Bisphosphonate, an ingredient in medications such as Boniva, Actonel and Fosamax, has been linked to stomach pain, heartburn and ulcers. A recent Oxford University Study has revealed that taking these drugs could possibly double your chances of esophageal cancer, indicating that the risk of esophageal cancer increases slightly after just one dose of a bisphosphonate-containing medicine.

To date, the connection between bisphosphonates and esophageal cancer has not been confirmed by the Food and Drug Administration, nor has the FDA ordered label warnings for these medications. However, there is an increased incidence of gastrointestinal discomfort with these drugs.

Common side effects like stomach pain, heartburn and ulcers, though non-life-threatening, can negatively impact your day-to-day life. However, if you follow the manufacturer’s instructions, these side effects can sometimes be lessened or avoided. The manufacturer advises:

• Drink a full glass of water before taking medication
• Take medication on an empty stomach
• Sit upright and don’t drink or eat for at least 30 minutes after taking medication

If you are taking drugs that contain bisphosphonates and your symptoms cannot be controlled through these measures, talk with your doctor about alternative treatment options.

However, if you are experiencing symptoms which are not relieved by over-the-counter medication, it may be time to check with a physician to see if you have a hiatal hernia.

A hiatal hernia occurs when a portion of the stomach is pushed up through the hiatus, a small hole in the diaphragm which the esophagus passes through on the way to the stomach. When the stomach pushes through, a small pocket or hernia is formed. This allows food and acid to back up, or reflux, into your esophagus. By allowing reflux to occur over time, there is an increased chance that esophageal cancer will develop.  Therefore it is important to seek treatment.

More than 60 percent of people over the age of 50 have a hiatal hernia. Out of that number, however, only about 9 percent will develop symptoms. In most cases, it will not even affect your lifestyle. But if the hernia becomes large or symptoms increase, a hiatal hernia can require medication or surgery.

Heredity is often a factor in the cause of hiatal hernia. The diaphragm may be weak or the hiatus may be larger than normal. Injury to the area or pressure within the abdomen caused by heavy lifting, hard coughing or sneezing, pregnancy, vomiting, constipation or obesity can cause a hernia. Smoking has also been determined to be a risk factor.

If diagnosed, there are minor lifestyle changes you can make to minimize the hiatal hernia’s effect on your daily life, including:

• Eat several smaller meals throughout the day rather than a few large meals.
• Avoid foods that trigger heartburn, such as chocolate, onions, spicy foods, citrus fruits or tomato-based foods.
• Avoid alcohol.
• Stop smoking.
• Limit foods high in fat.
• Sit up after you eat, rather than taking a nap or lying down.
• Eat at least three hours before bedtime.
• Lose weight if you’re overweight or obese.
• Elevate the head of your bed 6 inches.
• Reduce your daily stress.

In very rare cases, if you have been diagnosed with a hiatal hernia and your symptoms are not reduced through medication and lifestyle changes, a gastroenterologist may suggest surgery to return the stomach to its correct position or to make the hiatus smaller. The minimally invasive procedure may be performed through a small incision in the abdomen or chest cavity or laparoscopically with a camera inserted through several incisions on your abdomen.

Hiatal hernias affect millions of people each year and severe cases are very rare. With knowledge and a few lifestyle changes, people with the condition can normally reduce or even eliminate symptoms.

Heartburn affects many of us. In fact the American Gastroenterological Association reports that more than 60 million Americans experience symptoms at least once each month.

The burning sensation you feel is actually stomach acid splashing up into your esophagus. A valve at the end of the esophagus, called the lower esophageal sphincter (LES), normally prevents this. But factors such as overeating, pregnancy or even stress can keep the valve from shutting properly. When that happens, stomach acid can be pushed back up into the esophagus, causing pain along with a sour or bitter taste in the mouth.

Occasional heartburn is normally nothing to worry about and can easily be treated with over-the-counter antacids. However, frequent heartburn may indicate a more serious problem. Over time, stomach acid can damage the wall of the esophagus and, if left untreated, can lead to narrowing of the esophagus, bleeding and trouble swallowing, a condition called Barrett’s esophagus, and even cancer of the esophagus. Prolonged heartburn may also indicate more serious problems such as acid reflux disease, gastroesophageal reflux disease (GERD), gastritis, hiatal hernia or peptic ulcer.

There are several lifestyle changes you can make to help avoid heartburn:

• Avoid trigger foods such as chocolate; coffee; peppermint; spicy or greasy foods; tomato products; and alcoholic beverages.
• Eat smaller , more frequent meals.
• Don’t go to bed with a full stomach. Give food 2-3 hours to digest before going to bed.
• Stop smoking or using tobacco in any form. Tobacco inhibits saliva, the natural protection for your esophagus and the nicotine in tobacco increases acid secretion and relaxes the LES.
• Shed some pounds. Losing weight can help relieve symptoms.
• Eat high-protein, low-fat meals.
• Drink plenty of water during exercise to keep from being dehydrated.
• Avoid tight clothes and belts.

If you still experience heartburn, antacids usually give fast, short-term relief. Look for antacids that contain both magnesium hydroxide and aluminum hydroxide to reduce the chance of diarrhea or constipation. If your symptoms worsen when lying down, raising the head of your bed so that your head and chest are higher than you feet may help.

If symptoms persist or occur frequently, speak to your doctor. Continuous heartburn may indicate a serious problem, and sudden chest pain may be mistaken for heartburn when it is really a sign of heart disease. Your physician may suggest prescription medication or testing such as x-rays to check for ulcers, pH tests to check for acid in the esophagus, or endoscopy to look for other conditions. Seek medical attention when the following symptoms occur:

• Difficulty or pain when swallowing
• Vomiting blood
• Black or bloody stools
• Shortness of breath
• Lightheaded or dizziness
• Neck or shoulder pain
• Heartburn more than 2-3 times per week for more than 2 weeks.

If heartburn is becoming a more frequent problem, keep a heartburn record. Track how often you experience the symptoms, what time of day and what you are eating or doing when the symptoms occur. That will help you get a clearer picture of when it is time to seek medical care and help your doctor more effectively diagnose and treat your condition.