Heartburn and COVID-19: Gastroenterologist available for interviews

Physicians noticed an increase in “Pandemic Stomach" this spring – William Ravich, MD, a Yale Medicine gastroenterologist and part of Yale New Haven Health’s Digestive Health services, discusses why antacids are flying off the shelves.

Reflux: a common event

The stomach makes a strong acid that breaks down food to help the body absorb nutrients. When this acid enters the esophagus, it can cause pain by irritating the esophageal lining. Reflux can occur occasionally in almost anyone, especially if they eat too much and lie down soon after eating.

“Reflux is not abnormal,” said Dr. Ravich. “Continuous reflux monitoring studies show nine out of ten healthy people reflux daily. Reflux disease involves excessive levels of reflux or symptoms that seem correlated with reflux events such as burning in the chest, burning in the throat, and/or a sour taste in the mouth.”

A rise in reflux?

In December of 2020 The New York Times reported that, “People searching online or in stores for over-the-counter tummy soothers are finding that they can’t easily buy acid reducing medications"

Dr. Ravich says there may be multiple causes for this uptick.

Lifestyle

“Many people are behaving differently; eating more, lying down more,” said Dr. Ravich. “Small changes such as eating a larger lunch at home versus a smaller lunch at the office can have an impact on reflux.”

“Weight gain also plays a mechanical and hormonal role in increasing reflux symptoms,” Dr. Ravich adds.

Stress

Stress can also cause sensitivity to reflux. Dr. Ravich says heightened anxiety can lower someone’s pain threshold, especially when anxiety stems from something health-related. Additionally, he says stress can cause people to swallow more air throughout the day which can increase the pressure in the stomach and contribute to reflux.

Dr. Ravich suggests that when faced with more reflux symptoms, it helps to take inventory of what might be different behaviorally.

Behavior modification

Dr. Ravich recommends cutting back on coffee, both regular and decaffeinated, and avoiding other caffeine-containing beverages. It is also helpful to avoid deep fried snacks and lying down after a meal. He says eating small meals leads to less gastric distension, fewer reflux episodes and ultimately fewer symptoms.

Medications that ease the burn

There are two groups of medications that address reflux symptoms: antacids and acid suppressants.

Antacids are acid neutralizing agents. They are often liquid and neutralize acid already in the stomach. They do not prevent acid production. “When you neutralize acid, the stomach recognizes that there is less acid and revs up production,” said Dr. Ravich. “Antacids tend to work well immediately – but the effect only lasts around an hour.”

Acid reducers reduce acid production. Proton pump inhibitors and H2 blockers fall into this category.

H2 blockers reduce acid production by 70 percent.

Proton Pump Inhibitors block acid production by 90 percent. “These are very effective when needed,” said Dr. Ravich. “But shouldn’t be used if a lesser drug can do the job.”

Empty shelves

“The run on these drugs is not only tied to an increase in reflux symptoms,” says Dr. Ravich “There are reports that suggest H2 blockers might be associated with better outcomes for patients admitted to the hospital with COVID-19.”

“A few preliminary studies saw positive results among COVID-19 patients who were given an H2 blocker and this has resulted in people stocking up on both H2 blockers and antacids because of the confusion between the two medications.”

Dr. Ravich continues, “The evidence is not strong and the mechanism behind why an H2 blocker would have an impact on the trajectory of COVID-19 is unclear. As of January 2021, we are a ways away from understanding if there is a real effect.”

Before stocking up

Gastric acid may protect against infectious organisms. Studies show that people on proton pump inhibitors experience a 10 percent increase in C. difficile infection, a bacterial infection of the colon that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon.

Additionally, stock piling acid blockers can cause a state of scarcity for people with severe reflux who need consistent access to these medications.

“Stock piling medications does more harm than good,” said Dr. Ravich. “If you are experiencing new reflux symptoms, pandemic stress and behavior changes may be the culprit. When lifestyle changes are not giving you relief, it is time to speak with a physician.”