Gastroesophageal reflux disease (Acid reflux)

Several factors can increase the likelihood of developing GERD, including:

1. Aging

As people age, the lower esophageal sphincter (LES) may lose its strength, making acid reflux more likely.

2. Dietary Habits

Certain eating patterns elevate GERD risk, such as:

• Consuming spicy, fried, or acidic foods, particularly before bedtime (e.g., citrus juices, tomatoes, chocolate, coffee, tea, and carbonated drinks).
• Irregular meal schedules.
• Eating large meals in one sitting.
• Eating close to bedtime.

3. Alcohol Consumption

Excessive alcohol intake weakens the stomach’s protective lining, contributing to acid reflux.

4. Lack of Physical Activity

A sedentary lifestyle is associated with a higher risk of GERD.

5. Physical Activity After Meals

Engaging in intense exercise, such as running or weightlifting, immediately after eating can promote acid reflux.

6. Obesity

Excess weight increases intra-abdominal pressure, slows stomach emptying, and reduces LES function, all of which contribute to GERD. Research also indicates that central obesity (measured by waist-to-hip ratio) heightens the risk of complications.

7. Stress

Heightened stress levels can trigger excessive stomach acid production, worsening reflux symptoms.

8. Hiatal Hernia

A condition where part of the stomach pushes through the diaphragm into the chest cavity, increasing susceptibility to GERD and its complications.

9. Connective Tissue Disorders

Conditions like rheumatoid arthritis (RA) and scleroderma can elevate GERD risk.

10. Certain Medications

Some medications are associated with GERD development, including:

• Benzodiazepines
• Calcium Channel Blockers (used for hypertension)
• Asthma Medications
• Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
• Antidepressants

11. Pregnancy

Hormonal fluctuations during pregnancy often lead to gastric reflux, making GERD a common issue among expectant mothers.

GERD is primarily diagnosed based on symptoms and medical history. However, several tests can help confirm the condition:

1. Esophageal pH Monitoring

This test measures acidity in the esophagus, which is normally non-acidic. A low pH indicates acid reflux and confirms GERD. It is the most precise diagnostic tool and is also used to monitor treatment effectiveness.

2. Esophageal Impedance Test

This method detects the backflow of stomach contents into the esophagus. A thin tube is inserted through the nose into the stomach, and acid reflux activity is monitored via a connected computer. The device remains in place for 24 hours to track reflux patterns during different activities, such as eating, drinking, and sleeping.

3. Upper Gastrointestinal (GI) Endoscopy

A flexible tube equipped with a camera (endoscope) is inserted through the mouth to examine the esophagus, stomach, and duodenum. This test helps identify damage caused by acid reflux.

4. Upper GI X-ray

This imaging technique captures detailed pictures of the esophagus and stomach. It helps detect issues like ulcers, reflux, hiatal hernia, narrowing of the GI tract, and obstructions.

5. Biopsy

During an endoscopy, small tissue samples from the esophagus may be collected for microscopic examination. This test is primarily performed to identify GERD-related complications, such as Barrett’s esophagus or other abnormalities.

1. Maintain a Healthy Weight

Being overweight is a key factor in GERD development. Keeping a balanced weight helps reduce the likelihood of acid reflux.

2. Eat Smaller, More Frequent Meals

Consuming smaller portions throughout the day instead of large meals can help minimize acid reflux episodes.

3. Avoid Eating Late at Night

Late-night snacking or consuming heavy meals close to bedtime increases the risk of heartburn. To prevent this, avoid eating right before sleeping.

4. Reduce Intake of Spicy and Fried Foods

Regular consumption of spicy and deep-fried foods triggers excessive stomach acid production. Limiting these foods can lower the chances of reflux.

5. Refrain from Strenuous Activity After Eating

Engaging in intense physical activities, such as heavy exercise or bending, immediately after a meal can contribute to acid buildup in the esophagus. It’s advisable to wait before engaging in physical exertion.

When to See a Doctor

Mild GERD symptoms often improve with lifestyle changes or over-the-counter treatments. However, medical attention is necessary if symptoms persist for over a week or if additional complications arise, such as:

• Heartburn that does not improve with OTC medications
• Sleep disturbances caused by nighttime acid reflux
• Unexplained weight loss
• Chronic wheezing or hoarseness

Specialists to Consult

• General Physician – Initial evaluation and treatment
• Internal Medicine Specialist – Comprehensive care for complex cases
• Gastroenterologist – Specialized treatment of digestive disorders
• Gastrointestinal Surgeon – Surgical intervention for severe GERD
• Pediatrician – Management of GERD in children

The primary treatment strategy focuses on controlling symptoms and preventing complications. Lifestyle modifications serve as the first line of treatment. For individuals who do not respond adequately to dietary and behavioral changes, medical intervention is recommended.

I. Medications

1. Antacids

Antacids work by neutralizing stomach acid to relieve heartburn. These are available in chewable or liquid forms and include:

• Magnesium carbonate
• Magnesium trisilicate
• Calcium carbonate
• Sodium bicarbonate

2. H2 Receptor Antagonists (H2 Blockers)

These medications reduce acid secretion and are often taken at bedtime for individuals experiencing nighttime reflux. Examples include:

• Famotidine
• Cimetidine

3. Proton Pump Inhibitors (PPIs)

PPIs decrease acid production and aid in healing esophageal damage. They are suitable for long-term GERD management. Common PPIs include:

• Omeprazole
• Lansoprazole
• Esomeprazole
• Pantoprazole
• Rabeprazole

4. Prokinetic Agents

These medications improve digestive motility, helping reduce reflux symptoms. Examples include:

• Metoclopramide
• Domperidone

II. Endoluminal Therapy

This procedure involves applying radiofrequency energy to the lower esophageal sphincter (LES), creating a physical barrier to prevent acid reflux.

