OverviewKey FactsCausesSymptomsTypesRisk factorsDiagnosisCelebs affectedPreventionSpecialist to visitTreatmentHome-careComplicationsAlternatives therapiesLiving withFAQs
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Written By
Dr. Nitika Makhija
MDS, BDS
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Dr. Rajeev Sharma
MBA, MBBS
Last updated on:
12 Dec 2023 | 02:55 PM (IST)

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Gastroesophageal reflux disease (Acid reflux)

Gastroesophageal reflux disease (Acid reflux)

Overview

Food travels to the stomach through a tube-like structure known as the esophagus. The entry of food is allowed into the stomach through a valve-like structure known as the lower esophageal sphincter (LES).

GERD refers to stomach acid repeatedly flowing back into the esophagus. The major risk factor is unhealthy eating habits such as irregular meal timings, night time binge, and excessive consumption of fried and spicy food.  Obesity, hiatal hernia, pregnancy, smoking, and use of certain medications also increase its risk.

The treatment options include medications along with lifestyle interventions. In case of severe symptoms, surgery may be recommended.

Key Facts

Usually seen in
  • All age groups 
Gender affected
  • Both men and women but more common woman
Body part(s) involved
  • Esophagus
  • Stomach
Mimicking Conditions
  • Coronary artery disease
  • Achalasia
  • Eosinophilic esophagitis (EoE)
  • Non-ulcer dyspepsia
  • Rumination syndrome
  • Esophageal diverticula
  • Gastroparesis
  • Esophageal and gastric neoplasm
  • Peptic ulcer disease (PUD)

 

Necessary health tests/imaging
  • Esophageal pH monitoring
  • Esophageal impedance test
  • Esophageal manometry
  • Upper GI endoscopy
  • Upper GI X-ray
  • Biopsy
Treatment
Specialists to consult
  • General physician
  • Internal medicine specialist
  • Gastroenterologist
  • Gastrointestinal surgeon
  • Pediatrician

Causes Of GERD


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 the food is eaten. This allows the food to go downwards.

There are several mechanisms involved in GERD which may include:

1. Impaired LES function: In normal conditions, LES opens in response to a meal that facilitates the movement of food.  LES prevents the migration of gastric contents back into the esophagus. Individuals with GERD have more LES relaxations that are generally not triggered by food. This keeps the LES open even when it is not needed. It permits the reflux of gastric contents into the esophagus. 

2. Impaired mucosal defense: The stomach has a protective layer known as mucosa which acts as a barrier against acidic contents. It is seen that prolonged stay of food in the stomach may alter the mucosal layer and may cause GERD. 

3. Defective peristalsis: Peristalsis is a series of wave-like muscle contractions that move food through the digestive tract. The impaired peristalsis can cause reflux of gastric contents back into the esophagus.

Here are 10 tips to nurture your digestive health.

Symptoms Of GERD

 

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 taking food. Lying down also increases its occurrence.

The other signs and symptoms include:

  • Regurgitation (backward flow of swallowed food from stomach to food pipe)

  • 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 your upper digestive tract)

  • Epigastric pain (upper abdominal pain)

  • Hypersalivation

  • Nausea

  • Persistent vomiting

  • Frequent burping

Extraesophageal symptoms

  • Chest pain

  • Chronic cough 

  • Persistent sore throat

  • Asthma

  • Laryngitis

  • Dysphonia (having 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 having blood or coffee grounds

  • Dark coloured stool 

Did you know?
Normal stool colors include shades of brown and green, which are generally attributed to the breakdown of bile in the digestive process. However, significant changes in color, such as pale or black stools, might signal underlying issues and should be discussed with a doctor.
Did you know?

Types Of GERD

There are four stages of GERD depending upon the severity:

Stage 1: Mild

  • Individuals with mild GERD experience acid reflux only once or twice a month. 

  • The symptoms can be easily managed with over-the-counter medications and simple dietary changes at this stage. 

Stage 2: Moderate

  • Symptoms are frequent enough and need consultation with a doctor. 

  • The symptoms may affect daily activities.

Stage 3: Severe

  • Severe GERD causes painful symptoms and improves with only medications. 

  • It affects the quality of life.

  • In most of the cases, surgical correction is recommended. 

Stage 4: Precancer

  • In this, the esophagus can develop a precancerous condition known as Barrett’s esophagus over a period of time. 

Risk Factors For GERD


1. Old age

Aging increases the risk of GERD to several folds. This is due to the disruption of the tonicity of LES in old age. 

2. Eating habits

There are several eating habits that may increase the risk of GERD. These include:

  • Having fried, spicy, and sour food, especially at bedtime. These include 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. 

3. Consumption of excessive alcohol

Heavy drinking increases the risk of GERD by damaging the protective lining of the stomach. 

4. Less physical activity

Individuals who have sedentary lifestyles are more prone to develop GERD.

5. Postprandial physical activity

Strenuous physical activity such as running and weight lifting immediately after having food also increases the chances of GERD.

