Most people experience acid reflux at some point, and it may cause heartburn, a burning sensation in the chest or throat. Heartburn often gets worse after you eat or when you lie down.

Having multiple sclerosis (MS) doesn’t appear to make heartburn more common than it is in the general population. However, many people with MS have chronic gastrointestinal (GI) symptoms, including heartburn.

We’ll cover connections between MS and acid reflux, ways it can be treated, and tips for managing symptoms at home.

What Is Acid Reflux?

Acid reflux happens when stomach contents flow backward into the esophagus, the tube that connects your mouth to your stomach. It can cause a burning sensation in the chest, called heartburn.

Heartburn is typically felt behind the breastbone and may move up toward the throat.

You may experience a sour taste in your mouth or feel nauseated. Acid reflux can also cause hoarseness and difficulty swallowing.

MS doesn’t appear to make heartburn more common overall, but MS-related swallowing problems and medication side effects may complicate GI symptoms.

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How Does Reflux Happen?

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 contents can flow backward into the esophagus.

Your stomach lining is built to handle acid, but your esophagus isn’t. Acid in the esophagus can cause irritation and a burning sensation.

Over time, frequent reflux can seriously damage the esophagus or lead to Barrett’s esophagus, a precancerous change in the esophagus.

What’s GERD?

Many people have heartburn occasionally, such as after a large meal. When reflux causes repeated, bothersome symptoms or complications over time, it is called gastroesophageal reflux disease (GERD).

GERD or acid reflux may cause a combination of the following symptoms:

• Heartburn
• Regurgitation or a sour taste in the mouth
• Chest pain
• Nausea
• Trouble or pain with swallowing
• Chronic cough or hoarseness

Severe chest pain can also be a symptom of a heart attack, especially if accompanied by shortness of breath or pain in the jaw or arm. Seek medical attention right away.

Can MS Cause Acid Reflux?

People with MS aren’t necessarily more likely to have heartburn than anyone else. However, MS can be associated with GI symptoms, including heartburn, trouble swallowing, nausea, and constipation.

MS lesions affect nerve signaling in the brain and spinal cord. The vagus nerve helps regulate digestion, and nervous system conditions such as MS are among the possible causes of gastroparesis, a condition in which the stomach empties too slowly.

“I buy low-acid coffee and put a pinch of sodium bicarb in other coffees, which supposedly bring down the acid level.”

— A MyMSTeam member

Gastroparesis can slow how food moves out of the stomach. It can make you feel full after only a few bites or long after a meal, and acid reflux can also occur.

Research suggests that achalasia and diffuse esophageal spasm, two conditions that affect how the esophagus moves, are more common in people with MS.

In addition, certain oral disease-modifying therapies (DMTs) can cause GI side effects. Talk to your doctor or pharmacist if you take an oral DMT and develop new or worsening GI symptoms.

Other Possible Causes of Acid Reflux in MS

Occasional heartburn is common, whether or not you have MS. Here are several factors that may trigger reflux or make symptoms worse.

Diet and Lifestyle Factors

For some people, certain foods can trigger or worsen GERD symptoms. Common triggers include:

• Acidic foods, like lemons
• Alcohol
• Caffeine
• Chocolate
• High-fat foods
• Mint
• Spicy foods

If you have symptoms at night, when you eat and what you do afterward matter, too. Eating meals at least three hours before you lie down or go to bed may improve symptoms.

“I have terrible acid reflux from all the meds.”

— A MyMSTeam member

Tobacco and alcohol use can also play a role. Smoking can contribute to GERD, while alcohol may trigger reflux episodes.

Use of Certain Medications

Some over-the-counter drugs, such as aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, can irritate the esophagus and cause heartburnlike pain. Some prescription medicines, including tricyclic antidepressants and benzodiazepines, may worsen acid reflux.

LES Dysfunction

GERD may develop when the LES becomes weak or relaxes when it shouldn’t. Some factors can make this more likely.

Hiatal Hernia

The diaphragm is a large muscle that separates your chest from your stomach. A hiatal hernia happens when a portion of the top of the stomach pushes through the diaphragm, which can increase the chance of GERD or worsen symptoms.

Other Risk Factors

GERD is also associated with pregnancy, obesity, and exposure to secondhand smoke.

How To Manage Acid Reflux and MS

There are many strategies that may help manage reflux symptoms.

Work with your doctor to find the best treatment options for you. They may also refer you to a specialist called a gastroenterologist.

The following approaches may help relieve heartburn, but always talk with your doctor before making major lifestyle changes or starting new medications.

Lifestyle Modifications

If you’re overweight or have obesity, losing weight may reduce GERD symptoms. Maintaining a healthy weight can be challenging with MS, so ask your doctor about strategies that fit your needs.

Cutting back on alcohol, fatty foods, or spicy foods may help if they trigger your symptoms. Eating earlier in the evening may also help.

“I'm always last to leave the table. I try to eat slow, small bites, even if takes a long time.”

— A MyMSTeam member

If symptoms occur at night, elevate the head of your bed by 6 to 8 inches.

If swallowing is difficult, take smaller bites, chew thoroughly, and eat slowly. Ask your doctor whether a swallowing assessment with a speech-language pathologist would be appropriate.

Over-the-Counter Medications

There are three main classes of drugs that relieve GERD symptoms:

• Proton pump inhibitors (PPIs) such as omeprazole (Prilosec) and esomeprazole (Nexium)
• Histamine-2 (H2) blockers like famotidine (Pepcid) and cimetidine (Tagamet)
• Antacids including calcium carbonate (Tums) and aluminum hydroxide/magnesium hydroxide

If these don’t work, ask your doctor whether a prescription treatment might be appropriate.

A Note About Medication Interactions

A population-based study of people with MS noted frequent use of drugs for peptic ulcers and GERD. It’s also common for people with MS to take multiple medications.

Some H2 blockers can interfere with other medications. Review your full medication and supplement list, including anything you take over the counter, with your healthcare provider or pharmacist regularly.

If you take an oral DMT, ask your neurologist or pharmacist to check whether a reflux medicine could interact with it. The answer depends on the specific medicines you take.