If you’ve ever felt that uncomfortable burning sensation after eating or dealt with persistent heartburn, you’re not alone. Understanding gastroesophageal reflux disease, or GERD, is the first step toward addressing it and being able to enjoy meals without worry. Here we will discuss the causes, symptoms, and management strategies for GERD, so that you have the tools to take control of your gut health.
What is GERD?
Gastroesophageal Reflux Disease (GERD), also commonly known as acid reflux, is a condition in which the acid from the stomach backflows up into the esophagus. GERD occurs as a result of loosening of the lower esophageal sphincter. This sphincter is a ring-shaped muscle that closes the top of your stomach and is intended to prevent food from moving back up your esophagus. However, with GERD and the loosening of this muscle, acid and food can move back into the throat and cause symptoms such as burning, belching, or acidic taste in the mouth.
What are Common GERD Symptoms?
- Heartburn
- Acidic taste in the mouth
- Belching
- Sensation of having a lump in the throat
Atypical symptoms of GERD include coughing, sore throat, or difficulty swallowing. If you are experiencing these symptoms, make an appointment with your primary care provider or gastroenterologist to discuss further.
One possible complication of GERD is Barrett’s esophagus. About 5% of people with GERD will develop Barrett’s esophagus, which is characterized by abnormal changes in cells of the esophagus due to chronic inflammation or irritation. The best way to prevent this is to manage GERD to the best of your ability through lifestyle modifications and medical treatment, if necessary.
How is GERD Diagnosed?
Your healthcare provider may be able to diagnose GERD based on your history, symptoms, and performing a physical exam. GERD may be confirmed through a few other methods, including:
- Upper endoscopy, in which a camera is run down the esophagus to assess for any inflammation or damage. Biopsies may be taken, if indicated.
- Esophageal pH test (also called ambulatory pH monitoring), in which a sensor is placed in the esophagus typically for 24 hours to assess for acid regurgitation from the stomach.
- Esophageal manometry, in which a pressure catheter is passed through your esophagus to measure the muscle movement patterns of the esophagus.
How Can I Manage GERD with Lifestyle Changes?
First, there are many foods that can exacerbate GERD symptoms. These include foods that may contribute to more stomach acid or that may relax the lower esophageal sphincter. Limit the following trigger foods:
- Acidic foods: citrus fruits, tomatoes,
- High fat foods: fried food, fast food, processed snacks, fatty meats
- Spicy foods: chili powder and pepper
- Carbonated beverages
- Foods that may relax the lower esophageal sphincter: chocolate, peppermint, alcohol, caffeine
Other foods may help with acid reflux symptoms, on the other hand. These foods may dilute or neutralize the acid in the stomach. Focus on including the following foods:
- High fiber foods: whole grains, vegetables, nuts, seeds, beans, and legumes
- Alkaline foods: bananas, cauliflower, melons, nuts, ginger
- Foods with high water content: watermelon, herbal teas, soups, cucumber, celery
Finally, these additional food and lifestyle behaviors can all play important roles in managing GERD symptoms by relieving additional pressure on the lower esophageal sphincter or promoting overall gut health:
- Eat smaller, more consistent meals (4-5 meals spaced out every 2-4 hours)
- Slow down pace of eating, chewing thoroughly
- Avoid tight fitting clothing
- Remain upright after meals for at least 2-3 hours
- Finish eating 2-3 hours before bed or sleep with your head and shoulders elevated
- Reducing overall sugar and saturated fat intake
- Achieve a healthy weight
- Establish a consistent exercise routine
- Get adequate sleep
- Stop smoking
What Medical Treatments are Available for GERD?
There are many medications that work to manage GERD symptoms. These include:
- PPIs, or proton pump inhibitors, work to decrease the acid production in the stomach. There are some risks associated with using PPIs over long periods of time, including B12, magnesium, or calcium malabsorption or deficiency. This, in turn, increases risk of bone fracture long term. Examples of PPIs include omeprazole, pantoprazole, and lasoprazole.
- Histamine, or H2, blockers, also work to decrease the acid production in the stomach by blocking histamine-2 receptors. Some risks of these medications include impaired absorption of other medications, but H2 blockers are generally considered to be safe for long term use. However, it is thought that H2 blockers may not maintain the same effectiveness over long periods of time. Examples of H2 blockers include famotidine and cimetidine.
- Prokinetic agents stimulate contractions along the digestive tract to promote the stomach to empty more quickly as well as strengthening the lower esophageal sphincter. Prokinetic agents are typically prescribed along with another medication to treat GERD, such as PPIs or H2 blockers. Prokinetic agents may have different side effects depending on what they target. Examples include Baclofen, Bethanechol, and Metoclopramide.
- Antacids are available over the counter and neutralize the acid already present in the stomach. They typically provide quick symptom relief but do not address longer term issues. Antacids are also meant only for short term use, as long-term chronic use can be associated with increased acid production over time, thus possibly exacerbating GERD symptoms, in addition to other side effects.
If managing your GERD symptoms with lifestyle changes and medication is not enough, your doctor may offer surgery as another alternative. The most common surgery to treat GERD is a fundoplication, in which the top of the stomach is wrapped around the lower esophagus to reinforce the lower esophageal sphincter.
If you have GERD and would like more support, Avance Care has a free, bimonthly support group for people with a variety of GI conditions. Whether you are interested in more information about management and treatment or are just looking for social support from others with similar experiences, this groups is here for you! Join the support group email list by filling out this interest form and someone will be in touch soon.
