DEAR DR. DONOHUE: My son had an upper GI that indicated the sphincter at the bottom of his esophagus isn’t working. When he lies down after eating, he gets a horrible taste in his mouth, and he usually vomits. The options presented to him are medicines or surgery. Any advice you can give is appreciated. – B.H.

ANSWER: The sphincter (SFINK-tur) muscle at the bottom of the esophagus is a circular muscle that is in a state of constant contraction. It keeps stomach acid and digestive juices from entering the esophagus, a place where those corrosive fluids irritate and cause the pain of heartburn. Only when a person swallows does the sphincter relax to allow food to pass into the stomach.

About 15 percent of adults have heartburn once a week, and 7 percent have it daily. Heartburn, or GERD – gastroesophageal reflux – as it is officially called, can cause a bitter taste in the mouth, can cause coughing, can lead to hoarseness and can even precipitate asthma attacks. The disagreeable, burning pain behind the breastbone is only one of its symptoms, albeit the most common one.

Your son has a third option – changing those things that encourage the upward spurting of gastric juices. Smoking is one of those factors. If he smokes, he has to stop. Obesity is another. Weight loss is a surprisingly effective way to combat heartburn. He should not lie down after eating. He should put 6-inch blocks under the bedposts at the head of the bed so gravity can keep stomach juices in the stomach while he sleeps. He should eat very slowly and should cut back on the amount of fluid he drinks during a meal. Meals should be smaller, but he can eat more frequently so long as he keeps his eyes on the calories.

He must greatly limit or eliminate fats, fried foods, caffeine-containing foods and beverages, chocolate, peppermint, citrus fruits, tomatoes and any other food that causes him trouble. He should go easy with alcohol.

If the above changes don’t bring about relief of symptoms, then the next step is medicine. There are many that slow or suppress stomach-acid production, and they can generally be relied on to control acid reflux.

DEAR DR. DONOHUE: I am a woman, 78 years of age. A few weeks ago, I had my yearly eye exam. The doctor said I have borderline glaucoma. I have 20/20 vision. I asked him if it was like this last year, and he nodded his head yes. He asked if I have glaucoma in the family. I do not. He didn’t say anything else. I was too stunned to ask anything. I am so worried. What should I be doing now, and how long do I have before I lose my sight? – M.B.

ANSWER: Talk to your doctor. I am sure he doesn’t realize how worried you are. The worry, incidentally, is not necessary.

With glaucoma, two things happen. Fluid pressure in the eye rises. High fluid pressure compresses the optic nerve at the back of the eye. If the compression is not relieved, the optic nerve can be permanently damaged, and then sight is lost.

The doctor must have measured a slight rise in your eye’s fluid pressure. If he had measured a pressure that threatened your sight or if he had seen changes in your optic nerve that indicated it was compressed, he would have acted immediately with medicines to bring the pressure down.

Sight loss from glaucoma doesn’t happen overnight. It is usually a drawn-out process, one that can be nipped in the bud when there is a bud.

No doctor would let a patient go unattended if glaucoma threatened vision. That would be an extreme dereliction of duty.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.