Also known as Acid reflux and Gastroesophageal 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.
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)
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
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.
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:
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.
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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.
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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.
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:
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:
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.
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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?
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?
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?
Individuals with asthma along with GERD showed a considerable improvement in the symptoms of asthma during the treatment of acid reflux.
Frequently Asked Questions
The most common signs and symptoms of GERD include - a burning sensation in your chest (heartburn), usually after eating, which might be worse at night or while lying down.
GERD is defined as a group of symptoms caused by the flow of gastric contents into the esophagus. Heartburn is one of the symptoms of GERD.
Some studies suggest that inflammation in the esophagus from GERD can take up to 8 weeks to heal with successful lifestyle changes and medications. However, these measures will not fully cure GERD always.
Most patients spend one night in the hospital. They are usually able to resume routine activities within a week of surgery.
If the patient is treated for a hiatal hernia at the time of anti-reflux surgery, patients may not engage in vigorous activities or lift anything heavier than 10 pounds for six weeks following surgery.
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