Parkinson's Disease and Acid reflux Kathrynne Holden, MS, RD
Copyright 1999

Disclaimer: Information obtained at this online site is not exhaustive and does not cover all diseases, ailments, physical conditions or their treatment. The information contained here should not be considered complete, nor should it be used in place of a visit, call, consultation or advice of your physician or other health care provider. Self-management of health problems is not recommended. You should never ignore medical advice or postpone seeking it because of something you have read here.
Many people have heartburn, or its more severe condition called gastroesophageal reflux (acid reflux). People with Parkinson's disease, however, are especially prone to acid reflux. Why? To understand its cause, we need to know a little about the gastrointestinal tract (GI tract).
When food is swallowed, it moves down the throat until it reaches a valve called the esophageal sphincter. This valve remains tightly closed, only opening up to allow food to pass through into the stomach. Its job is to keep food down in the stomach where it can be prepared for digestion.
Once food arrives in the stomach, special muscles begin grinding it into a paste. This paste of tiny food particles is then mixed with acids and other chemicals before moving on to the small intestine.
A strong Lower Esophageal Sphincter acts as a one-way valve at the top of the stomach to keep food and fluids down.
How does Parkinson's disease change the action of the GI tract?
Parkinson's disease can change these processes. The nerves that guide the muscles of the GI tract may be slowed, and this slows the muscle action as well. The stomach takes longer to grind and mix the food. When food and stomach acid sit in the stomach for too long, the acid acts on the food to form gas, which can distend the stomach, causing burping, and sometimes severe bloating and painful cramping.
Also, the esophageal sphincter may be weakened, so that it's harder for it to stay closed properly. This means that stomach acids, gas, and food may be pushed upward against the sphincter, causing a feeling of "fullness." If the sphincter becomes too weak, it can be pushed open, allowing acids to come up into the throat, and producing a burning feeling. This is acid reflux.
Why is acid reflux a problem?
· The throat and esophageal sphincter have a delicate lining. The powerful stomach acids can eventually lead to permanent scarring. The sphincter may become deformed and unable to close.
· The throat scarring can lead to a precancerous condition. The individual will have increasing difficulty with swallowing, more frequent reflux, and may even develop cancer.
· Stomach acids and/or food may be aspirated (inhaled) into the lungs. The lungs provide a warm, moist environment. Food particles, warmth and moisture provide perfect conditions for bacteria to breed. This leads to infection and pneumonia. Hospitalization for pneumonia is not uncommon in people with PD.
Controlling bloating and acid reflux
To avoid these problems, it's best to control bloating and acid reflux before they can cause damage. Certain foods are more likely to trigger reflux; avoiding these foods can help. Foods that can trigger reflux include alcohol, tomatoes, citrus fruits, caffeine, chocolate, and peppermint. Other foods may be trigger foods for you, though -- different people are affected by different foods. Keeping a record of foods eaten can help you detect which foods are a problem for you.
Large meals can also lead to bloating and reflux, because the stomach needs more time to process a lot of food. The large meal will stay in the stomach longer, and increase the likelihood that gas will form, and produce upward pressure against the esophageal sphincter.
A meal high in fat will also stay in the stomach longer, because fat takes more time to empty from the stomach than carbohydrate or protein. It's usually fine to eat fatty foods; however, portions should be small so that they can clear the stomach quickly.
If you're troubled with reflux, pay close attention to your personal "trigger foods" ­ those that trigger an attack. Avoid those foods whenever possible. For both bloating and reflux, try to eat smaller meals and eat more frequently. Instead of three large meals daily, aim for five or more smaller meals and nutritious snacks. Or, you can eat half your meal, wait an hour or so, then eat the other half.
Example: If your usual breakfast is juice, cereal with milk, and toast, eat the cereal, wait at least an hour, then have the toast and juice.
For difficulty with bloating and acid reflux, ask your physician for a referral to a registered dietitian who specializes in diet for Parkinson's disease. Dealing early with acid reflux can help you prevent such problems as pneumonia, scarring, and hospitalizations later on.

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