Can Food Allergies Cause Heartburn?

Heartburn is caused by gastric acid rising up out of the stomach and into the esophagus, causing irritation and inflammation. This condition, referred to medically as gastroesophageal reflux disease (GERD), usually occurs because of loosening of the sphincter muscle where the esophagus enters the stomach and may be present in people of all ages. A number of foods and beverages may cause or aggravate GERD, including caffeine-contain-ing drinks  (especially coffee), alcohol, and greasy and spicy foods. All of these foods are thought to provoke acid reflux by causing the esophageal sphincter to become more relaxed  than usual, allowing stomach contents to enter the esophagus.

It must be emphasized that the effects of these foods are not due to allergy. However, there is another esophageal condition in which allergic inflammation occurs in the esophagus, referred to as eosinophilic esophagitis. This diagnosis is usually suspected when a patient does not improve with appropriate treatment for acid reflux, such as antacids,H2 blocking drugs (e.g., ranitidine), or proton-pump inhibitors (e.g., omeprazole).

Because these patients do not usually respond to appropriate reflux therapy, it is important for a gastroenterologist to confirm the diagnosis of eosinophilic esophagitis by visual endoscopic inspection and biopsy of the esophagus. In this disease, food allergens may play an important role in causing inflammation. Accurate determination of which foods are acting as allergens requires a combination of prick/puncture skin tests followed by delayed-type hypersensitivity testing (patch testing). Patch testing involves the placement of a sample of pulverized food into a small metal holder which is then taped onto the patient’s skin for 2 days.

At the end of the 2-day period, the container of food is removed and the area of skin in contact with the food is inspected for redness and/or blistering. In patients in whom a food is identified as a relevant trigger, avoidance of the implicated food(s) may have a profound effect upon the esophageal inflammation and symptoms of reflux.

James’s comment:

I started having bad heartburn last year, and it seemed to get worse after eating. Occasionally, during a spell of heart-burn, I would feel a squeezing pain in my chest that got a little better with Tums. My doctor told me to stop having coffee and other caffeinated drinks and to eat no later than 7 PM.

He started me on Zantac twice a day, which didn’t really help. After a couple of weeks, he switched the medicine to Prilosec twice a day, but I was still having heartburn and pain. I was referred to a gastroenterologist, who did an endoscopy and took a biopsy that showed something called “eosinophilic esophagitis.” She referred me to an allergist, who first did a skin prick test, which was negative to every food. The allergist then did a special test called a “food patch test,” which was left on my back for 2 days and showed that I had an allergy to soy and milk. Since stopping those two foods, which I used to eat all of the time, my heartburn has gradually gone away.