Gastroesophageal Reflux Disease (GERD), commonly known as acid reflux disease, is a common gastrointestinal condition which is experienced by a large number of people all over the world. Due to specific reasons the acid from the stomach seeps back into the esophagus or in the throat. More often than not, this condition is experienced by people at night after the meals.
When GERD happens, acidic stomach juices can flow back up into the esophagus more frequently than normal, leading to symptoms like acid reflux and heartburn. Risk factors include pregnancy, alcohol, and stress. Over time, GERD can lead to bleeding, ulcers, or scarring of the esophagus.
When we eat, the food passes through the esophagus to reach the stomach. Esophagus is an elongated tube that connects the throat to the stomach and has an opening at the end which is known as lower esophageal sphincter (LES). When food reaches the stomach, this valve closes. However, when it fails to do so, a person is said to have GERD or gastroesphageal reflux disease. When a person has GERD, it happens that the fluids or acids in the stomach returns back to the esophagus, thus causing damage to its lining. Over time, the inflammation can erode the esophagus, causing complications such as bleeding or breathing problems.
GERD can occur to people of all ages. It is commonly seen in pregnant women, obese people and also in people who indulge in smoking. Certain food stuffs like drinks that contain caffeine, spicy foods, oranges, pizzas, tomatoes, peppermint, chocolate, etc., also play a role in the occurrence of GERD. Sometimes, the LES and the upper region of the abdomen shifts its position by moving over the partition (diaphragm) that marks the end of the chest area and the beginning of the stomach area. This condition is called hiatal hernia and is also one of the cause of GERD.
While the exact causes of GERD are still unknown, several risk factors can work to increase your chances of developing it. Conditions that can increase your risk of GERD include:
Obesity
Hiatal hernia
Pregnancy
Smoking
Dry mouth
Asthma
Diabetes
Delayed stomach emptying
Connective tissue disorders, such as scleroderma
Zollinger-Ellison syndrome
The symptoms of GERD vary according to the person's age. GERD symptoms in adults are slightly different from those in children. Similarly the symptoms in case of children as different from those observed in case of infants.
The most common symptom of GERD is heartburn. People having this disease experience a burning sensation along with pain in the middle of the chest, and also sometimes in the neck, stomach and back area. At times, people with GERD can also feel a sharp pain behind the breast bone (in the chest) which may seem like a heart attack.
These symptoms usually occur after a person has taken his meals, more so when he lies down, because there is no gravitational force to push the acids in the stomach downwards. Most of us experience this kind of feeling sometime or the other, but that does not mean that we have GERD. Only when a person has heartburn frequently, it can be said that he or she has this disorder.
Regurgitation occurs when the fluid that is pushed back from the stomach reaches the mouth. In most patients, only a small amount of liquid is pushed back and so it only reaches the esophagus. However, sometimes it can happen that, food along with the fluids, reach the throat and even the mouth. When this happens, the individual senses an acidic and bitter taste in the mouth.
In certain cases, it has been experienced that patients have a hard time while swallowing food and sometimes they feel that something has got stuck in their throat. Many times, due to the presence of stomach fluids in the throat area, an individual may feel soreness or hoarseness. A person with GERD can also experience dry cough.
One of the symptom that is very rarely seen in GERD patients is nausea. Some people happen to feel giddy and nauseous, and this causes them to vomit frequently.
Heartburn is the most prominent symptom of GERD. The person experiences burning sensation in his chest due to the strong stomach acid. Therefore among all GERD symptoms, chest pain is the most important one. Sometimes while explaining GERD symptoms, back pain is also mentioned by some of the patients. It is rare and may or may not be observed. The following are the other symptoms of acid reflux in adults.
Sour taste in the mouth
Difficulty in swallowing
Sore throat
Hoarseness
Nausea
Cough
Vomiting is a common symptom of acid reflux in children. Apart from these, the following are the other symptoms of GERD seen in children.
