Gastroesophageal reflux (GER) is the term for reflux of stomach contents (acid, food, air, bile and pancreatic enzymes) into the esophagus. GER is prevented by the lower esophageal sphincter (LES) which separates the esophagus from the stomach. Upon swallowing, food is propelled through the esophagus, the LES relaxes and food enters the stomach whereupon the LES closes. Certain events, such as distension of the stomach due to accumulation of swallowed air can stimulate the LES to relax and allow this accumulated air to escape in the form of a belch – always great entertainment for children and teenagers. Certain foods, large volume of food, rapid eating and timing of eating can provoke GER.

The presence of certain foods in the stomach can directly relax the lower esophageal sphincter. The culprits include: rich or high fat items, alcohol, chocolate and mints. As well, the volume of food can promote relaxation of the LES; the greater the volume of food the more frequent the episodes of relaxation of the lower esophageal sphincter. Mothers have scolded their children for years – eat your food more slowly or you will have an upset stomach! Recent research has confirmed this advice; eating rapidly causes repeated episodes of relaxation of the LES allowing reflux. Finally, the timing of a meal can promote reflux. Eating later in the evening and retiring to bed shortly thereafter with a full stomach can facilitate reflux if the lower esophageal sphincter relaxes. In the horizontal position gravity will not be able to keep food in the stomach.

So consider a night out on the town in Naples, Florida. You go to a fine restaurant and eat a rich, tasty meal. The high fat content of the meal insures that it will take hours for the stomach to empty. Since you were indulging at your favorite restaurant you ate more than you intended also prolonging the emptying of the stomach. You imbibed alcohol since this was a celebration. A chocolate desert was included and as you were departing the restaurant you ate an after dinner mint. Finally it is late, you are sleepy and you retire for the evening while your stomach is still full. All of these events conspire to provoke GER and an unhappy night of heartburn.

This is not to suggest you cannot enjoy a night out in Naples but to minimize GER restrain the volume you eat, moderate your portions of the entrée (and desert), moderate the alcohol, eat earlier and do not retire for the evening for at least 3 hours after such a meal.