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Heartburn and Peptic Disease


Heartburn

If you have a severe case of heartburn every time you dive and it gets worse on ascending to the surface, you probably have pressure-induced GERD (gastroesophageal reflux disease). Remember Boyle's Law--air filled sacs decrease in size as pressure is increased and increase in size as pressure is decreased. What is happening is that you are swallowing air subconsciously as you try to equalize during the dive. As you do this at depth due to the small up and down movements in the water column, you are putting air into your stomach. As you ascend to the surface, your lower esophageal sphincter is being overwhelmed by the expanding air in your stomach.

This is a very common complaint and it doesn't necessarily mean you have a serious problem--unless you have it while not diving. You might possibly go to your MD and be sure everything is OK---if so you can manage this yourself with several easy maneuvers.


First--don't eat a big meal and then dive.

Second--carry some medication along on the trip that will cut down on acid reflux,i.e., Pepsid, Tagamet or Zantac.
Third, take along a bottle of of antacid tablets and take several before each dive.

Many divers are prone to this problem and find that their greatest problem is on the  second dive--usually after eating gas producing dive boat food! It's best to eat less food and try not to wash food down with liquids--during which most air is swallowed.


One other cause of this problem is an alpha blocker medication that causes relaxation of the sphincter (muscle); "Hytrin" or "Cardura", a mild blood pressure drug that's also used for prostate problems can also cause heart burn as well as nasal congestion.

Try these simple tricks and I think your dives will be more pleasant!

Peptic Ulcer Disease

Peptic ulcer disease is now known to be caused by a bacteria, but still occurs frequently enough to be a relative hazard to the diver. The main problem with scuba divers is that the diver is very often in remote areas far from definitive medical care. Perforations under these circumstances can be disastrous.

If surgery has been performed, post-operative wait before returning to diving should be at least three months and there should be no evidence of air-trapping in the abdominal cavity or gut. There should be no possibility of obstruction to the gastric outlet that might lead to vomiting underwater  and drowning or to panic ascents with pulmonary barotrauma and air embolism.



Reference:
Diaphragmatic rupture resulting from gastrointestinal barotrauma in a scuba diver.
Hayden JD; Davies JB; Martin IG, Division of Surgery, Centre for Digestive Diseases, The General Infirmary at Leeds. Br J Sports Med, 32(1):75-6 1998 Mar
Abstract
     A fit young man sustained a ruptured diaphragm during a recreational scuba dive three months after undergoing an uncomplicated laparoscopic Nissen fundoplication for gastro-oesophageal reflux disease. It is proposed that this rare occurrence was  attributable to gastrointestinal barotrauma. The injury was treated by laparotomy, mobilisation of herniated abdominal viscera back into the abdomen, repair of the crura and gastropexy. He made a full postoperative recovery. It is concluded that scuba diving should be avoided in patients who have undergone fundoplication.




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