Sensation of lump in throat
Tightness in throat
Cough
Difficulty in breathing
Difficulty in swallowing
Chest pain
Vomiting and constant coughing are the major GERD symptoms in infants. In rare cases, certain severe symptoms like bleeding in the esophagus or poor growth are also observed. Other signs and symptoms of GERD in infants include:
Difficulty in breathing
Loss of appetite
Irritation
Refusal to eat
Crying
People who do nothing to treat their gastroesophageal reflux disease (GERD) have a higher risk of developing severe GERD symptoms. These symptoms are common when the esophagus becomes inflamed, esophageal ulcers develop, or the esophagus narrows because of scar tissue formation. Some common signs and symptoms of severe GERD include bleeding in the esophagus, shortness of breath, a choking feeling, ever increased coughing, a hoarse voice, chest pain that may be severe, and feeling that food is getting stuck behind the breastbone after you swallow.
These severe GERD symptoms are common when the esophagus has become inflamed, esophageal ulcers have developed, or the esophagus narrows because of scar tissue formation.
Other GERD complications are also possible. Some people develop Barrett's esophagus, where cells in the esophageal lining take on an abnormal shape and color, which, over time, can lead to cancer. About 1 out of 100 people who have severe damage to the lining of their esophagus develop a form of esophageal cancer.
Also, studies have shown that asthma, chronic cough, and pulmonary fibrosis may be aggravated or even caused by GERD.
If a person experiences any of the above symptoms of acid reflux, he can take over-the-counter medications as they can be useful in treating the discomfort. However, if the symptoms persist for more than a couple of days even after taking these medications, you need to consult the doctor. Sometimes, if the above mentioned symptoms are accompanied by other symptoms like weight loss, improper bowel movement, etc. you should visit the doctor immediately.
GERD can be effectively treated by several ways. Antacids help in overcoming the discomfort and nausea. Whereas, medications like H-2-receptor blockers and Proton pump inhibitors help in reducing acid production. If a person suffers from GERD persistently, he can undergo a surgery which helps in tightening of the lower esophageal sphincter muscles. There are several effective natural remedies for acid reflux.
Changes in lifestyle and diet helps reduce the severity of acid reflux or even cure it completely if diagnosed early with mild symptoms. One needs to find out the natural remedy that works best for them, as results would widely vary for every individual.
Lifestyle Changes as a Natural Remedies for Acid Reflux Disease
Avoid over-eating and late-night snacking
Maintain upright position after meals. Wait at least three hours after eating before lying down or going to bed
Smaller meals help ease digestion, eating at least 3 hours before bedtime is advisable
Quit tobacco and smoking. Smoking decreases the lower esophageal sphincter's ability to function properly
Weight reduction can aid in releasing the pressure on stomach that causes the liquid to reflux into esophagus
Wear proper fitting or loose clothes, avoid waist bands that would exert force on the abdomen thus causing acid reflux. Clothes that fit tightly around your waist put pressure on your abdomen and the lower esophageal sphincter
Adequate sleep is necessary for proper digestion and relaxation
Tilted sleeping position where the upper half of the body is elevated reduces the risks of reflux. Lying on the left side helps digestion. Place wood or cement blocks under the feet of your bed so that the head end is raised by six to nine inches. If it's not possible to elevate your bed, you can insert a wedge between your mattress and box spring to elevate your body from the waist up. Wedges are available at drugstores and medical supply stores. Raising your head with additional pillows is not effective.
Stress affects digestion of food causing acid reflux. Regular meditation and exercise helps to be stress-free
Medications could be a possible cause of heartburn and need to be stopped or complemented with other drugs or alternative therapies to curb its harmful effects
Acid Reflux - Foods to Avoid
Coffee, alcohol, spicy food, chocolate, peppermint and fatty foods tend to aggravate symptoms. Carbonated drinks, tomato sauce and fried foods increase acid secretion. Citrus fruits like lemon, oranges and pineapple should be avoided. Avoid processed and flavored foods. In addition to the above foods, there are specific substances that cause heartburns only in a particular individual. A food diary would help find out such foods.
