Gastroesophageal reflux disease (Acid reflux)

The major characteristic symptom of GERD is heartburn, experienced as a burning sensation or discomfort in the middle of the chest. This painful burning feeling is felt behind the breastbone, rising from the lower tip of your breastbone toward your throat. The discomfort may radiate to the neck and typically occurs after eating. Lying down also increases its occurrence.

The other signs and symptoms include:

• Regurgitation (backward flow of swallowed food from stomach to esophagus)
• Acidic taste in the mouth
• Choking while eating
• Aspiration (inhalation of stomach contents into the respiratory system)
• Dysphagia (difficulty in swallowing)
• Odynophagia (pain while swallowing)
• Belching (expelling excess air from the upper digestive tract)
• Epigastric pain (upper abdominal pain)
• Hypersalivation
• Nausea
• Persistent vomiting
• Frequent burping

Extraesophageal symptoms include:

• Chest pain
• Chronic cough
• Persistent sore throat
• Asthma
• Laryngitis
• Dysphonia (abnormal voice)
• Hoarseness of voice
• Painless sensation of a lump in the throat
• Loss of appetite
• Unexplained weight loss
• Dental erosions
• Inflammation of the gums
• Bad breath
• Otitis media (infection of the middle ear)

In severe cases, GERD can cause bleeding in the digestive system, which can be tracked by the following symptoms:

• Vomiting blood or material resembling coffee grounds
• Dark-colored stool

The stomach is connected to the mouth through a tube known as the esophagus. A muscle-like flap is present at the bottom of the esophagus known as the lower esophageal sphincter (LES). The muscles of the LES relax and open when food is eaten, allowing it to move downwards.

There are several mechanisms involved in GERD, which may include:

• Impaired LES function: Under normal conditions, the LES opens in response to a meal, facilitating the movement of food. The LES prevents the migration of gastric contents back into the esophagus. Individuals with GERD experience more LES relaxations that are generally not triggered by food, keeping the LES open even when it is not needed. This permits the reflux of gastric contents into the esophagus.
• Impaired mucosal defense: The stomach has a protective layer known as mucosa that acts as a barrier against acidic contents. Prolonged retention of food in the stomach may alter the mucosal layer, potentially causing GERD.
• Defective peristalsis: Peristalsis refers to a series of wave-like muscle contractions that move food through the digestive tract. Impaired peristalsis can lead to the reflux of gastric contents back into the esophagus.

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• Old age: Aging increases the risk of GERD several folds due to the disruption of the tonicity of the lower esophageal sphincter (LES).
• Eating habits: Several eating habits may increase the risk of GERD, including:
  • Consuming fried, spicy, and sour foods, especially at bedtime (e.g., orange and grapefruit juice, tomatoes and tomato preserves, chocolate, coffee/tea, and carbonated beverages).
  • Irregular meal timings.
  • Eating large portions at a time.
  • Having dinner just before bedtime.
• Consumption of excessive alcohol: Heavy drinking increases the risk of GERD by damaging the protective lining of the stomach.
• Less physical activity: Individuals with sedentary lifestyles are more prone to developing GERD.
• Postprandial physical activity: Strenuous physical activity, such as running and weight lifting, immediately after eating also increases the chances of GERD.
• Obesity: Obese individuals experience increased intra-abdominal pressure, delayed gastric emptying, and decreased LES pressure, which can trigger GERD. Central obesity, measured as the waist-to-hip ratio, is also linked to a higher risk of GERD complications.
• Stress: Stress is associated with increased acid secretion in the stomach.
• Hiatal hernia: This condition occurs when the stomach bulges through the diaphragm, increasing the likelihood of developing GERD and its complications.
• Connective tissue disorders: Individuals with connective tissue diseases, such as rheumatoid arthritis (RA) and scleroderma, are at a higher risk for developing GERD.
• Certain medications: The use of specific medications is associated with GERD, including:
  • Benzodiazepines
  • Calcium channel blockers (antihypertensive medications)
  • Asthma medications
  • Non-steroidal anti-inflammatory medications (NSAIDs)
  • Antidepressants
• Pregnancy: Hormonal fluctuations during pregnancy increase the risk of gastric content reflux, leading many pregnant women to develop GERD.