6. Obesity

Obese people have increased intra-abdominal pressure, delayed emptying of food from the stomach, and decreased LES pressure which triggers GERD. 

Studies also suggest that central obesity (measured as the waist-to-hip ratio) makes the individual more prone to GERD complications. 

7. Stress

Stress is linked to increased acid secretion in the stomach.

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8. Hiatal hernia 

It is a condition in which the stomach bulges through the large muscle separating your abdomen and chest (diaphragm). People with this condition are more likely to develop GERD and its complications.

9. Connective tissue disorders

Individuals with connective tissue diseases such as rheumatoid arthritis (RA) and scleroderma are also at a high risk of developing GERD. 

10. Certain Medications 

The use of certain medications is also associated with GERD. The class of medications that may cause GERD to develop are:

  • Benzodiazepines

  • Calcium channel blockers (antihypertensive medications)

  • Asthma medications

  • Non-steroidal anti-inflammatory medications (NSAIDs)

  • Antidepressants

11. Pregnancy 

The fluctuations in hormones increase the risk of reflux of gastric contents in pregnancy. The majority of pregnant women tend to develop GERD.

Are you on your family's way? Here is a list of medical tests that are a must during pregnancy.

Diagnosis Of GERD


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

1. Esophageal pH monitoring

  • pH is a measure of the acidity. Generally, the esophagus does not have acid. The presence of acid that is reflected by the low pH of the esophagus indicates GERD.

  • It is the most accurate way of diagnosing GERD.

  • This test is also used to check the progress of the treatment. 

2. Esophageal impedance test

  • This method is used to assess the reflux of gastric contents back into the esophagus. 

  • This is done by inserting a thin tube into the opening of the stomach through the nose. The acid reflux activity is tracked through a computer attached to the tube. 

  • The tube stays in place for 24 hours to detect the changes during eating, drinking, sleeping, and doing other activities. 

3. Upper gastrointestinal (GI) endoscopy

  • This involves an examination of the upper GI system (esophagus, stomach, and duodenum- initial part of the small intestine) using an endoscope. 

  • An endoscope is a flexible tube attached to a camera. The tube is passed through the mouth and the images are seen on a screen. 

4. Upper GI X-ray

  • During this procedure, a special type of camera sends beams to the upper GI.

  • The images of the esophagus and stomach are recorded on the system. 

  • This helps in detecting signs of problems such as ulcers, gastric reflux, hiatal hernia, blockages, or narrowing of the upper GI tract.

5. Biopsy

  • In this, small pieces of tissue are taken from the esophagus through the endoscope.

  • These tissues are examined under the microscope for any abnormality.

  • It is generally done to detect complications of GERD. 

Booking lab tests is just a click away.


Celebs affected

Ilena D.Cruz
Ilena D.Cruz is a famous bollywood actress. She shared her story about suffering from a severe episode of acid reflux.
Bill Clinton
The former US president suffered from severe episodes of GERD. He shared that he experienced hoarseness while working. He managed his condition by avoiding several foods that trigger acid reflux.
John Elway
The famous American football player suffered from GERD for a very long period of time. He shared his journey about having a sour taste in his mouth. He kept his symptoms under control through diet modifications and medications.

Prevention Of GERD


1. Maintain a healthy weight

Obesity is a major risk for GERD. Thus, maintaining a healthy weight is proven to be beneficial in preventing acid reflux.

Explore our wide range of weight management supplements.

2. Eat small meals at a time

One of the simple tips to lower your risk of acid reflux is to eat small yet frequent meals.

3. Avoid late-night binge

Eating late at night because of work pressure or snacking heavily in the evening can, in turn, make you more prone to heartburn. Therefore, avoid this habit of late-night snacking or eating close to bedtime.

Are you just overeating occasionally or is it a Binge eating disorder?


4. Limit consumption of spicy and deep-fried foods

Regular intake of highly spicy and deep-fried foods can stimulate excessive gastric acid production. Hence, these kinds of food should always be consumed in moderation.

5. Avoid strenuous physical activity right after eating

Strenuous physical activities like exercising or bending right after meals can lead to a build-up of acid in the esophagus. So give your stomach some time to empty its contents before you start exercising.

Specialist To Visit 


In most cases, the symptoms of GERD are occasional and may resolve through lifestyle changes or over-the-counter medications. It is advised to consult a healthcare professional if symptoms persist continuously for more than a week.

The other symptoms that need immediate medical consult include:

  • Heartburn even after taking (OTC) medications

  • Disturbed sleep due to nighttime reflux

  • Unexplained weight loss

  • Chronic hoarseness or wheezing

Specialists you should visit include the following:

  • General Physician

  • Internal medicine specialist

  • Gastroenterologist

  • Gastrointestinal surgeon

  • Pediatrician (in case of children)

A general physician will examine your symptoms and initiate treatment.

In case of severe cases, they may refer you to an internal medicine specialist who provides comprehensive care for adult patients, managing complex cases and addressing underlying health conditions.

