Non-medical Secrets to Controlling Acid Reflux (GERD)

Dear Dr. Deena,
I have really bad heartburn. Should I be concerned with GERD? What can I do to treat it?
Dana

Having heartburn can be really tough, and many of us (myself included) are subject to this condition...luckily there are some tips that might help you feel better!

GERD stands for Gastro-Esophageal Reflux Disease and is commonly referred to as "acid reflux". This condition occurs when the contents of the stomach move upwards (or "refluxes") into the esophagus and/or into the mouth. GERD effects 20% of our population; however, there are many people who are undiagnosed as they are unaware of this disease.

In order to better understand this disease, lets take a look at the anatomy of the stomach (the organ which collects and stores food) and the esophagus (the tube which connects the mouth to the stomach). 

(Courtesy of Uptodate.com)

Once food is swallowed, it travels from the mouth through the esophagus - which is a long tube consisting of muscles that contract to propel food forward. At the end of the esophagus, food must go through a "Gate-keeper" known as the lower esophageal sphincter ("LES") prior to entering the stomach. The LES is a muscle that contracts to prevent back-flow of food into the esophagus and relaxes to allow food to move forward into the stomach. When the LES is weak or in a relaxed state more food "refluxes" into the esophagus and mouth which is one way of how we develop GERD. GERD can also be caused by a weakness in the muscles of the diaphragm leading to a "hiatal hernia".


GERD can present with some of the following symptoms:
-heartburn (a "burning sensation" that is often in the upper abdomen, chest, or behind the breastbone)
-abdominal pain (generally in the upper part of the abdomen)
-regurgitation (food particles coming back up from the stomach into your mouth)
-vomiting
-difficulty swallowing
-pain with swallowing
-chronic cough
-voice changes/hoarseness of the voice
-sore throat
-increased salivation 
-waking up with a strange taste in one's mouth (generally a bitter taste)
--new onset of asthma (especially at an older age)
--persistent dental disease


The diagnosis of GERD is usually made by a physician after a full history and physical, especially if the patient states experiencing some of the above symptoms at least 2-3 times weekly. The diagnosis can sometimes be confirmed if symptoms improve after specific interventions.

Luckily if you have mild symptoms of acid reflux, my following tips  might help you:

1. Lose weight if you are obese. Obesity predisposes you to GERD and many other medical problems

2. Elevate the head of your bed up to 8 inches while sleeping (instead of lying flat). This allows gravity to help control reflux with food traveling downward rather than upward. This step is especially important if your heartburn occurs at night-time

3. Figure out what your triggers for increased acid production might be. Most of my patients have such different triggers ranging from orange juice to yogurt. If you notice certain foods are bothersome to you, avoid them and see if your symptoms improve. Common food triggers of acid reflux include citrus juices (orange, grapefruit juices), spicy foods, tomatoes, alcoholic beverages (especially wine)

5. Avoid substances that are known to cause relaxation of the LES (thus promoting acid reflux) like chocolate, peppermint and caffeine

6. Quit smoking! Smoking not only decreases salivation and saliva is a neutralizer of acid, but it also causes increases relaxation of the LES

7. Stress management! Stress is known to stimulate acid production in the stomach and can lead to worsening reflux

8. Eat your last meal 2-3 hours before bedtime

9. If you find that your acid reflux is worse after eating heavy meals, then attempt to eat smaller meals throughout the day

10. If you have a infrequent heart burn symptoms, try antacids (Rolaids, Tums, Mylanta) for short-term relief

If lifestyle changes do not help, then ask your physician if medications are right for you.

It is very important to have acid reflux examined and controlled with your MD because the complications related to this disease can be fatal! Most patients do not develop these complications but it is important to be aware of them. 

These complications include:

1. Ulcers
Ulcers are caused by damage to the tissue of the esophagus or stomach due to increased acid production. Ulcers can lead to bleeding in your digestive tract and is a medical emergency!

2. Changes to the voice with hoarseness or chronic sore throat
Acid reflux leads to inflammation of the throat and vocal cords

3. Esophageal Cancer 
Cancer can develop after a a long period of exposure to constant irritation and inflammation of the lining of the esophagus due to increased acid reflux

4. Barret's Esophagus
This condition is a risk factor for esophageal cancer. The stomach is an organ that is well-equipped to deal with a high acid environment, and the esophagus is not. In this condition the tissue lining and cells of the esophagus become distorted and abnormal, which can predispose patients to further irregular cell division/growth (cancer).



I hope you find this information helpful, and hopefully with my lifestyle change recommendations your acid reflux will improve! 

As always, please email your questions/comments to DoctorDeenaMD@gmail.com.

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