GERD is a condition in which the stomach acid or contents from the stomach flow back into the food pipe (esophagus). The backwash (reflux) irritates the lining of the esophagus and causes GERD. Gastroesophageal refers to the stomach and the esophagus. While reflux refers to the back-flow of acidic or non-acidic stomach contents into the esophagus. A band of muscles at the junction of the stomach and esophagus called the lower esophageal sphincter (LES) normally act, in conjunction with the diaphragm, as a barrier to prevent the reflux of stomach contents into the esophagus. It is when that barrier is relaxed at inappropriate times or is otherwise compromised that reflux occurs.
GERD is characterized by symptoms and/or tissue damage that results from repeated or prolonged exposure of the lining of the esophagus to contents from the stomach. If tissue damage is present, the individual is said to have esophagitis or erosive GERD. The presence of symptoms with no evident tissue damage is referred to as non-erosive GERD.
GERD symptoms are often persistent, such as chronic heartburn and the regurgitation of acid. But sometimes there are no apparent symptoms, and the presence of GERD is revealed only when complications become evident. While the symptoms of GERD vary from person to person, the majority of people with GERD have mild symptoms, with no visible evidence of tissue damage and little risk of developing complications.
Periodic heartburn is a symptom that many people experience. If it occurs occasionally just after a meal and less than once per week, it is likely a “benign” condition. However heartburn that occurs more frequently than once a week, becomes more severe, or occurs at night and wakes a person from sleep, may be a sign of a more serious condition and consultation with a physician is advised. Even occasional heartburn – if it has occurred for a period of 5 years or more, or is associated with difficulty in swallowing– may signal a more serious condition. People with long standing chronic heartburn are at greater risk for complications including stricture or a potentially pre-cancerous disease that involves a cellular change in the esophagus called Barrett’s esophagus.
Persistent chronic heartburn and acid regurgitation are the most common symptom of GERD. But there are numerous less common symptoms that also may be associated with GERD. These may include:
- Difficulty or pain when swallowing
- Water brash (sudden excess of saliva)
- Dysphagia (the sensation of food sticking in the esophagus)
- Chronic sore throat
- Inflammation of the gums
- Erosion of the enamel of the teeth
- Chronic irritation in the throat
- Hoarseness in the morning
- A sour taste
- Bad breath
Chest pain may also indicate acid reflux. Nevertheless, this kind of pain or discomfort should prompt urgent medical evaluation in order to exclude possible heart conditions. Relief of symptoms after a two-week trial therapy with a proton pump inhibitor (a prescription medication that inhibits gastric acid secretion) is an indication that GERD is the cause. This can also be confirmed with pH monitoring, which measures the level of acid refluxing into the esophagus and as high as the larynx.
On the positive side, since GERD is a lifestyle disorder, making significant changes in your lifestyle and eating habits can greatly reduce the impact of GERD or even prevent its onset to begin with. Here are 10 tips you can try to prevent GERD.
- Lose weight. Obesity is the leading cause of GERD because the extra stomach fat places pressure on your abdomen, pushing gastric juices up into your esophagus.
- Avoid foods known to cause reflux.If you’re at risk for GERD, avoid:
- Fatty foods
- Spicy foods
- Acidic foods, like tomatoes and citrus
- Coffee or any caffeinated beverage
- Carbonated beverages
- Eat smaller meals.Large meals fill the stomach and put pressure on the LES, making reflux and GERD more likely.
- Don’t lie down after eating.Wait at least three hours before you lie down after a meal. Gravity normally helps keep acid reflux from developing. When you eat a meal and then stretch out for a nap, you’re taking gravity out of the equation. As a result, acid more easily presses against the LES and flows into the esophagus.
- Elevate your bed.Raising the head of your bed six to eight inches can help gravity keep gastric acid down in your stomach. You could also use a wedge-shaped support. Don’t use extra pillows, as they only raise your head and will not help with GERD. You need your entire upper body elevated to get relief.
- Review your medications.There are a number of medications that can increase your risk of GERD, either by relaxing the LES, interfering with the digestive process, or further irritating an already inflamed esophagus. These medications include:
- Non-steroidal anti-inflammatory drugs, or NSAIDs
- Calcium channel blockers (often used to treat high blood pressure)
- Certain asthma medications, including beta-agonists like albuterol
- Anticholinergics, medications used to treat conditions such as seasonal allergies and glaucoma
- Bisphosphonates, used to boost bone density
- Sedatives and painkillers
- Some antibiotics
- Iron tablets
If you are taking any of these medications, talk to your doctor about switching to another drug that does not have the same effect on the upper digestive tract. However, never stop taking a prescribed medication without first consulting your doctor.
- Quit smoking.Some studies have found that nicotine can relax the muscles of the LES and can also interfere with your saliva’s ability to clear acid out of the esophagus.
- Cut back on alcohol.As with smoking, alcohol can cause the LES to relax. Alcohol can also cause the esophageal muscles to spasm.
- Wear loose-fitting clothes.Do not wear tight clothing or belts that can constrict your stomach.
In the UAE itself, there has been a rise in the incidents of patients suffering from some degree of GERD. Specialists at Aster Hospital and Clinic often receive 2 to 3 patients a day with GERD. In the last 1.8 years, they have treated around 320 patients with the condition. Aster Hospital and Clinic has initiated a “GERD Awareness Campaign” to educate the residents of UAE on alarming symptoms or critical symptoms associated with the disease which, if noted, should prompt medical attention. Through dedicated programmes for the general population, Aster aims to encourage early diagnosis and proper treatment in order to improve the quality of life of people suffering from the condition.
Dr. Sabu Antony
Aster Clinic, Bur Dubai (AJMC)