Elias Darido MD FACS has been a frequent contributor to RefluxMD with outstanding articles such as The Four Stages of GERD Treatment, Obesity and GERD, and Nissen Fundoplication 101. In this recent article initially published in MD News, Dr. Darido discussed GERD symptoms and exercise, a topic we hear about from our members frequently.
Several studies have shown that acid reflux occurs more frequently when a person is exercising than when he or she is at rest. Vigorous physical activity leads to increased ventilatory effort. An increase in the inspiratory thoraco-abdominal pressure gradient may overcome the resting lower esophageal sphincter pressure, resulting in acid reflux.
The type of exercise and the amount of food in the stomach affect the severity of reflux. Studies using ambulatory pH monitoring show that acid reflux lasts longer with higher-impact activities, such as running, compared with more stationary activities, such as cycling. Furthermore, postprandial exercise results in longer acid reflux times when compared with exercising after a fasting period.
Many athletes experience a variety of upper gastrointestinal symptoms with physical exertion. Heartburn, chest pain and food regurgitation suggest acid reflux. However, a confirmatory work is always recommended before starting any treatment. Ambulatory pH monitoring is an excellent tool to confirm the diagnosis of gastroesophageal reflux disease (GERD), evaluate the severity of reflux and check for symptom association. Chest pain in particular is an important symptom to evaluate, as it may be secondary to angina pectoris. Some patients with coronary artery disease may be misdiagnosed with acid reflux when their heartburn is actually angina. Other causes for exertional chest pain and heartburn include but are not limited to asthma episodes, esophageal distention from aerophagea, esophageal dysmotility, and esophageal hypersensitivity.
Patients with a positive acid reflux confirmatory study are advised to avoid eating for three hours prior to exercise. Patients can reduce the severity of attacks with low impact activities and exercises that don’t require bending or lying flat. Excess weight is a major contributor to GERD, and weight reduction leads to improvement or resolution of acid reflux. Medical therapy in the form of Histamine H2 receptor blockers and proton pump inhibitors may be added to neutralize gastric acid and alleviate symptoms. Patients with severe acid reflux disease will benefit from surgical treatment. Surgery, unlike medical therapy, eliminates acid reflux and regurgitation. Nissen fundoplication surgery is currently the gold standard and most reliable treatment for GERD. A floppy and short gastric wrap is constructed around the lower esophagus, creating an effective barrier against reflux. The procedure is performed laparoscopically with a very low complication rate. Younger athletes who wish to avoid the side effects of long-term proton pump inhibitor therapy may find the Nissen fundoplication an excellent alternative to medications. Will endoscopic anti-reflux procedures, currently available on the market, have a place in the treatment of severe GERD? I don’t think so. In a future column, I will go over the history of anti-reflux surgery, why Nissen fundoplication is effective in stopping acid reflux and why endoscopic procedures fail to do so.
About Dr. Darido
Elias Darido, MD, is a RefluxMD GERD expert and he is both a board-certified, fellowship-trained acid reflux surgeon and a bariatric surgeon. He serves patients throughout the Houston region and offers a wide variety of laparoscopic surgeries for the treatment of acid reflux disease, gastroparesis, achalasia and obesity. He is the founder of the Houston Heartburn and Reflux Center and Houston Weight Loss Surgery Center. While at the University of North Carolina, Chapel Hill, he completed training in not one, but two subspecialty fellowships. This dual expertise now addresses both acid reflux and obesity — two closely related disorders that have reached epidemic levels in our society. To schedule an appointment with Dr. Darido, please call 832-945-8717.
Permission to publish provided by Elias Darido, MD FACS.