GERD Diet Tips
Water helps dilute the acid when the reflux is mild
Milk can be a good reliever of acid reflux and especially cold milk helps reduce the acidic effect
Coconut water, buttermilk with coriander juice is also known to reduce acidity
Increase fiber intake with lots of vegetables like leafy vegetables, bitter gourd, cucumber and pumpkin
Fruits like banana, watermelon and papaya help reduce acidity
Increase whole grains and protein in your diet
Alternative Remedies for Acid Reflux
Ginger and garlic are known to aid in the digestion process and thus reduce the back up of contents into esophagus
Fennel seeds benefits in digestion and acts as a powerful reliever of heartburns. It is either consumed with warm water or as fennel tea
Herbal tea and green tea is known to be effective
Apple cider vinegar consumed with meals also cures heartburns
Licorice and Aloe vera are good for stomach ailments and acidity
Lemon juice along with rock salt should be taken 2 hours before meals
Cardamom, chamomile and sandalwood are some herbs used to for its soothing effects on stomach
Careful diagnosis and prevention of causative factors would be the first step towards curing acid reflux naturally.
Treatment for heartburn and other signs and symptoms of GERD usually begins with over-the-counter medications that control acid. If you don't experience relief within a few weeks, your doctor may recommend other treatments, including medications and surgery.
Initial
treatments to control heartburn
Over-the-counter treatments that may help control heartburn
include:
Antacids that neutralize stomach acid. Antacids, such as Maalox, Mylanta, Gelusil, Rolaids and Tums, may provide quick relief. But antacids alone won't heal an inflamed esophagus damaged by stomach acid. Overuse of some antacids can cause side effects, such as diarrhea or constipation.
Medications to reduce acid production. Called H-2-receptor blockers, these medications include cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR) or ranitidine (Zantac 25, Zantac 75, Zantac 150). H-2-receptor blockers don't act as quickly as antacids, but they provide longer relief. Stronger versions of these medications are available in prescription form.
Medications that block acid production and heal the esophagus. Proton pump inhibitors block acid production and allow time for damaged esophageal tissue to heal. Over-the-counter proton pump inhibitors include lansoprazole (Prevacid 24 HR) and omeprazole (Prilosec OTC).
Contact your doctor if you need to take these medications two or more times a week or your symptoms are not relieved.
Prescription-strength
medications
If heartburn
persists despite initial approaches, your doctor may recommend
prescription-strength medications, such as:
Prescription-strength H-2-receptor blockers. These include prescription-strength cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid) and ranitidine (Zantac).
Prescription-strength proton pump inhibitors. Prescription-strength proton pump inhibitors include esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), rabeprazole (Aciphex) and dexlansoprazole (Dexilant).
Rarely, these medications may lead to bone loss and increase the risk of a bone fracture. Your doctor may suggest that you take a calcium supplement to reduce these risks.
These medications may decrease the effectiveness of the blood-thinning medication, clopidogrel (Plavix). If you are prescribed a proton pump inhibitor and are taking Plavix, tell your doctor.
Medications to strengthen the lower esophageal sphincter. Called prokinetic agents, these medications help your stomach empty more rapidly and help tighten the valve between the stomach and the esophagus. Side effects, such as fatigue, depression, anxiety and other neurological problems, limit the usefulness of these medications.
GERD medications are sometimes combined to increase effectiveness.
Surgery
and other procedures used if medications don't help
Most GERD can be controlled through medications. In situations
where medications aren't helpful or you wish to avoid long-term
medication use, your doctor may recommend more invasive procedures,
such as:
Surgery to reinforce the lower esophageal sphincter (Nissen fundoplication). This surgery involves tightening the lower esophageal sphincter to prevent reflux by wrapping the very top of the stomach around the outside of the lower esophagus. Surgery can be open or laparoscopic. In open surgery, the surgeon makes a long incision in your abdomen. In laparoscopic surgery, the surgeon makes three or four small incisions in the abdomen and inserts instruments, including a flexible tube with a tiny camera, through the incisions.
Surgery to create a barrier preventing the backup of stomach acid (EndoCinch endoluminal gastroplication). This procedure uses a tool that's like a miniature sewing machine. It places pairs of stitches (sutures) in the stomach near the weakened sphincter. The suturing material is then tied together, creating barriers to prevent stomach acid from washing into your esophagus. Your doctor may recommend this procedure if medications aren't effective or if you're not a candidate for Nissen fundoplication. However, it's not clear who is best suited for this treatment, and research is ongoing.
