting the esophagus to the stomach. This leads to stomach acid travelling back up into the esophagus, causing a burning sensation in the upper chest.

There is evidence that people who significantly slim down experience big improvements in heartburn symptoms. For example, a report published in February in the journal Obesity Surgery followed 295 patients who were given gastric banding operations. Four years after the surgery, 79 percent of patients who initially had heartburn problems said their symptoms cleared up. Another 11 percent of patients said their heartburn had improved significantly.

Diet, pregnancy and reflux
Still, there’s no consensus among experts as to why weight loss might improve GERD. It’s not clear whether heartburn is extinguished because pounds have melted away or because people have changed their diets and eating habits.

The most likely explanation for symptom improvement is the change in eating habits that accompanies most diets, says Dr. Bennett Roth, a professor of medicine and chief of clinical gastroenterology at the David Geffen School of Medicine at UCLA.

“When you lose weight, you eat less,” Roth explains. “And when you’re eating less, there’s a tendency to not go to bed with a full, overextended stomach.”

Beyond this, dieters often cut back on items that tend to spark heartburn, such as fatty foods and chocolate, Roth says.

The real answer may be a bit of both, says Dr. Felice Schnoll-Sussman, an assistant attending physician at the NewYork-Presbyterian Hospital/Weill Cornell Medical Center and an assistant professor of medicine at Weill Medical College of Cornell University.

To explain how the extra pounds can lead to GERD, Schnoll-Sussman points to the problems pregnant women experience.

“It’s very common for pregnant women to have reflux even if they’ve never had heartburn before,” Schnoll-Sussman says. “The reason is that their expanding uterus presses upon the stomach, which now has a lot less capacitance. The extra pressure thrusts the contents of the stomach up against the esophagus.”

And, generally, when pregnant women give birth and slim down again, their heartburn clears up.

You can extrapolate from that example to obesity, Schnoll-Sussman says.

“Here you also have an expanding abdomen,” she explains. “And that may put pressure on the stomach, especially when you’re lying down. Now you’ve got gravity working against you pushing the belly against your stomach.”

A weighty issue
Dr. David C. Metz, a professor of medicine in the division of gastroenterology at the University of Pennsylvania Health System in Philadelphia, compares the pressure put on the stomach by extra fat to the effects of wearing tight clothing and eating a big meal. “That’s why we tell people to loosen their belts after a meal,” he says.

Metz suspects that obesity also increases the risk that a person will develop a hiatal hernia, which, in turn, would make a person more prone to developing heartburn. It’s possible that when you hit a certain weight, the extra pressure may permanently stretch out the esophagus, leading to the hiatal hernia, he says. Once the hernia has developed, weight loss won’t help put out the heartburn, Metz says.

Weight loss doesn’t help everyone, Schnoll-Sussman allows. People with other predisposing factors may still experience symptoms even after they drop the extra pounds.

“But, I’ve had patients who’ve lost a lot of weight and they were completely cured,” Schnoll-Sussman says.

The amount of weight loss it takes to improve heartburn may be an individual thing, experts say.

“My own father had a threshold weight above which he got reflux and below which he didn’t,” Metz says. “He could tell me what he weighed based on that.”

Linda Carroll is a health and science writer based in Salem, N.J., and former associate editor of the Medical Tribune.