GERD is diagnosed primarily through symptoms and medical history. The various medical tests that can aid in the diagnosis of GERD are:

• Esophageal pH monitoring: pH is a measure of acidity. Generally, the esophagus does not contain acid. The presence of acid, indicated by a low pH in the esophagus, suggests GERD. This is the most accurate method for diagnosing GERD and is also used to monitor treatment progress.
• Esophageal impedance test: This method assesses the reflux of gastric contents back into the esophagus. A thin tube is inserted through the nose into the stomach, and acid reflux activity is tracked via a computer attached to the tube. The tube remains in place for 24 hours to detect changes during eating, drinking, sleeping, and other activities.
• Upper gastrointestinal (GI) endoscopy: This examination of the upper GI system (esophagus, stomach, and duodenum) uses an endoscope, a flexible tube with a camera. The tube is passed through the mouth, and images are displayed on a screen.
• Upper GI X-ray: In this procedure, a special camera sends beams to the upper GI tract, recording images of the esophagus and stomach. This helps detect issues such as ulcers, gastric reflux, hiatal hernia, blockages, or narrowing of the upper GI tract.
• Biopsy: Small tissue samples are taken from the esophagus through the endoscope and examined under a microscope for abnormalities. This procedure is generally performed to detect complications of GERD.

• Maintain a healthy weight: Obesity is a major risk factor for GERD. Maintaining a healthy weight is beneficial in preventing acid reflux. Explore our wide range of weight management supplements. Order Now.
• Eat small meals at a time: One simple tip to lower your risk of acid reflux is to eat small yet frequent meals.
• Avoid late-night binge eating: Eating late at night due to work pressure or heavy snacking in the evening can increase the likelihood of heartburn. Therefore, avoid late-night snacking or eating close to bedtime. Are you just overeating occasionally or is it a binge eating disorder? Find Out.
• Limit consumption of spicy and deep-fried foods: Regular intake of highly spicy and deep-fried foods can stimulate excessive gastric acid production. These foods should always be consumed in moderation.
• Avoid strenuous physical activity right after eating: Strenuous activities like exercising or bending immediately after meals can lead to a build-up of acid in the esophagus. Allow your stomach some time to empty its contents before starting any exercise.

The primary goal of treatment is to manage the symptoms and prevent complications. The primary treatment approach is lifestyle modification. The following treatment options are recommended for individuals who do not respond to lifestyle modifications, such as having smaller meals, avoiding spicy foods, and adhering to a meal routine.

I. Medications

• Antacids: These medications are used to relieve heartburn by neutralizing acid. They are readily available in liquid and chewable tablets as over-the-counter (OTC) products. Common examples include:
  • Magnesium carbonate
  • Magnesium trisilicate
  • Calcium carbonate
  • Sodium bicarbonate
• Antihistamines (H2 receptor antagonists): These drugs inhibit the secretion of acid in the stomach. Bedtime administration is recommended for individuals experiencing GERD symptoms at night. Common examples include:
  • Famotidine
  • Cimetidine
• Proton pump inhibitors (PPIs): These drugs reduce acid production and are known to heal the damaged esophageal lining. They can be safely used for long-term treatment of GERD. Common PPIs include:
  • Omeprazole
  • Lansoprazole
  • Esomeprazole
  • Pantoprazole
  • Rabeprazole
• Prokinetic agents: These drugs enhance gastrointestinal motility, helping to reduce GERD symptoms. Examples include:
  • Metoclopramide
  • Domperidone

II. Endoluminal therapy

This involves the delivery of radiofrequency energy to the lower esophageal sphincter (LES), creating a mechanical barrier that prevents the reflux of gastric contents into the esophagus.

III. Surgery

Surgery is required in the following cases:

• Refractory GERD (persistence of GERD even in the absence of symptoms)
• Non-adherence to medications
• Presence of a large hiatal hernia

The available surgical options for GERD include:

• Fundoplication: This is the most commonly performed surgery for GERD. In this procedure, the top of the stomach is sewn around the end of the esophagus, adding pressure to the LES to help prevent reflux.
• Bariatric surgery: This surgery involves modifications to the digestive system to aid in weight reduction, recommended for obese individuals with severe GERD symptoms. Commonly performed surgeries include:
  • Roux-en-Y gastric bypass (RYGB)
  • Laparoscopic adjustable gastric banded plication (LAGP)
  • Sleeve gastrectomy

