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Feeling the burn might be welcome when you’re working out, but not so much after you’ve eaten.

Acid reflux is a common stomach condition in which stomach acid and juices flow from the stomach back up into the esophagus, causing heartburn. Occasional heartburn is common, but when it’s frequent and accompanied by symptoms of dry cough or long-lasting burning pain behind the breast bone (especially at night or after eating), it’s considered to be gastroesophageal reflux disease, or GERD.

HealthLink BC recommends seeking treatment when you experience regular GERD symptoms, as it can lead to ulcers, damage to your esophagus, and even esophageal cancer.

Some research indicates that GERD may be considerably more common among people with SCI than in the general population, although this evidence is inconclusive. Regardless, the research suggests that common complications of SCI are known risk factors for GERD, and that GERD is poorly diagnosed and often found at an advanced stage among people with SCI. Impaired sensation may also prevent individuals with higher injury levels from detecting symptoms of GERD. Also, I’ve seen GERD cause AD when people with SCI are lying down. So it’s important to understand GERD, and especially its symptoms and risk factors specific to SCI, so you know how to respond to it. Individuals with SCI may have specific risk factors for heartburn, acid reflux, and GERD:

• Slow digestion (motility): The gastrointestinal system of people with SCI moves at roughly half the speed as that of someone without SCI, and sometimes even less than that for people with quadriplegia. This slow motility means delays in stomach emptying, which can in turn lead to reflux.
• Positioning: Spending more time lying down or reclined in your wheelchair can make GERD symptoms worse.
• Abdominal Pressure: Increased pressure in the abdominal space, due to abdominal muscle spasticity, chronic constipation, and bearing down for bowel care routines, can force stomach acids into the esophagus.
• Medications: Many common medications taken by individuals with SCI for chronic pain or spasticity may put them at higher risk for GERD. These include opioids, anti-inflammatories like naproxen or ibuprofen.
• Inactivity: Physical activity aids gastrointestinal motility, speeds up the emptying of the stomach and preventing reflux—but SCI often makes it difficult to get sufficient physical activity.

So what can you do if you believe you’re experiencing GERD? Here are some suggestions:

• Avoid eating before bed or before you need to be horizontal. Remain upright in your chair, bed or couch for two to three hours after eating.
• If you’ve been prescribed medications that need to be taken with food, eat small amounts over a period of time to avoid stimulating your stomach to produce a lot of acid.
• Work to reduce your body weight to help reduce pressure on your abdominal cavity. Losing weight can be particularly difficult for individuals with SCI, so seek support and advice from a rehabilitation specialist or exercise physiologist familiar with SCI.
• Consult with a rehab specialist to discuss options for managing spasticity in the abdominal area if this is an ongoing issue for you. A discussion may be helpful to help balance needs for function, use of anti-spasticity medications and therapies, and managing GERD.
• Discuss medication for GERD with a physician familiar with SCI complications. Doctors may prescribe a limited course of a class of medications called proton-pump inhibitors (PPIs) or H2 inhibitors that can help treat GERD. Make sure to discuss the risks and benefits of this class of medication, as chronic use can increase risk for osteoporosis and fractures. A short course of PPI medications can also be a less invasive and more manageable way to diagnose GERD in individuals with SCI than an endoscopy procedure.
• You might also be a candidate for medications that can help improve your gastrointestinal efficiency, which can in turn decrease the time it takes for your stomach to empty (more time leads to heartburn, acid reflux, and GERD).
• Talk to your physicians and SCI specialists. As GERD tends to be under-diagnosed in people with SCI, have a conversation with your family doctor if you experience symptoms of acid reflux or GERD, and with your rehab specialist if you are concerned about how to recognize the symptoms of GERD.

Generally speaking, the same advice for managing GERD in the general public applies to individuals with SCI, so have a look at the excellent general resources on dyspepsia and GERD from HealthLink BC.