**What is acid reflux?** Acid reflux is a normal and common condition in the body that most people experience during their lifetime. This condition usually occurs when stomach acid backs up into the esophagus. People with heartburn have a burning sensation mainly in the chest and below. Various reasons can cause or aggravate gastric reflux. It is not bad to know that there is a connection between gastric reflux and hypothyroidism! In the following, we will examine the cause of this issue and we will examine ways to prevent gastric reflux in hypothyroidism. ### **symptoms of gastric reflux** In addition to the burning sensation, other symptoms of acid reflux include: - Nausea - Heartburn: a burning sensation in the chest that may worsen after eating or lying down. - Chest pain: a feeling of pressure or discomfort in the chest that may resemble a heart attack - Indigestion - Stomach acid reflux: sour or bitter taste in the throat due to increased stomach acid Difficulty in swallowing, feeling of food stuck in the throat - Bad breath - Chronic cough or hoarseness ### **What is the cause of acid reflux?** At the end of the esophagus is a muscle called the lower esophageal sphincter (LES). This muscle opens and closes to allow food to enter the stomach. When you swallow, the LES relaxes, allowing food to move down the esophagus into your stomach. The LES normally stays closed when you're not eating to help keep stomach contents inside the stomach. Sometimes, the LES relaxes when it shouldn't, or the LES becomes weak. As it falls, food and stomach acid back up into your esophagus, causing a burning sensation. Premature relaxation or weakness of the LES can occur for the following reasons: - Overweight or obesity - Taking certain drugs, muscle relaxants, blood pressure drugs, antihistamines, antidepressants or sedatives - Performing previous stomach or esophagus surgeries - Smoking or being exposed to cigarette smoke - Eating large meals or lying down immediately after eating - Eating spicy or fatty foods - pregnancy - Hiatal hernia Additionally, low thyroid hormone levels can also affect how your LES functions. **What is the connection between hypothyroidism and gastric reflux?** When the thyroid gland is underactive, a lack of thyroid hormone may weaken muscle contractions. As mentioned, a weak contraction causes the contents of the stomach to pass into the esophagus In addition, the esophagus also requires muscle contractions to move food down. A lack of thyroid hormone may slow down the movement of the esophagus and make food take longer to enter the stomach and digestive tract. As a result, it can lead to swallowing problems and heartburn. Due to the lack of thyroid hormone and the reduction of stomach-esophageal movement, the contents of the stomach may remain in the stomach for a longer period of time. The longer stomach contents stay in the stomach, the more likely you are to experience symptoms. In addition, people with thyroid hormone deficiency may experience tension and anxiety, which can aggravate heartburn. It should be noted that controlling hypothyroidism with levothyroxine can change stomach acid levels and help with heartburn symptoms. ### **Methods to control heartburn in people with hypothyroidism** Here are some strategies to control heartburn in people suffering from thyroid hormone deficiency: #### **Control of hypothyroidism:** The main way to treat the problem of hypothyroidism and gastric reflux is to take medicines prescribed by the doctor. It is also important to perform periodic thyroid tests and frequent reviews by a doctor. #### **Change in behavior and lifestyle:** Consuming light, low-fat and easy-to-digest foods can help reduce heartburn. Avoid consuming foods containing saturated and acidic fats. #### **Increasing the number of meals and snack consumption**: Instead of three large meals, eat small and frequent meals. #### **Avoidance of food before sleep**: Eating before bed can aggravate heartburn. #### **Reduce alcohol and tobacco consumption**: These substances can aggravate the symptoms of heartburn. #### **Consumption of some drugs with a doctor's prescription** - Proton pump inhibitors: are a group of drugs whose main function in the body is to reduce stomach acid; They are the strongest group among similar drugs. These drugs can reduce the production of stomach acid. - Gastric antacid drugs: such as H2 receptor antagonists - Combined drugs: some drugs are a combination of PPIs and H2 receptor antagonists. #### **Physician consultation:** Consultation with a specialist doctor is an important step. Your doctor can prescribe medications and behavioral changes based on the severity of your symptoms and condition. Note that you should always consult your doctor and take the medicines according to the doctor's instructions. #### **quit smoking** Smoking is a known risk factor for acid reflux. Talk to your doctor about ways to quit smoking. Some nicotine patches, gum, or other medications are helpful. #### **weight loss** One of the common symptoms of hypothyroidism is weight gain. Weight loss may be difficult even after starting thyroid hormone replacement therapy. Losing weight reduces acid reflux symptoms by reducing pressure on the LES, allowing it to open and close properly. Consider consulting a nutritionist or an exercise trainer to help you with your weight loss process. #### Read more: Why don't we lose weight with hypothyroidism? Dr. Seyed Ahmad Fanai is a thyroid and parathyroid surgeon and an active member of the American Association of Thyroid Surgeons (ATA). You can contact us for appointment and consultation.