Acid reflux, gastroesophageal reflux disease (GERD) or just simple heartburn occurs quite frequently in many people, but Parkinson’s disease patients seem to be more prone to developing this condition. There are a number of reasons why this is so.

How Does Acid Reflux Occur?

When food is swallowed, it moves down through the esophagus (food pipe) into the stomach. The esophageal sphincter, situated between the esophagus and the stomach, opens to allow this action to take place and closes back again so that the food does not go back into the esophagus. In this way, the esophageal sphincter acts as a one way-valve.

In certain situations, the lower esophageal sphincter (LES) becomes weak, so that the stomach contents push against it and give rise to a feeling of fullness, or the stomach acids may regurgitate or flow back into the esophagus through the weakened sphincter and cause a burning sensation in the throat. If the condition is mild, the patient may suffer from heartburn once in a while, but if this acid reflux occurs frequently, the patient is said to be suffering from GERD.

Why are Parkinson’s Disease Patients more Prone to Acid Reflux?

• There is slower action of the nerves supplying the gastrointestinal tract in people suffering from Parkinson’s disease, so that movement of food during the process of digestion is slowed down. Food remaining in the stomach for long causes acid and gas build-up.

• The esophageal sphincter is frequently weakened in a Parkinson’s patient.

• Parkinson’s disease drugs (anticholinergics and dopamine) can cause or aggravate acid reflux.

Symptoms of Acid Reflux

• Heartburn – a burning sensation in the chest, under the sternum (breast bone), usually after a meal. This may be worse at night or on lying down. It can also be aggravated by a heavy meal or on bending or lifting a heavy weight after a meal.
• Belching or burping.
• Regurgitation of food.
• Nausea or vomiting.
• Difficulty swallowing.
• Chest pain.
• Chronic cough.
• Sore throat.
• Hoarseness.

Diagnosis of Acid Reflux in Parkinson’s Disease

Diagnosis can usually be made on the basis of signs and symptoms. If necessary, the following investigations may be done :

• Esophageal gastroduodenoscopy – to detect signs of acid reflux and changes in the esophagus.
• Barium swallow – to detect signs of regurgitation.
• Manometry – to measure pressure of the sphincter muscle.

Treatment of Acid Reflux in Parkinson’s Disease

Certain dietary and lifestyle changes can help.

• Avoid rich, spicy or acidic food and caffeinated drinks.
• Avoid eating anything for several hours before bedtime.
• Eat small frequent meals.
• Avoid alcohol and tobacco.
• Avoid lying down, bending or lifting weights after a meal.
• Lose weight if obese.
• Avoid wearing tight clothes or belts.
• Raise head-end of the bed.
• A change in Parkinson’s disease drug therapy if the symptoms are severe.
• Medication such as antacids, histamine H2 blockers, proton pump inhibitors or a prokinetic drug like metoclopramide may help. Always speak to your doctor about drug interactions before starting any medication.
• Alternative therapies, including homeopathy and herbal treatment should be done only after consulting with the supervising doctor.
• Surgery – a procedure called fundoplication may be done if the symptoms are severe and all other treatments fail.