• Milk: Milk reduces heartburn by neutralizing acidity. It is always advised to choose low-fat milk as whole milk may contribute to heartburn.
• Ginger (adrak): An excellent remedy for heartburn due to its anti-inflammatory properties. It can be consumed by boiling with a glass of water for a few minutes.
• Baking soda: Known for neutralizing acid. It can be taken by dissolving a teaspoon with a cup of water.
• Basil leaves (tulsi): These leaves relieve heartburn and help soothe the stomach lining. They can be taken as a tea by boiling two to three basil leaves in water.
• Coconut water: Rich in fiber and protects the stomach lining from acid exposure. Individuals with heartburn are advised to consume at least two glasses of coconut water for symptomatic relief.
• Mint (pudina): The natural cooling properties of mint help curb the symptoms of acid reflux. Boil the mint leaves and consume the brew to control GERD.
• Aloe vera: It has anti-inflammatory properties. Take some pure aloe vera juice, mix it with water, and consume it two to three times per day.
• Watermelon: Watermelon juice naturally relieves heartburn due to its alkaline nature.
• Banana: A low-acid fruit that is beneficial for people suffering from acid reflux. It acts as a protective layer to the irritated esophageal lining to prevent acidity.

Persistent acid reflux over a very long period of time may lead to the following complications:

• Esophagitis (inflammation of the esophagus)
• Stricture (abnormal narrowing of the esophageal lumen)
• Difficulty in breathing
• Barrett’s esophagus (a condition in which tissue similar to the lining of your intestine replaces the tissue lining your esophagus)
• Esophageal cancer

The alternative therapies for GERD include:

• Yoga: Some simple yoga asanas that can help relieve acidity include:
• Pawanmuktasana
• Vajrasana
• Virabhadrasana
• Shashankasana
• Trikonasana
• Acupuncture: This therapy is part of ancient Chinese traditional medicine. It involves the penetration of the skin with thin, solid, metallic needles, stimulating the sensory nerves to provide symptomatic relief.

Individuals with GERD should undergo several lifestyle changes for better management of symptoms and a faster rate of healing.

1. Follow some dietary recommendations

What to eat?

There are certain foods that help to prevent acid reflux. Such foods should be included in the diet. The foods that are beneficial for individuals with GERD include:

• Whole grains such as oatmeal and brown rice
• Root vegetables such as sweet potatoes, carrots, and beets
• Green vegetables such as asparagus, broccoli, and green beans
• Watery foods such as celery, cucumber, watermelon, broth-based soups, and herbal tea

What to avoid?

People with acid reflux should limit certain foods as they trigger the acid reflux. Fried, sour, and spicy foods contribute to GERD symptoms. The foods that cause the exacerbation of symptoms and thus should be avoided include:

• Tomato
• Onion
• Garlic
• Tea
• Coffee
• Carbonated beverages

Moderation is key since many people may not be able to or want to completely eliminate these foods.

2. Be conscious about the meal timings

The irregular meal timings disturb the body clock. This can lead to an imbalance in the release of acid and intake of food. People should stick to their meal timings in order to reduce the symptoms. It is also advised to have dinner at least 3 hours before sleeping to help alleviate nighttime episodes.

3. Limit meal size

The intake of a larger meal can also cause acid reflux as it puts more pressure on the LES. Limiting meal size at a time greatly helps in curbing acid reflux.

4. Avoid lying down after having food

Gravity during standing or sitting positions helps keep acid in the stomach. Avoid lying down for at least 2 to 3 hours after having a major meal.

5. Maintain good sleep hygiene

The inadequate amount of sleep also triggers acid reflux. It is always advised to maintain a sleep routine every day, which will help in reducing episodes of heartburn.

6. Keep the head elevated while lying down

Studies have shown an improvement in symptoms with the elevation of the head. This can be done by placing some extra pillows under the head during sleep or small naps. Ideally, your head should be six to eight inches higher than your feet.

7. Quit smoking

Smoking is an important trigger for GERD due to the effect of nicotine on the LES. Smoking also stimulates the stomach to produce more acid, increasing the risk of gastric juices being refluxed into the esophagus. Quitting smoking helps to curb symptoms to a larger extent.

8. Limit the intake of alcohol

The consumption of alcohol causes an increase in GERD symptoms by damaging the protective layer of the stomach. Various studies have shown a significant decline in symptoms after withdrawing alcohol. Persons with GERD are recommended to avoid or limit alcohol.

9. Lose weight

Overweight or obese individuals have a higher chance of developing acid reflux. Obese people with GERD are strongly recommended to lose weight.

10. Choose medications wisely

It is always recommended to consult a doctor before taking OTC medications, as several medications are associated with an increased risk of acid reflux.