III. Surgical Treatments

Surgery may be necessary in the following cases:

• Severe GERD that does not improve with treatment
• Inability to adhere to long-term medication use
• Presence of a large hiatal hernia

1. Fundoplication

A widely performed procedure in which the upper part of the stomach is wrapped around the lower esophagus to strengthen the LES, preventing acid reflux.

2. Bariatric Surgery

Recommended for individuals with severe GERD and obesity. This procedure modifies the digestive system to promote weight loss and reduce reflux. Common types include:

• Roux-en-Y Gastric Bypass (RYGB)
• Laparoscopic Adjustable Gastric Banded Plication (LAGP)
• Sleeve Gastrectomy

If GERD is left untreated for an extended period, it may result in serious complications, including:

• Esophagitis – Inflammation of the esophagus
• Esophageal Stricture – Narrowing of the esophagus due to scar tissue
• Breathing Difficulties – Caused by acid reaching the airways
• Barrett’s Esophagus – A condition where intestinal-like tissue replaces the esophageal lining
• Esophageal Cancer – Long-term GERD may increase the risk of esophageal cancer

1. Yoga

Certain yoga poses may help alleviate acidity and promote digestive health, including:

• Pawanmuktasana
• Vajrasana
• Virabhadrasana
• Shashankasana
• Trikonasana

2. Acupuncture

This ancient Chinese practice involves inserting fine needles into specific points on the body, stimulating sensory nerves and providing symptom relief.

1. Milk

Low-fat milk can help soothe heartburn by neutralizing stomach acid. However, whole milk should be avoided as it may aggravate acid reflux.

2. Ginger (Adrak)

Ginger’s anti-inflammatory properties make it an effective remedy for heartburn. Drinking ginger-infused water by boiling a few slices can provide relief.

3. Baking Soda

Baking soda acts as an acid neutralizer. Dissolving a teaspoon in a cup of water can help alleviate acidity.

4. Basil Leaves (Tulsi)

Basil leaves help soothe the stomach lining and relieve heartburn. A tea made by boiling two or three basil leaves in water can be beneficial.

5. Coconut Water

Coconut water is high in fiber and provides a protective effect on the stomach lining. Drinking two glasses daily may help manage heartburn.

6. Mint (Pudina)

Mint has natural cooling properties that can help ease acid reflux symptoms. Mint leaves can be boiled in water to prepare a soothing drink.

7. Aloe Vera

Aloe vera has anti-inflammatory effects. Mixing pure aloe vera juice with water and consuming it two to three times a day may help reduce symptoms.

8. Watermelon

Due to its alkaline nature, watermelon juice can naturally relieve heartburn.

9. Banana

Bananas are low-acid fruits that provide a protective coating for the esophageal lining, helping to prevent irritation from stomach acid.

Lifestyle changes play a crucial role in controlling symptoms and promoting healing.

1. Dietary Recommendations

Foods to Eat

Including the following foods in your diet may help prevent acid reflux:

• Whole grains – Oatmeal, brown rice
• Root vegetables – Carrots, sweet potatoes, beets
• Green vegetables – Broccoli, asparagus, green beans
• Hydrating foods – Cucumber, celery, watermelon, broth-based soups, herbal tea

Foods to Avoid

Certain foods can trigger acid reflux and should be consumed in moderation or avoided altogether:

• Tomatoes
• Onions
• Garlic
• Tea and coffee
• Carbonated drinks
• Fried and spicy foods

Since eliminating these foods entirely may not be feasible for everyone, moderation is recommended.

2. Maintain Regular Meal Timings

Eating at irregular times can disrupt the body’s acid production, leading to reflux. Adhering to a consistent meal schedule can help manage symptoms.

3. Avoid Eating Before Bedtime

It is advisable to have dinner at least three hours before sleeping to minimize nighttime reflux episodes.

4. Reduce Meal Size

Overeating puts pressure on the lower esophageal sphincter (LES), increasing the risk of acid reflux. Eating smaller portions can help prevent this.

5. Stay Upright After Eating

Gravity helps keep stomach acid in place. Lying down immediately after eating can worsen reflux, so it’s best to remain upright for at least two to three hours post-meal.

6. Practice Good Sleep Hygiene

Poor sleep habits can exacerbate GERD. Maintaining a regular sleep routine can help reduce heartburn episodes.

7. Elevate Your Head While Sleeping

Raising the head by six to eight inches while sleeping can prevent acid from traveling up the esophagus. This can be achieved using extra pillows or an adjustable bed.

8. Quit Smoking

Nicotine weakens the LES and stimulates acid production, worsening GERD symptoms. Quitting smoking can significantly reduce acid reflux.

9. Limit Alcohol Consumption

Alcohol can erode the stomach’s protective lining, increasing acid reflux. Studies suggest that reducing alcohol intake can lead to noticeable symptom improvement.

10. Maintain a Healthy Weight

Being overweight puts pressure on the stomach, increasing the likelihood of acid reflux. Weight loss is strongly recommended for individuals with obesity-related GERD.

11. Be Cautious with Medications

Certain medications may worsen GERD. Consulting a healthcare provider before taking over-the-counter drugs is advisable.