Acid Reflux and Caving

jwtbids

New member
Hi all,

Just wondering if anyone has any experience with what presumably is acid reflux / indigestion on longer caving trips. A few times on longer trips (12+ hours, has always been after camping) I've had an acidic feeling in my throat which is at best uncomfortable and at worst painful. It noticeably gets worse with extended flat-out / crawling sections and means I'm frequently burping (or trying to) and feeling sick.

Just wondering if anyone has had a similar experience and what you may have found that helps with it.
 
Yep, I get this. I avoid things that make acid reflux worse for me, such as coffee and other caffeinated drinks, too many biscuits or other similar snacks. I thought pork pies would be a nice caving snack so I took some of those caving, but discovered they gave me acid reflux. Eating large meals can also make it worse. Crawling basically makes reflux worse because the position puts more pressure on the oesophageal sphincter
 
Since I cant get THAT advert's earworm out of my head at the moment, have you tried Gaviscon?

Rice puds, milkshakes, oat-based snacks can also help extinguish the flames.
 
HEALTH WARNING. If you have never experienced symptoms like this before and you're over 25-30 OR if you have had these symptoms for a while, but they're getting worse, go to your GP and talk it through.

Otherwise, there are two parts to this - reflux, and acid. Reflux is the experience of nasty tasting liquid flooding up your oesophagus into your mouth. The acid is what gives it the painful, burning sensation (there is a caveat to this to which I will return). Reflux is more likely to occur in those who are overweight, have anatomical problems at the lower end of the oesophagus and who eat particular foods. The first two are difficult to modify...

Fatty foods are particularly likely to provoke reflux (hence pork pies), partly because they're digested slowly and linger longer in the stomach (there are other reasons too). Some find caffeine provocative and several other foods are suggested as difficult, including alcohol. You are less likely to get reflux if you avoid a heavy meal before caving (ie eat 3-4 hours beforehand) or if you confine yourself to small volume, low fat (high calorie) snacks. These should minimise your likelihood of experiencing reflux but won't guarantee you won't get it.

Without the acid, reflux merely gives an unpleasant sensation and taste - also bad breath - (second hand, partly digested food is rarely desirable). To control the acid component there are two options.

(1) Drugs like omeprazole and pantoprazole can be bought over the counter and will give you 10-14 hours of acid suppression (so relatively painless reflux). Esomeprazole probably gives you a couple of hours more. What they do is stop your stomach producing acid when it has been stimulated by eating. Therefore, you need to take them an hour before food or several hours after eating. This may make scheduling complex...

(2) Acid neutralising drugs, which vary from simple antacids to more complex drugs like Gaviscon (cheaper generic versions are available). you can buy this in glass bottles (convenient for a quick glut after a hard night in the pub, but impractical underground) or in chewable tablet form - much more sensible.

Recommendation: (1) Review your pre-caving meal (2) Consider taking omeprazole (or similar) before a trip or, dependent on the length of the trip, during it. Remember, it will take 30 minutes for the tablet to work and you shouldn't eat a big meal for at least 30 minutes after taking the pills. (3) Take some form of antacid with you for emergency relief. The cheap and cheerful ones work briefly, the more expensive ones should give you a longer period of relief (Gaviscon is very expensive and Boots will sell you a similar thing much more cheaply).

Finally, if none of this works, seeks gastroenterological advice. There are surgical options that are pretty effective but should be a late, if not last resort.

The caveat I mentioned earlier is that if you successfully block acid production from the stomach, you can get bile refluxing from the small intestine, through the stomach to the oesophagus. this is alkaline (so still irritating) and tastes equally disgusting. I don't have a simple solution to suggest for this...
 
