Association Between Heartburn and Cystic Fibrosis

We are all guilty of occasionally consuming too much of the "wrong food" -- spicy food, anyone? -- and ending up with indigestion and heartburn. The medical term for consistent heartburn is gastroesophageal reflux disease (GERD). GERD is more common in people with cystic fibrosis (CF) than in the overall population. In fact, 30-40% of people with CF have GERD.¹ The following article will outline why GERD is more prevalent in the CF population and provide an overview of some lifestyle and pharmaceutical interventions that may provide relief.

Why is GERD prevalence higher in CF?

It is thought that GERD is more common in people with CF because of an abnormality of the esophageal (the tube that carries food from the mouth to the stomach) closing.² When the muscle at the bottom of the esophagus cannot close properly, acid from the stomach can go back up into the esophagus. Because acid is irritating, it causes that discomfort -- or burning -- sensation people feel with GERD. Furthermore, there are additional factors contributing to the association between GERD and CF:²

• Laying down during chest physical therapy: Laying down increases the risk of heartburn, especially after recent meal intake. For this reason, it's recommended to space meals from bedtime or any other activity where a supine position is required.
• Increased pressure in the stomach after coughing, especially after coughing spells.
• Longer time for the stomach to digest food.

Does GERD worsen CF symptoms?

There is some evidence to show that those who exhibit GERD symptoms may have worse CF outcomes. For example, one study analyzed about 7000 patients with CF and found that those who also had a diagnosis of GERD had worse lung outcomes and more CF exacerbations.³

Role of medications

A common class of medications used to treat GERD are proton pump inhibitors. These drugs block the stomach from making acid. They can be effective in relieving symptoms of heartburn for many people; For example, after 5 days of treatment, proton pump inhibitors can reduce the acid secretion by about 66%.⁴

While we have studies to support the use of these drugs in the general population, there is less data to analyze the effectiveness of these drugs in people with CF. However, we know that people with CF use proton pump inhibitors frequently: For example, more than 50% of people with CF in the United States was on one of these drugs in the year 2012.⁵

Depending on your doctor, you may be prescribed a proton pump inhibitor for a few weeks' duration to see if it is effective. Examples of drugs that you may be prescribed are pantoprazole (Tecta or Pantoloc), esomeprazole (Nexium), omeprazole (Losec), and others. While some of these drugs are available over the counter (without a prescription), I recommend always consulting your doctor.

Lifestyle interventions

Depending on your doctor’s recommendations, it might be suggested to implement some lifestyle modifications as well. Examples include:

• Minimizing culprit foods, which may include spicy food, chocolate, foods high in acidity, and beverages high in caffeine.
• Eating more often but smaller portions.
• Reducing fatty food, which can delay stomach emptying. However, always consult with your doctor before implementing this intervention, as people with CF may have reduced fatty acids, and require fatty food to help manage deficiencies.
• If heartburn occurs when lying down, propping up the bed with extra pillows may help improve symptoms.
• Reducing or abstaining from from smoking

Have you received treatment or implemented lifestyle modifications to control heartburn? Share your experience below!