Multiple sclerosis (MS) is a chronic disease where the immune system attacks the protective myelin sheath surrounding nerve fibers in the central nervous system. Acid reflux, commonly known as heartburn or gastroesophageal reflux disease (GERD), occurs when stomach acid flows back into the esophagus, causing irritation. While MS does not directly increase stomach acid production, the neurological damage it inflicts can disrupt the body’s involuntary processes, including digestion. This link is often a combination of direct nerve damage and the secondary effects of MS symptoms and treatments, which can increase the likelihood of experiencing chronic acid reflux.
The Neurological Link Between MS and Digestion
The central nervous system, which MS targets, regulates the body’s internal functions through the autonomic nervous system (ANS), a network that controls involuntary actions like heart rate, breathing, and digestion. Lesions caused by demyelination in MS can affect the ANS pathways, impairing the processes of the digestive tract. This disruption often involves the vagus nerve, which runs from the brainstem and acts as a major communication line between the brain and the gut.
The vagus nerve is responsible for coordinating the muscular contractions that move food through the digestive system and for controlling the lower esophageal sphincter (LES), the ring of muscle that seals the stomach entrance. Damage to the vagus nerve signaling can lead to LES dysfunction, causing it to relax inappropriately and allow stomach acid to escape into the esophagus. This nerve damage can also contribute to a condition called gastroparesis, where the stomach muscles work inefficiently, slowing the movement of food into the small intestine. When the stomach is slow to empty, stomach contents and acid are pushed back up, resulting in reflux.
The swallowing process, known as deglutition, can also be impacted, leading to dysphagia, or difficulty swallowing. This occurs when MS lesions disrupt the coordination of the muscles in the mouth and throat. While distinct from acid reflux, severe dysphagia can prevent clearing of the esophagus, compounding the irritation caused by reflux. Lesions in specific areas of the brainstem, such as the medulla oblongata where the vagus nerve originates, have been implicated in gastroesophageal reflux in MS patients.
How MS Symptoms and Treatments Contribute to Reflux
Beyond direct neurological impairment, many common symptoms and treatments can indirectly exacerbate or trigger acid reflux. Certain medications prescribed to manage MS symptoms, such as muscle relaxants used for spasticity or anticholinergics for bladder issues, are known to inadvertently relax the LES. This unintended relaxation can compromise the sphincter’s ability to remain tightly closed, increasing the risk of acid backflow.
Medications used to treat MS relapses, such as high-dose corticosteroids, can irritate the stomach lining or stimulate an increase in acid production. This heightened acidity makes any reflux event more painful and damaging to the esophageal tissue. Reduced mobility, a frequent consequence of MS, can contribute to reflux symptoms. Spending more time sitting or lying down removes the benefit of gravity, which normally helps keep stomach acid in place.
Chronic constipation is a prevalent gastrointestinal issue for people with MS, and it can play a role in reflux. Constipation increases pressure within the abdomen, and this elevated intra-abdominal pressure can physically push stomach contents back up through the LES. Severe fatigue, a hallmark symptom of MS, can also lead to poor dietary and lifestyle choices, such as eating larger, less frequent meals or eating close to bedtime, which are triggers for acid reflux.
Managing Acid Reflux When Living with MS
Managing acid reflux in the context of MS involves a combination of targeted lifestyle adjustments and careful medication review. One of the most effective positional strategies is to elevate the head of the bed by six to eight inches using blocks or a wedge under the mattress, rather than simply using extra pillows. This utilizes gravity to prevent nighttime reflux without causing neck strain.
Dietary modifications should focus on eating smaller, more frequent meals, which helps prevent the stomach from becoming overly full and putting pressure on the LES. Identifying and avoiding personal trigger foods like chocolate, caffeine, spicy foods, or fatty meals is also helpful, although no single diet works for everyone. Because MS-related fatigue can make meal preparation difficult, simple, consistent eating patterns are often more sustainable than overly restrictive diets.
Patients should discuss the timing of any MS-related medications with their healthcare providers, particularly those known to affect the LES or increase stomach acid. Over-the-counter acid-suppressing medications, such as proton pump inhibitors or H2 blockers, are generally safe, but potential interactions with MS treatments should always be verified with a doctor or pharmacist. Addressing underlying chronic constipation is also a proactive step in reflux management, as reducing abdominal pressure can lessen the physical force driving acid upward.
Specialized Evaluation
If swallowing difficulties or dysphagia are present, a specialized evaluation by a speech-language pathologist or gastroenterologist is warranted to rule out a direct neurological issue requiring specific management.