By Paul M. Dake, MD

 Q:  I seem to always have heartburn, particularly after a large meal or drinking anything containing caffeine. My doctor recommended I take an over-the-counter medication called omeprazole; it does seem to help, but I’ve been reading about some concerns about the long-term use of this medication.  What can I do for this problem that doesn’t carry such risks?

A:  It certainly sounds as if you have gastro-esophageal reflux disease, or GERD.  Untreated for years, this problem has been shown to predispose to esophageal cancer, so it’s certainly worth trying to do something about it.

At the bottom of the esophagus is a ring of muscle called the lower esophageal sphincter (LES), that normally squeezes the bottom of the esophagus closed, preventing acid in the stomach from working its way up into the esophagus.  The only time this muscle is supposed to relax is as swallowed food/fluids reach the bottom of the esophagus, allowing the food/fluids to pass into the stomach to begin digestion, then immediately closing again.

A number of substances (alcohol and caffeine are prime examples) and conditions (abdominal obesity, tight-fitting clothing over the abdomen, overeating, and lying down soon after finishing a meal) can cause the LES to relax more than it should, allowing the acid to rise into the esophagus.

Avoiding intake of any substances that you find seem to cause your heartburn is the most important first step, followed by working on your waist measurement (weight loss), and avoiding the other conditions noted above.  Since the stomach loops to the left of the bottom of the esophagus, you can also minimize your symptoms by lying on your left side, when you do lie down.

Thanks to Marlene G. for this question.  If you have any particular topic you would like to hear more about, please message me at

To learn more about this and many other health topics, visit the American Academy of Family Physicians’ website, where you can click on the “I would like to find” box and enter your topic of interest.