A procedure to form scar tissue in the esophagus (Stretta procedure). This approach uses electrode energy to heat esophageal tissue. The heat creates scar tissue and damages the nerves that respond to refluxed acid. The scar tissue that forms as your esophagus heals helps to strengthen the muscles. Your doctor may recommend this procedure if medications aren't effective or if you're not a candidate for Nissen fundoplication. However, it's not clear who is best suited for this treatment, and research is ongoing.
No alternative medicine therapies are proven to treat GERD or to reverse damage to the esophagus. Still, some complementary and alternative therapies may provide some relief, when combined with your doctor's care.
Talk to your doctor about what alternative GERD treatments may be safe for you. Options may include:
Herbal remedies. Herbal remedies sometimes used for GERD symptoms include licorice, slippery elm, chamomile and marshmallow. Herbal remedies can have serious side effects, and they may interfere with medications. Ask your doctor about a safe dosage before beginning any herbal remedy.
Relaxation therapies. Techniques to calm stress and anxiety may reduce signs and symptoms of GERD. Ask your doctor about relaxation techniques, such as progressive muscle relaxation or guided imagery.
Acupuncture. Acupuncture involves inserting thin needles into specific points on your body. One small study reported that acupuncture helped people with heartburn that persisted despite medication. Ask your doctor whether acupuncture is safe for you.
Taking medicines without fail but ignoring GERD diet will not help to cure this digestive problem. Diet for GERD victims involve the exclusion of certain foods, as they are known to aggravate the symptoms of GERD.
Alcohol
Intake of alcohol has to be strictly avoided, as it can aggravate the existing chest pain. Alcohol consumption can further reduce the ability of LES to work properly, thus allowing stomach acids to easily enter the food pipe. Also, the thin mucus layer lining of the food pipe dries due to alcohol intake, causing further irritation. In this condition, even a few sip of alcohol can restrict the esophagus to perform its function of pushing food and stomach acid. Also, alcohol intake hampers saliva production, thus aggravating this digestive issue. This is because saliva plays a very important role to alleviate the effects of stomach acid in food pipe.
Caffeine
Ask any doctor about diet for GERD and he would say that avoiding coffee is a must for GERD. Coffee basically decreases the resting pressure of the LES, thus reducing its ability to contract properly. Proper contraction of LES is necessary to close the food pipe completely, thus preventing entry of stomach acids to the food pipe.
Spicy or Fried Foods
In order to control GERD symptoms, it is necessary to keep these foods away from the diet. In this condition, eating spicy foods can lead to frequent episodes of heartburn. Spicy or fried fruits can stimulate production of stomach acid which is likely to gain entry in the food pipe as the end muscle (LES) would not be working efficiently.
Other Foods to Avoid
High fat foods such as eggs, butter and cookies as well as vegetables like tomatoes increase stomach acidity, hence cannot be included in the diet for GERD. Tomato based products such as sauces also need to be avoided in order to get relief from GERD. Studies also show that chocolate and tea can also bring GERD symptoms. So, to be on the safer side say 'no' to these foods.
Citrus Fruits
Citrus fruits can also aggravate this acid reflux problem. This is because these fruits increase stomach acid. This in turn the increases the probability of stomach acids gaining access to food pipe. Citrus foods that may trigger worsening of GERD symptoms are as follows:
Oranges
Pineapple
Grapefruit
Lemon
The best diet for GERDs means having foods that discourage excess production of stomach acids, thus relieving symptoms of GERD. They are mentioned below:
Vegetables: When it comes to vegetables, foods that form an integral part of diet for GERD patients are given below:
Broccoli
Potatoes
Cabbage
Carrots
Peas
Fruits: Fruits, too can contribute to ease the symptoms of GERD. Following are the foods included in GERD diet.
Bananas
Apples
Meat: Although consumption of fatty foods is not recommended, one can have cooked or steamed fish and lean meat such as skinless chicken in the GERD diet.
Restrict Carbohydrate Intake: A low carbohydrate diet is the key to heal this condition at the earliest. Having too many carbohydrates can cause excruciating heartburn. Doctors often say that carbohydrate restriction can help cure GERD.
Keep in mind that diet for GERD is crucial to restore normal functioning of the LES. Following this diet for a specific period of time, can surely help to get rid of this acid reflux disease.