Acid Reflux and diving

[Komodo]

GERD should not disqualify anyone from diving but it can be very troublesome if not controlled. The worse case scenario is aspiration. Beyond taking the medications, and if its particularly severe it maybe best to:

Avoid caffeinated drinks or foods during diving
Avoid eating 1-2 hours before diving ... liquids and light snacks are ok

The rationale is there is less to reflux if your stomach is empty; caffeine slows down the opening of the stomach sphincter and prolongs the food stay in your stomach; the medications are still necessary to neutralize or lower the stomach fluid acidity which can still reflux.

I have a question on this. The gentleman stated that he feels the reflux is job related, i.e. stress. Shouldn't that bit be sorted out before he begins diving as stressed people are less well capable of dealing with other stressful situations?

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Robert

 

[GoBlue!]

Acid Reflux can cause inflamation of the throat tissue or can lead to a Hiatus Hernia, espercially if the person is swallowing air and ascending fast.

Whoah there, highly doubt that. You're making a lot of jumps. First, acid reflux will not LEAD to a hiatal hernia. Hiatal hernias predispose one to having GERD, but you must realize that many, many people have asymptomatic hiatal hernias that never require acid suppression or other GERD treatment.

Now, you've raised a second point as to whether or not diving can lead to a hiatal hernia. It's hard for me to imagine that even if you swallowed air to the point of serious gastric distension, that the pressure caused herniation of the stomach instead of just making you belch or gas to go through the pylorus and ultimately end up coming out your backside.

More than likely, you had your hiatal hernia before that trip. Unless you tell me that you had an EGD or barium swallow immediately before the trip & again immediately after the trip, I'll be one of your unbelievers. Sorry, but it's just not probable.

Hiatus hernia affects people in different ways but left ignored and the patient doesnt change their lifestyle it can get worse to the extent you have difficulty swallowing and can lead to throat cancer.

Now, given that, you should realize by now that it's actually the acid reflux (GERD) that affects different people in different ways. The most common complications are esophagitis (inflammation of the esophagus) which (if severe) lead to difficulty swallow due to development of a stricture, bleeding, or the development of Barrett's esophagus (a pre-cancerous state of the lower portion of the esophagus....not the throat). GERD can, as has been previously stated, also lead to chronic microaspiration (can make asthma worse, for example), hoarseness, chronic cough, erosion of tooth enamel, some lung conditions, etc.

worse case you take too many proton inhibotors and your stomach becomes Atropic (completely acid free) which is bad.

Show me the data. PPIs (Protonix, Nexium, Prilosec, Aciphex, Prevacid) are widely used. To my knowledge, they do not cause clinically significant gastric atrophy, and they have quite a safety record to date. There are theoretical concerns with longterm use, but with over a decade of use they haven't been seen in humans to my knowledge (and have nothing to do with gastric atrophy or "lack of acid").

NOW, I'd suggest to a diver with GERD that they should continue their meds, avoid substances that tend to relax the lower esophageal sphincter (caffeine, alcohol, peppermint, chocolate) or irritate the esophagus (greasy/spicy foods, citrus), avoid large meals before diving, and chew gum on the dive boat (increases saliva production which helps neutralize stomach acid). I'd also warn them that the constriction of dive gear & the mouth-drying effect of regulators both tend to exacerbate symptoms, so they shouldn't be surprised if they get a touch of breakthrough heartburn at depth. Having a supply of Tums in the dive bag for some immediate relief after the dive is always handy.

Jim

 

[GoBlue!]

I have a question on this. The gentleman stated that he feels the reflux is job related, i.e. stress. Shouldn't that bit be sorted out before he begins diving as stressed people are less well capable of dealing with other stressful situations?

Isn't stress fun to blame?

I doubt his reflux is job-related, unless he tends to eat differently (drinks more coffee, eats bigger meals, etc.) because of his job. To my knowledge, "stress" has not been independently linked to GERD. Oh, and it doesn't cause ulcers either, no matter what your mom said.

Jim

 

[Komodo]

Isn't stress fun to blame?

I doubt his reflux is job-related, unless he tends to eat differently (drinks more coffee, eats bigger meals, etc.) because of his job. To my knowledge, "stress" has not been independently linked to GERD. Oh, and it doesn't cause ulcers either, no matter what your mom said.

Jim

Never said any such thing. My point is that the gentleman himself feels he's stressed. That stress is not a cause of reflus is not relevant, what is relevant is that gentleman feels stressed.

And no, stress is not fun to blame but it is a relevant factor in being able to cope with even more stress. Further, it has been observed that anxiety like states in rats causes an increase in low frequency power in heart-rate variability (HRV) whilst leaving the high frequency power unaltered (meaning an increase in sympathetic outflow cmpared to vagal outflow), whereas fear like states in rats causes an decrease in high frequency power (vagal outflow) in HRV and left low frequency power in HRV unaltered. In both states heart rate itself was increased. Since I am merely a physiologist I don't know how clinically relevant this is, hence my question.

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Robert

 

[GoBlue!]

Robert-

Ah, OK, I misunderstood. I thought you were making a stress-reflux connection.

I'd bet (although admittedly have no data to back it up) that many divers have job stress. I certainly doubt that many would take a psychosocial history as a general rule prior to accepting someone for certification, nor do I think that we have evidence that it's necessary. Heck, even during training, I found diving very relaxing.

Jim

 

[Hank49]

Robert-

Ah, OK, I misunderstood. I thought you were making a stress-reflux connection.

I'd bet (although admittedly have no data to back it up) that many divers have job stress. I certainly doubt that many would take a psychosocial history as a general rule prior to accepting someone for certification, nor do I think that we have evidence that it's necessary. Heck, even during training, I found diving very relaxing.

Jim

You're obviously the expert here, Doc. Why do I get mild heartburn most times after snorkeling for over an hour? Hard swimming and breathing hard. I have to keep swallowing or it starts burning a bit. It goes away as soon as I get out of the water and drink some water.