Excellent advice there. I have a few observations based on my 30 experience as a GP (and somebody who suffers from reflux). In the past most reflux was related to hiatus hernia where the hole through the diaphragm (the dome shaped breathing muscle separating abdomen and chest) is large enough for the valve at the base of the oesophagus to be impaired allowing stomach contents to resurge into the oesophagus which is vulnerable to the effect of acid. However in the latter years I was encountering an increasing number of younger people with persistent reflux (including my daughters) suggesting environmental factors in play as it appears to be in China. At the same time there was a rise in cases of oesophageal cancer again occurring in younger individuals. This fortunately has levelled off but reflux remains common (you only have to watch TV ads). As stated persistent reflux particularly in older people is probably worth investigating by the simple procedure of gastroscopy (had a fair view of those) to check you haven't got the precancerous change in the cells of the oesphagus named Barrettt's oesophagus. This is particularly important if you have a family history of oesophageal or gastric cancer. Early treatment is now simple and painless as I can vouch for.

If you are pregnant in the late second trimester it is well worth taking an antacid prior to the trip. My wife suffered badly from reflux when caving in her first pregnancy to the point it was mentioned by others in a trip report! The previous post has all the other advice I would offer.
 
My wife has had a few gastro issues and one observation is if you buy antacid tablets like Gaviscon or cheaper generic equivalents (basically carbonate to neutralise acid) there are commonly 2 versions. Just the carbonate or the other version that also has sodium alginate. The alginate can make it chewy to eat slightly like a bit of toffee stuck between your back teeth. But the sticky gloopiness of it thickens/gloops stomach content a bit which can help reduce reflux for many people. She doesn't cave so can't comment if the benefits of alginate are still there while crawling
 
Excellent advice there. I have a few observations based on my 30 experience as a GP (and somebody who suffers from reflux). In the past most reflux was related to hiatus hernia where the hole through the diaphragm (the dome shaped breathing muscle separating abdomen and chest) is large enough for the valve at the base of the oesophagus to be impaired allowing stomach contents to resurge into the oesophagus which is vulnerable to the effect of acid. However in the latter years I was encountering an increasing number of younger people with persistent reflux (including my daughters) suggesting environmental factors in play as it appears to be in China. At the same time there was a rise in cases of oesophageal cancer again occurring in younger individuals. This fortunately has levelled off but reflux remains common (you only have to watch TV ads). As stated persistent reflux particularly in older people is probably worth investigating by the simple procedure of gastroscopy (had a fair view of those) to check you haven't got the precancerous change in the cells of the oesphagus named Barrettt's oesophagus. This is particularly important if you have a family history of oesophageal or gastric cancer. Early treatment is now simple and painless as I can vouch for.

If you are pregnant in the late second trimester it is well worth taking an antacid prior to the trip. My wife suffered badly from reflux when caving in her first pregnancy to the point it was mentioned by others in a trip report! The previous post has all the other advice I would offer.
Any thoughts on the long term use of PPIs? They seem to be the go to treatment but I've always been nervous to take them for a long period of time due to various medical reports about long term implications..
 
There is reasonable evidence that PPIs increase the risk of a variety of gut infections - campylobacter, salmonella and clostridioides difficile (the 'new' name for clostridium difficile) - probably because stomach acid is quite good at killing bacteria, so blocking its production reduces your defences. The risk appears to be greater if you're taking PPIs long term or at high dose.

As far as I know, most of the other reported risks of long term PPIs come from observational studies which have linked them inconsistently to cardiovascular disease, dementia, increased fracture risk, and some vitamin and mineral deficiencies (including magnesium). I don't think any of these are conclusive and in many cases are likely coincidental.

Overall, if you have severe reflux that makes life miserable, the balance of risk and benefit probably favours taking the PPI. If your symptoms aren't too bad, it would be sensible to take a short course only (if at all) then shift to simple antacids (probably alginate based). Be aware that after you stop taking PPIs, there tends to be a period where you 'rebound' and produce more acid - this can usually be controlled with alginates.

