Allergic Heartburn: Does it Really Exist?

Heartburn, or Acid Reflux as it is commonly referred to by doctors, is a very uncomfortable symptom. It also strikes fear in patients because it mimics the sensation of having a heart attack!

The common triggers of heartburn tend to be acidic foods that make the stomach too acidic and this acidity causes backflow up into the esophagus causing stomach and chest pain. The common food culprits are tomato sauces, garlic, oily or greasy foods and unfortunately alcohol.

We have become a nation that loves these foods: antacids and more powerful acid-blocking prescription medications are commonplace in most people’s medicine cabinets. These medications tend to be effective temporarily, although they do have side-effects if used long-term. What if these medications don’t work?

In my Immunology practice at Mitchell Medical Group, we closely examine the underlying cause for a patient’s gastric complaints. The chief reason a patient is experiencing gastric reflux is, of course, their diet. The older we get, the more sensitive our stomachs are to foods that alter the stomach pH. In addition, the enzymes and gastric juices needed to digest the difficult foods are also less abundant.

Stress is another common cause of gastric reflux. No, it’s not all in your head, but it can be coming from your head. The brain is wired to control parts of the stomach. The vagus nerve(Greek for the “wandering nerve”) sends nerve signals from the brain directly to the stomach. A common symptom for a person under duress is to feel stomach pain and a sore throat from the acid running up their esophagus.

And what about food allergies? People always like to blame a medical problem on an allergy. Allergies, like a viral infection, is a great scapegoat for patients; doctors like to use it as a default diagnosis when they can’t figure anything else to explain the symptom. However, in some cases we now know that Allergic Heartburn does exist!

The recent discovery of the condition called Eosinophilic Esophagitis can be the underlying cause of a patient’s heartburn. The importance of distinguishing this condition from typical gastric reflux is critical because the treatment is very different.

Eosinophilic gastritis and esophagitis can be present in infants, adolescents and adults. The symptoms are very similar to regular acid reflux with similar abdominal pain and nausea; however, another hallmark feature in these patients is dysphagia- or difficulty swallowing. Patients complain that they feel their food is getting stuck in their throat. Eosinophilic Esophagitis(EE) was definitively diagnosed by gastroenterologists when they would do an upper endoscopy and see thickened tissue in the esophageal tissue. In addition, the finding of abundant eosinophils in the biopsied tissue help confirm the diagnosis.

The reason this diagnosis was under recognized for years was that the biopsied tissue wasn’t stained for these special cells. Eosinophils are cells found in tissue and the blood normally in small amounts, but if they are increased, this tends to indicate an allergic condition.

The good news is that a small number of foods have been associated with EE. The bad news is that they are common foods in our diet: milk, eggs, wheat, soy, tree nuts and legumes(like peanuts). The fascinating part is that if patients avoid these foods, especially infants and children you can completely reverse this condition. Allergy testing for these foods is done by conventional skin or blood testing but the yield is not always perfect. I sometimes must recommend that a patient avoid all these foods for a period of 2 months to see if their symptoms improve. If a patient has active EE, the treatment is using a cortisone inhaler- that is actually swallowed not inhaled to get the medicine into the esophagus.

Allergic Heartburn is a real diagnosis. Of course, my training in Mind-Body medicine also reminds me that stress is never a good thing for your gut. Please make sure if you see a gastroenterologist for heartburn or acid reflux that they consider EE; and if it is a concern see an allergist for further evaluation.

- Dr. Dean Mitchell
Mitchell Medical Group, NYC

Categories: Allergies, Heartburn

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