Acid reflux occurs when stomach acid flows back into the esophagus, the tube connecting the mouth to the stomach. This backward flow can cause a burning sensation in the chest (heartburn) and a sour or bitter taste in the mouth due to regurgitation. While many people experience occasional acid reflux, it can become a persistent issue, and for individuals undergoing cancer treatment, chemotherapy can contribute to its occurrence.
How Chemotherapy Can Lead to Acid Reflux
Chemotherapy drugs are designed to target rapidly dividing cells, which include not only cancer cells but also healthy cells in the digestive tract. This non-specific action can directly irritate the lining of the esophagus and stomach, leading to inflammation called esophagitis. This irritation can make the digestive system more sensitive and prone to acid reflux.
Chemotherapy can also affect the lower esophageal sphincter (LES), a muscular valve that normally prevents stomach acid from flowing back into the esophagus. Some chemotherapy agents can cause this sphincter to relax or function improperly, allowing stomach acid to leak upwards.
Chemotherapy-induced nausea and vomiting (CINV) are common side effects that can indirectly contribute to acid reflux. Forceful vomiting increases pressure within the abdomen, which can push stomach contents into the esophagus. Even without vomiting, persistent nausea can disrupt normal digestive processes, potentially leading to reflux symptoms.
Changes in diet and eating patterns during chemotherapy also play a role. Patients might consume different foods, eat at irregular times, or have a reduced appetite, which can impact digestion and stomach acid production. The overall physical and emotional stress associated with cancer and its treatment can affect the digestive system, potentially aggravating acid reflux symptoms.
Recognizing and Managing Symptoms
Individuals undergoing chemotherapy might experience several acid reflux symptoms. These include heartburn, regurgitation, difficulty swallowing (dysphagia), a chronic cough, hoarseness, or a feeling of a lump in the throat.
Managing acid reflux symptoms during chemotherapy often involves dietary adjustments. Eating smaller, more frequent meals instead of large ones can help reduce pressure on the stomach and prevent acid reflux. Identifying and avoiding trigger foods is also beneficial; common culprits include acidic foods like citrus and tomatoes, fatty or fried foods, spicy dishes, chocolate, caffeine, and alcohol. Keeping a food diary can help pinpoint individual triggers.
Lifestyle modifications can also provide relief. Elevating the head of the bed by 6 to 8 inches, or using a wedge pillow, can help prevent acid from flowing back into the esophagus during sleep. It is also helpful to remain upright for at least 30 minutes, or ideally two to three hours, after eating and to avoid lying down or bending over immediately after meals. Avoiding tight clothing around the abdomen can further reduce pressure on the stomach.
Over-the-counter medications can help manage symptoms, but it is important to discuss their use with the healthcare team due to potential interactions with chemotherapy. Antacids, such as Tums or Mylanta, can neutralize stomach acid for quick relief. Histamine-2 receptor blockers (H2 blockers) like famotidine (Pepcid) reduce acid production and can be found over-the-counter or as prescriptions. Proton pump inhibitors (PPIs) such as omeprazole (Prilosec) or lansoprazole (Prevacid) are stronger acid reducers that block acid production. Some PPIs may interact with certain chemotherapy drugs, potentially reducing their effectiveness, so medical guidance is necessary.
When to Consult a Healthcare Professional
Open communication with the healthcare team is important throughout chemotherapy treatment, especially regarding side effects like acid reflux. While many acid reflux symptoms can be managed with lifestyle changes and common medications, certain signs require immediate medical attention.
Consult a healthcare professional if symptoms are severe, worsen despite home management, or persist for an extended period. Difficulty swallowing (dysphagia) that becomes more pronounced or painful, or the sensation of food getting stuck, warrants prompt evaluation. Unexplained weight loss, which can occur if reflux makes eating too uncomfortable, should also be reported.
More serious warning signs include black or tarry stools, or vomiting blood. These symptoms can indicate bleeding in the digestive tract and require immediate medical assessment. Your oncology team can provide specific guidance and adjust your treatment plan or prescribe additional medications to manage these concerns safely.