Dr. David Labowitz (NorthShore)
Thank you for the great question. The answer is yes. Now, let me explain. I break symptoms of reflux down into two categories. The first set of symptoms I categorize as typical or esophageal symptoms. These include heartburn, upper abdominal pain and indigestion. These are the traditional symptoms associated with reflux. However, reflux is when contents from the stomach flow back up into the esophagus. This can also flow back higher, affecting the throat region, lungs and larynx (voicebox). So a second category of symptoms are the atypical or extra esophageal symptoms. These include a brash taste in the mouth, throat irritation, hoarseness, and cough. So to answer your question, reflux is in the differential for a patient with a persistent excessive dry cough.

Dr. David Labowitz (NorthShore)
Great question. Spicy foods are always at the top of the list of triggers that people report for their reflux symptoms. Most doctors recommend patients with heartburn stay away from spicy foods (especially if bothersome to them when eaten). Thereby, an important take home message is if there is a food that bothers you, whether causing you upper abdominal pains or heartburn, you should avoid it. However, the answer to this question is a bit more complicated. Reflux is caused when the muscle at the end of the esophagus (called the lower esophageal sphincter) opens, allowing contents from the stomach to flow back up. In studies that have looked at what weakens this muscle, spicy foods have NOT been found to be responsible. However, they definitely irritate people's stomachs, and if the lower esophageal sphincter muscle is weak at the time the spicy foods are eaten, they definitely can irritate the esophagus as well (causing heartburn and indigestion). So, avoid foods that bother you!

Dr. David Labowitz (NorthShore)
Great question. The over the counter (OTC) meds work by neutralizing or blocking the acid production inside the stomach. They do not stop the backflow of material up into the esophagus. They simply change the acidity of the stomach. Antacids are first line OTCs. They provide immediate relief by soothing minor heartburn by neutralizing stomach acid. They typically contain bicarbonate salts. The next set of medications are the H2 blockers. These medications work by blocking histamine which is an important stimulator of acid production. They are typically very good at treating heartburn, but if there is inflammation of the esophagus, they tend not to work as well. The next category of medications are the proton pump inhibitor's. These medications directly block the acid producing pumps in the stomach. They are more effective than the H2 blockers. They are not great on- demand medications. Deciding which medication to use depends on the nature, severity, and frequency of symptoms.

Dr. David Labowitz (NorthShore)
Great question. Yes, stress definitely plays a role in GI symptoms. We have to remember that the intestines have their own nervous system that talks with the brain. So we often manifest stress through GI symptoms. I often use a GI psychologist in my practice to help better manage stress and anxiety, and thus improve GI symptoms. As far as reflux, stress has been shown to weaken the muscle at the end of the esophagus, leading to the backflow of stomach contents. Stress control or relaxation is a great way to help symptoms during the holiday season.

Dr. David Labowitz (NorthShore)
Thank you for asking this great and timely question. People with celiac disease cannot have gluten, which is in wheat, barley and rye. Vegetables are safe. However, the sauces that are added often may contain gluten. If you simply steam, broil, grill the vegetables (on a clean surface) then you should be safe. However, celiac patients can have turkey but should avoid traditional stuffing. There are many gluten free recipes and websites that can assist you.

Dr. David Labowitz (NorthShore)
Great question. Alcohol and caffeine impact GI symptoms, expecially in reflux. These both have been shown to weaken the muscle at the end of esophagus, leading to reflux symptoms. If one suffers from heartburn, it is a great idea to avoid both caffeinated products and alcohol. As far as other GI symptoms, caffeine has also been shown to increase intestinal motility, leading to looser stools. As far as them being an irritant, I would advise anyone who gets symptoms after taking in alcohol or caffeine to simply avoid them. This is often a great tip to get patients through the holiday season.

Dr. David Labowitz (NorthShore)
Great question. I can give some general guidelines but we need to remember that this is not a one size fit all solution. Here are some tips for getting through the holiday season. 1. Limit or avoid alcohol and tobacco. 2. Avoid caffeine 3. Eat small, frequent meals. When we have larger meals, they tend to take a longer time to leave the stomach (especially fatty foods) and can lead to more abdominal pains and reflux. 4. Stay way from peppermint products if your reflux is bad. 5. Do not lie down for 2-3 hours as this can worsen reflux symptoms. 6. Eat slowly. 7. Wear loose fitting clothing. Don't forget to enjoy yourself, too!!

Dr. David Labowitz (NorthShore)
Great question. Bloating is a very difficult symptom for both patients and physicians. Treating it is more of an art than a science. I typically take a long history from the patient, consider their bowel habits, other symptoms and dive into possible triggers. Improving things can take multiple visits. My best recommendation would be to track your symptoms and then discuss with a gastroenterologist. You can use some of the tips noted above to help as well. However, there are often other foods that we take out of the diet, which is a little too complex to discuss here.