Most people will experience heartburn at some point in their lives. It’s often caused by lifestyle or dietary choices. However, if you are living with multiple sclerosis (MS), your heartburn may be caused or made worse by your illness. Fortunately, several strategies can help you manage your heartburn and indigestion with MS.
Heartburn, or acid reflux, is a burning sensation in the chest. It’s caused by stomach acid spilling into the esophagus, the tube that connects your mouth to your stomach. Typically, the symptoms of heartburn move up from your stomach to directly behind your breastbone. Sometimes the pain moves upward to the throat. You may experience a sour taste in your mouth or the feeling that you may vomit.
Your stomach is separated from your esophagus by a muscle called the lower esophageal sphincter (LES). The LES typically opens to allow food to enter the stomach and closes shortly afterward. When the LES fails to close properly, stomach acid can flow back into the esophagus. Your stomach lining is built to handle acidic environments, but your esophagus is not. Therefore, stomach acid in the esophagus causes irritation that is felt as a burning pain centered behind the breastbone or higher in the throat.
Most people will experience heartburn occasionally. Some people experience acid reflux with such intensity or frequency that it impacts their day-to-day life. This condition is referred to as gastroesophageal reflux disease (GERD).
People who are living with GERD or acid reflux often experience a combination of the following symptoms:
Many people living with MS experience gastrointestinal symptoms caused or made worse by their illness. These symptoms include heartburn, indigestion, bloating, and regurgitation.
People with MS often develop a condition called gastroparesis, where the muscles of the stomach and upper digestive tract stop working or work less efficiently. Gastroparesis causes food to build up in the gastrointestinal tract. As a result, many people with MS feel full even though they are still hungry. In some cases, they can become malnourished. Because the stomach doesn’t empty properly, there is less room in the stomach for stomach acid. This can lead to acid reflux.
MS is an autoimmune disease in which the immune system attacks the myelin sheaths on neurons, the cells that form the majority of the nervous system. Neurons act like microscopic wires. They transmit information about things like pain and temperature throughout your body, and they also send movement commands between your brain and body.
Myelin sheaths insulate neurons and let them transmit signals more efficiently. As your immune system attacks and degrades these myelin sheaths, nerves aren’t able to transmit signals as well, resulting in various health issues.
Bundles of neurons going to similar parts of the body are called nerves. One of the major nerves affected by MS is the vagus nerve, or the X cranial nerve. The vagus nerve transmits signals from the brain to the heart, stomach, and other organs. As a result, damage to the vagus nerve can impair the stomach’s function and cause gastroparesis.
There is no single cause of heartburn in most cases. Instead, many different things can contribute to and perpetuate symptoms. While MS may contribute to your acid reflux, reflux could be the result of other causes as well.
Dietary choices are a major lifestyle factor that contribute to GERD symptoms. Eating spicy foods is a common cause of acid reflux; spicy foods can trigger severe heartburn in people with GERD. Likewise, eating fatty foods is often a GERD trigger because foods high in fat can stimulate stomach acid production.
Heartburn isn’t just caused by what you eat — when you eat and what you do afterward matter too. Many people find that lying down after eating can trigger acid reflux. Sleeping too soon after eating is also associated with symptoms of GERD, likely due to changes in gastrointestinal activity during sleep.
Tobacco and alcohol use are also associated with worsening GERD symptoms.
Some over-the-counter drugs like aspirin or nonsteroidal anti-inflammatory drugs can cause heartburn symptoms and indigestion. Prescription drugs such as albuterol, antidepressants, and benzodiazepines can also contribute to acid reflux.
The most common cause of GERD symptoms is problems with LES function. Some conditions make it harder for the LES to close tightly. In some people, the LES briefly opens even when there is no food to move into the stomach. These brief relaxations allow stomach contents to splash into the esophagus.
The diaphragm is a large muscle that helps you breathe. It separates your chest from your abdomen. A hiatal hernia occurs when a portion of the top of the stomach pushes through the diaphragm. This causes reflux and irritation of the esophagus. Typically, larger hiatal hernias are associated with worse GERD symptoms than smaller ones.
The esophagus is a common source of GERD-related symptoms. A protective layer of mucus in the esophagus helps protect against occasional exposure to stomach acid. Sometimes, this layer is damaged or absent, which can increase the pain of acid reflux.
The motion of the esophagus, called peristalsis, helps move food down toward the LES and the stomach. Disorders and conditions that impair esophageal peristalsis can lead to a backup that causes heartburn symptoms.
GERD is also associated with other medical conditions. These include pregnancy, obesity, and connective tissue disorders. Some autoimmune disorders are also associated with GERD.
Although there is no surefire way to cure or prevent heartburn completely, many strategies can help you to reduce your symptoms. Work with your doctor to find the best treatment options for you. Your doctor can prescribe or recommend certain medications or lifestyle changes that can help treat your symptoms. They may also refer you to a gastroenterologist who can provide more involved care.
The following recommendations could also help you alleviate your heartburn — but always talk with your doctor before making major lifestyle changes or starting new medications.
Consuming less alcohol, fatty foods, or spicy foods may also help reduce your heartburn symptoms. Try eating earlier in the evening and elevating the head of your bed as well. These two changes may reduce your nighttime GERD symptoms and improve your sleep quality.
There are three main classes of drugs that relieve GERD symptoms: proton pump inhibitors (PPIs), histamine-2 (H2) blockers, and antacids. Regardless of the solution you choose, make sure to talk with a pharmacist or your care team about potential side effects or interactions with other medications.
PPIs reduce the stomach acid your body produces by blocking the protein that acidifies stomach contents. Examples of over-the-counter PPIs include omeprazole (Prilosec) and esomeprazole (Nexium).
After eating, the body releases a chemical called histamine that tells certain cells in the stomach to produce more stomach acid. H2 blockers prevent histamine from acting on these cells, reducing stomach acid production.
Examples of over-the-counter H2 blockers include:
Antacids neutralize or weaken stomach acid, preventing it from irritating your esophagus. Common examples of antacids include calcium carbonate (Tums) and Maalox.
MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 183,000 members come together to ask questions, give advice, and share their stories with others who understand life with multiple sclerosis.
Are you living with multiple sclerosis and heartburn? Share your experience in the comments below, or start a conversation by posting on your Activities page.