The special risks of night-time heartburn
Many people in the UK have heartburn with night-time symptoms that disrupt sleep.
Chronic (long-term) heartburn, also known as GORD, gastro-oesophageal reflux disease, is a condition in which stomach acid refluxes back up into the oesophagus.
Around 1 in 5 people will experience at least one episode of GORD a week.
However, night-time heartburn can be treated.
Why is night-time heartburn more dangerous?
Night-time heartburn is a special problem as lying flat can aggravate the symptoms. Night-time heartburn tends to leave acid in the oesophagus longer, so it can cause more damage than daytime heartburn.
During the day acids from the stomach may briefly force their way into your oesophagus, but gravity quickly pulls them back down to the stomach.
When you're lying down, gravity isn't pulling in the right direction. Instead, the stomach contents are pressing on the sphincter muscle that connects the oesophagus to the stomach. In people with GORD, which means nearly everyone with chronic heartburn, the sphincter is faulty. It doesn't fully close. So acids can reflux back up into the oesophagus. Because you're lying down, once acids get into the oesophagus they can sit there for much longer than during the day. That can increase the damage.
When you're awake you naturally swallow whenever acid begins to reflux. This pushes the acid back down into the stomach. Saliva also contains bicarbonate, which can neutralise stomach acid. When you're asleep, the swallowing impulse is suppressed.
What complications can GORD and night-time heartburn cause?
A common GORD complication is inflamed lining of the oesophagus called oesophagitis.
In rare cases, GORD can lead to oesophageal cancer.
The effects of night-time heartburn aren't confined to the oesophagus. It can also result in chronic insomnia. Night-time heartburn can wake you up and keep you up.
Controlling night-time heartburn
Fortunately there are lots of different treatments for night-time heartburn. They can reduce your symptoms and your discomfort. They also lower the risk of developing serious complications.
Many people can find relief by:
- Avoiding foods that can lead to heartburn such as alcohol, chocolate, peppermint, coffee, fizzy drinks, citrus fruits and juices, tomatoes, pepper, vinegar, ketchup and mustard, and spicy or fatty foods
- Eating smaller meals with the evening meal 3 to 4 hours before bedtime
- Losing weight if overweight
- Quitting smoking
- Chewing gum in the evening to increase saliva
- Putting blocks safely under the head of the bed to elevate your head end by around 20cm (8 inches). Extra pillows won't help as they can put extra pressure on the abdomen.
Over-the-counter medicines for heartburn
If changes to your lifestyle don't ease your night-time heartburn, over-the-counter medications may help. Antacids neutralise the acid in the stomach. These include liquids, and solid tablets.
Another type of over-the-counter medicine is alginates. These produce a protective coating that shields the stomach and oesophagus linings.
Prescription medication for heartburn and GORD
If other measures haven’t helped, a doctor may prescribe a month's course of proton-pump inhibitors or PPIs. These drugs reduce the amount of acid the stomach produces.
If PPIs haven't helped, a 2 week course of H2-receptor antagonist or H2RA drugs may be recommended. These help to block histamine which the body needs to make stomach acid.
If other treatments haven't helped relieve the symptoms, a short-term dose of a prokinetic may be suggested. These help the stomach to empty more quickly, which helps lessen the risk of acid irritation.
medication hasn’t relieved the symptoms, several operations and surgical procedures are available. A doctor will discuss the risks and benefits of possible procedures and any side-effects.