Heartburn / reflux after diving

[judyo1]

I was wondering if any others have encountered similar problems. I don't usually get heartburn or reflux. Occasionally I will if I have a heavy night of drinking but it would be pretty unusual. I went on a week long liveaboard trip in March and loved it but toward the end was suffering from really bad heartburn. I have never previously done so many dives in such a short time. I assumed it was because of the rich food we were eating (I was drinking minimal alchol). Unusually for me it lasted 3-4 weeks after I got back and it felt like ranitidine and mylanta made little difference. Then it completely disappeared.
I dived one other time but only 4 dives over 2 days and no heartburn.
In September I went on another liveaboard trip and half way through terrible heartburn reappeared. I couldn't work out why as I wasn't eating rich foods (lots of fresh salads and fruits) and no alchol. Gutted. Once I got off the boat I found antacids and omeprazole and after 3 days of 80mg of omeprazole a day (my friend an anaesthetist assured me this dose was fine...) the heartburn was still awful. I saw my GP who googled diving & heartburn and we found that diving can cause heartburn with the mechanism being swallowing air at depth and that air expands as you come up to the surface, stretching the lower oesophageal sphincter.
Well a week later I'm on pantoprazole 40mg, i've tried metachlopramide (to enhance gastric emptying for what it's worth) and of course buckets of mylanta and gaviscon.
Has anybody else experience this or got thoughts? I'm guessing on my next trip I'll take a prophylactic course of a PPI and have plenty of antacids ready...

 

[DocVikingo]

I'm guessing on my next trip I'll take a prophylactic course of a PPI and have plenty of antacids ready...

Hi judy01,

Sounds like a plan, but make sure you commence the pantoprazole prior to the dive trip & use as prescribed (e.g., 30 mins before a meal).

Of course avoid substances that tend to relax the lower esophageal sphincter such caffeine, alcohol, peppermint, chocolate. Regarding all those fresh salads & fruits you were eating, be aware citrus/acidy fruits can irritate the esophagus, and that large meals of any sort should be eschewed before diving.

As you know, make sure you are not swallowing any air, or Boyle's law may bite you.

Finally, it may help to remain upright underwater, such as while doing descents & cruising at your chosen depth.

Hope this brings some relief.

Regards,

DocVikingo

 

[tursiops]

I have to avoid all acidic things (like orange slices on a SI) or have heartburn.
Too much food (of any kind!) causes my problem too....tough on a liveaboard!
I just had my gall bladder removed....and diving after that seemed actually be a little better...but it may have been from the smaller portions I was eating.

 

[Diver0001]

I used to get it every time I dived.....

and then I realized that I used to stop at McDonalds to meet my buddies on the way to the dive.

Aside from the odd bout of drinking I haven't had anything like acid reflux during a dive (or any other time) since I stopped eating anything from McDonalds and stopped eating any kind of deep-fried and overly fatty food.

I'm sure that's simplistic but I honestly used to think that indigestion pain was part of the experience of diving.... and driving to work... and doing my emails in the afternoon.... and driving home.... and watching TV. In my case, no fat = no pain.

Maybe your body doesn't trigger on the same things mine does but I would look for the problem (and therefore the solution) in something you're eating.

R..

 

[Duke Dive Medicine]

Hi Judy,

Are you 100% certain it was heartburn? Did you get any type of workup?

There is evidence to suggest that an upright posture worsens reflux because the pressure in the esophagus is less than that in the stomach. Other experts think that a head-down posture pulls stomach contents toward the esophagus and increases the risk for reflux.

Best regards,
DDM

 

[judyo1]

Cheers for the input guys. There was no caffiene, peppermint, alcohol to worsen it, and definitely no McDs on the way. I'm pretty certain is was heartburn - it was relieved with antacids (albeit only briefly) and not cardiac pain / no cardiac risk factors.
THe posture suggestion is one to try.
So now just to make sure I don't swallow any air...

 

[Iralub]

I have the same problem and it's definitely not cardiac. Don't have any serious stomach issues otherwise. It's worse if I have a drink at night or if I don't eat before first dive. I take plenty of antacids on dive trips now

Sent from my XT905 using Tapatalk

 

[Doctorfish]

Simple to improve for most people.
Start a Proton Pump inhibitor regimen before trip.
Don't over eat before going out diving.
Avoid stimulatory foods as stated above.

I find that if I develop acid reflux underwater, assuming a head up position relieves it.

 

[DocVikingo]

Simple to improve for most people.

Start a Proton Pump inhibitor regimen before trip.
Don't over eat before going out diving.
Avoid stimulatory foods as stated above.

I find that if I develop acid reflux underwater, assuming a head up position relieves it.

Amen.

Cheers,

DocV