Final point (not directly supported by evidence but it makes sense to me). If you're off to foreign places where water quality and food hygiene is questionable, you may reduce your risk of D&V if you discontinue your PPI a week or two before you travel (but probably take some with you in case your symptoms become unbearable).
 
Things that I've noticed improve mine are avoiding ultra processed foods and alcohol, especially in the evening. I've read that there's some evidence that eating fermented foods can help, but the smell of Kimchi put me off being able to experiment with it!
 
In addition to Spelfish comments on potential problems I have been taking high dose PPI's (40 mg esomeprazole twice a day) for the last 18 years. I started as part of a clinical study on whether a regime of aspirin and a PPI (proton pump inhibitor) would reduce the development of oesophageal cancer in patients with Barrett's oesophagus. The only issue I can honestly say might be associated with it is the development of gastric polyps which I have but the gastroenterologist's after a brief spell of recommending a reduction in dose seem to be quite relaxed about. Hope they are right.
 
My wife has had a few gastro issues and one observation is if you buy antacid tablets like Gaviscon or cheaper generic equivalents (basically carbonate to neutralise acid) there are commonly 2 versions. Just the carbonate or the other version that also has sodium alginate. The alginate can make it chewy to eat slightly like a bit of toffee stuck between your back teeth. But the sticky gloopiness of it thickens/gloops stomach content a bit which can help reduce reflux for many people. She doesn't cave so can't comment if the benefits of alginate are still there while crawling
As an aside - the use of alginate-containing products in the health care setting is quite widespread. I used it in my area of work as it has the benefit of thickening various body fluids, and in particular, bleeding and 'weeping' wounds. Whilst all bleeding will stop eventually without intervention*, alginate was very good in the 'interesting' practice of stopping bleeding in anticoagulated patients, where incisions or vascular access was required. Made from seaweed, in the remote case anyone's interested. 🧐

*;)
 
As an aside - the use of alginate-containing products in the health care setting is quite widespread. I used it in my area of work as it has the benefit of thickening various body fluids, and in particular, bleeding and 'weeping' wounds. Whilst all bleeding will stop eventually without intervention*, alginate was very good in the 'interesting' practice of stopping bleeding in anticoagulated patients, where incisions or vascular access was required. Made from seaweed, in the remote case anyone's interested. 🧐

*;)
Was interested and aware of the seaweed origin, I can also add the factoid that it's a key stabiliser in commercial ice cream and essential for the "Mr Whippy" variety of machine splurged stuff, and (urban myth?) Margaret Thatcher when still working for Lyons developed it. Think of that next time you have a whippy ice-cream. Anyway a bit of a digression!
 
Was interested and aware of the seaweed origin, I can also add the factoid that it's a key stabiliser in commercial ice cream and essential for the "Mr Whippy" variety of machine splurged stuff, and (urban myth?) Margaret Thatcher when still working for Lyons developed it. Think of that next time you have a whippy ice-cream. Anyway a bit of a digression!
Thatcher worked on "Langmuir–Blodgett films". Strange the things that stick in your mind.
 
She helped develop soft ice cream, but not by adding alginate:
Seems that her only published paper was about L-B films, which she studied whilst at Oxford Uni:
Although they were discovered well before her time:
 
The seaweed in question. Kelp, also used as fertiliser. I have bagged up quantities in the past when it washes up on the beach after storms and put it on the garden. It used to be dried and burnt in kelp pits. The Aran Isles in Galway Bay were farmed using seaweed as soil improver as well as the Scilly Isles and Orkney. It is currently being farmed as can be eaten. Nice deep fried like a veggie poppadum. So something to think about next time you see the label 'contains alginates'
 

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Having taken NSAIDs for many moons for an arthritic condition, I suffer with regular episodes of gastritis, for which I've been taking omeprazole, a proton pump inhibitor (“Warp drive overloading! Scotty, engage the proton pump inhibitors!” “She canna' take much more of this captain!”) for many years with no obvious side effects, and my GP seems content to leave me on this medication.
 
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