read GERD and Acid Reflux: Everything You Need to Know

GERD and Acid Reflux: Everything You Need to Know

GERD, acid reflux and heartburn symptoms

You just had a big meal at your friend’s place, and now you feel like your tummy is going to explode. In fact, you can feel the food, along with the stomach acid, rushing back to your throat and mouth. This is called regurgitation or acid reflux, and it leaves a sour and bitter taste in your mouth.  

Acid reflux, which causes heartburn, happens when the food washes back into the esophagus (food pipe). Under normal conditions, the lower esophageal sphincter (LES) — a valve-like barrier between the esophagus and the stomach — acts as a gateway. It relaxes and opens for food to enter the stomach and then closes immediately. It does not allow stomach acid, undigested food, or gastric juices to leak into the esophagus. But at times, LES, a circular-shaped specialized muscle, becomes weak and fails to do its job, and is unable to control the reflux.  

What happens when LES is dysfunctional?

When the LES does not completely close or accidentally opens, the stomach contents move up the esophagus, irritating the tissue lining, which results in heartburn.

The stomach is a muscular bag that secretes a mixture of digestive enzymes, hydrochloric acid, mucus, and bicarbonate. They  work in symphony to break down and digest food. The acid is particularly important as it also helps fight pathogens and the absorption of nutrients such as proteins. However, when this acid flows back to the upper digestive tract, such as the esophagus, it can damage the tissue lining. 

GERD, Barrett’s esophagus, and LPR

Although acid reflux is extremely common, a severe form of frequently occurring acid reflux is called gastroesophageal reflux disease (GERD). GERD is diagnosed when the symptoms are severe and occur more than twice a week. If left untreated, it can lead to further complications requiring urgent medical attention

Over a period of time, constant heartburn severely damages the esophageal lining. This results in inflammation and formation of scar tissue, which narrows down the diameter of the esophagus, making it difficult to swallow food. 

In a rare condition, under the influence of constant acid reflux, the cells lining the esophagus get damaged and start resembling the cells lining your intestine. This condition is known as Barrett’s esophagus. This can elevate the risk of developing esophageal cancer.

A common form of acid reflux, which often gets misdiagnosed, is laryngopharyngeal reflux (LPR). In this condition, the acid reflux is so severe that it reaches the vocal cords, leading to coughing and hoarseness of voice. Very often, patients with LPR keep looking for a cure for the throat pain and cough, while the actual problem of the reflux goes unnoticed.

Symptoms 

Symptoms of GERD and acid reflux

Heartburn is the most common symptom of GERD. It is  characterized by a burning sensation in the chest area. This condition can aggravate after you consume food or when you bend or lie down. Often, it feels like you might regurgitate the food. 

Besides heartburn, you might also experience: 

  • Bitter or sour taste in the mouth
  • Bad breath
  • Coughing or wheezing
  • Difficulty in swallowing
  • Nausea
  • Vomiting
  • Hoarseness of voice or laryngitis

Triggers

This digestive disorder is often linked to your diet. Your body responds to every food item differently. Sometimes, there can be adverse reactions depending on your body’s tolerance. If you have had such experiences in the past, you are probably already familiar with the foods or beverages that trigger such symptoms. 

Yet, GERD can happen at the most unexpected times and can cause great discomfort. Maintaining a journal of all the food items that trigger your symptoms will help track and eliminate these from your diet.   

Some common potential triggers are:

  • Caffeine
  • Spicy foods
  • Chocolate
  • Peppermint
  • Citrus fruits
  • Carbonated drinks
  • Alcohol
  • Anxiety and intense emotions like anger

Diagnosis of GERD

A good history and examination will help your physician in reaching a diagnosis for GERD fairly easily. However,  confirmation may require few tests, which may be invasive. An endoscopy may be advised to look for any ulceration or abnormal growths in the stomach and esophagus.

Another special test, called an esophageal pH metry, may be done to check for acid reflux that’s causing damage to the vocal cords and throat. Similarly, tests involving measurements of pressures at the lower esophageal sphincters may be done in few specialised centres.

All these tests require a tube to be passed through the nose or throat and kept in situ for about 24 hours, after which the readings are taken and a confirmatory diagnosis is made.

Treatment

Simple, mindful lifestyle changes go a long way towards treating GERD. Although medications can be prescribed to accelerate the treatment process, following a suitable diet and maintaining your weight can keep GERD at bay.

Dietary and lifestyle changes

1. Avoid foods or beverages that trigger your symptoms. Generally, spicy food, caffeinated beverages, fried food, peppermint, and citrus fruits affect the digestive system. But these differ from person to person, and you need to identify your triggers to eliminate them.

2. Have frequent, small meals (five meals a day). This ensures that the stomach is never empty for too long. Also, by having smaller meals, you ensure that you don’t overstuff yourself, which can, in turn, produce excessive acid and cause acid reflux.

3. Chew properly and slowly to ensure that alkaline juices in your mouth mixes well with the food. These juices help in reducing acidity in the stomach.  

4. Quit smoking, as smoking weakens or loosens the LES, which makes it easier for the stomach contents to move up to the esophagus. Smoking also causes irritation of the stomach and esophageal lining, leading to more damage during the reflux.

5. Avoid lying down immediately after a meal. Maintain a gap of 2 to 3 hours before bedtime, as lying down after a heavy meal can cause indigestion, bloating, and an increase in stomach acid.

6. Sleeping on your left side, and elevating not just your head but your entire upper body will keep acid reflux in check. Gravity will keep the acid in place — ie, the stomach. Lying down on your back will make it worse, making it easier for acid to leak from the stomach into the esophagus. Use a wedge pillow while lying down to avoid reflux.

7. Weight loss is one of the best ways to manage GERD. Excess weight can put pressure on the abdomen, which can relax the LES when not in use.  

Exercises for GERD

Mild to moderate intensity exercises done in upright positions, or the ones which do not increase pressure inside the abdomen, are considered good for GERD.

1.Walking, yoga and cycling are considered good exercises for managing GERD symptoms.

2. Meditation is an excellent technique for increasing the parasympathetic tone (rest and digest mode) of the body. It calms the mind and nerves, leading to lesser anxiety that itself is an important trigger for acid reflux.

Over-the-counter medications

While several over-the-counter medications are available to relieve acidity, it’s advisable to only consume them under prescription. Self-medication can be dangerous in the short and long term. 

1. Antacids: These drugs work by neutralising stomach acid. They provide temporary relief; however, excessive usage of antacids can result in diarrhea, nausea, or kidney problems.

2. Histamine 2 blockers: H2 blockers prevent chronic acid reflux by blocking the production of stomach acid and healing inflammation or ulcers.

3. Proton pump inhibitors (PPI): These work by reducing stomach acid production by acting on the enzyme responsible for producing the acid.

The long and short of it is that stomach acid needs to stay in its place. It is needed for maintaining your gut health and aids digestion. But the moment it washes back to the esophagus, it is bad news. However, it is  possible  to keep GERD in check. So take control, help your digestive system work well, and do not let GERD become a persistent, larger problem.

References
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