Gastroenterologists can also be consulted as they have expertise in diagnosing and treating gastrointestinal disorders like GERD.

Gastrointestinal surgeons can be consulted if there is a need for any surgery due to complications of severe GERD.

A pediatrician can be consulted for medical treatment and preventive healthcare services for children and adolescents.

Consult India’s best doctors for your health concerns.


Treatment Of GERD

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 in individuals who do not respond to lifestyle modifications such as having smaller meals, avoiding spicy foods, and sticking to a meal routine. 

I. Medications

1. Antacids: These medications are used to relieve heartburn by neutralizing acid. They are readily available in liquid and chewable tablets as an OTC product. The common examples include:

 


2. Antihistamines (H2 receptor antagonist): These drugs inhibit the secretion of acid in the stomach. The bedtime administration of these drugs is recommended in persons having symptoms of GERD at night. 

Common examples are:


3. Proton pump inhibitors (PPIs): These drugs also reduce the production of acid. PPIs are also known to heal the damaged esophageal lining. They can be safely given for long-term treatment of GERD. The common PPIs used are:


4. Prokinetic agents: A prokinetic agent is a type of drug that enhances gastrointestinal motility. This helps in reducing the symptoms of GERD. Examples are:


II. Endoluminal therapy

This involves the delivery of radiofrequency energy to the LES. It creates 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 large hiatal hernia

The available surgical options for GERD are:

1. Fundoplication: It is the most commonly performed surgery for GERD.  In this surgery, the top of the stomach is sewn around the end of the esophagus. This adds pressure to the LES and helps in preventing reflux.  

2. Bariatric surgery: It is a surgery in which slight modifications are done in the digestive system which helps in reducing weight. It is recommended in obese individuals with severe GERD symptoms. There are three commonly performed surgeries:

  • Roux-en-Y gastric bypass (RYGB)

  • Laparoscopic adjustable gastric banded plication (LAGP)

  • Sleeve gastrectomy

Did you know?
Bariatric surgery is recommended for individuals who have a BMI of more than 37.5 kg/m2 or who have a BMI of more than 32.5 kg/m2 with obesity-related health problems like type 2 diabetes, and high blood pressure. Find out more such facts about this weight loss surgery. 
Did you know?

Home-care For GERD


1. Milk: Milk reduces heartburn by neutralizing acidity. It is always advised to choose low-fat milk as whole milk may contribute to heartburn.

2. Ginger (adrak):  It is 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.

3. Baking soda: It is also known for neutralizing acid. It can be taken by simply dissolving a teaspoon with a cup of water.

4. Basil leaves (tulsi): These leaves relieve heartburn and help to soothe the stomach lining. It can be taken as a tea by boiling two to three basil leaves in boiling water.

5. Coconut water: It is 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.

6. Mint (pudina): The natural cooling properties of mint helps in curbing the symptoms of acid reflux. Boil the mint leaves and have the brew to control GERD.

7. 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.

8. Watermelon: Watermelon juice naturally relieves heartburn due to its alkaline nature.

9. Banana: Banana is a low-acid fruit that is known to be beneficial for people suffering from acid reflux. It works by acting as a layer to the irritated esophageal lining to prevent acidity.

Complications Of GERD

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 that is similar to the lining of your intestine replaces the tissue lining your esophagus)

  • Esophageal cancer

Alternative Therapies For GERD

The alternative therapies for GERD include:

1. Yoga

Some of the simple yoga asanas that can help relieve acidity include:

  • Pawanmuktasana 

  • Vajrasana

  • Virabhadrasana

  • Shashankasana

  • Trikonasana

2. Acupuncture

It is a part of ancient Chinese traditional medicine. In this, the skin is penetrated with thin, solid, and metallic needles. This stimulates the sensory nerves which helps in symptomatic relief.

Living With GERD

Individuals with GERD should undergo several lifestyle changes for the 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 food should be included in the diet. The foods that are beneficial for individuals with GERD include:

  • Whole grains such as oatmeal, 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 before 3- hours of sleeping. This helps in alleviating nighttime episodes. 

3. Limit meal size

The intake of a larger meal can also cause acid reflux as it puts more pressure on 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 a good sleep hygiene

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

Shop exclusive products for maintaining a sound sleep.


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 which increases the risk of gastric juices being refluxed into the esophagus.

Quitting smoking helps to curb symptoms to a larger extent. Here are some products that help you in the cessation of smoking.


8. Limit the intake of alcohol

The consumption of alcohol causes an increase in GERD symptoms through damaging the protective layer of the stomach. There are various studies that have shown a significant decline in the symptoms after withdrawing alcohol.

Persons with GERD are recommended to avoid/limit alcohol. Try these 5 tips to drink in moderation!

9. Lose weight

Overweight/obese individuals have more chances to develop acid reflux. Obese people with GERD are strongly recommended to lose weight. 

10. Choose medications wisely

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

Did you know?
Individuals with asthma along with GERD showed a considerable improvement in the symptoms of asthma during the treatment of acid reflux.
Did you know?

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