Gastroesophageal reflux disease (GERD) is a chronic digestive disorder that occurs when acidic stomach juices, or food and fluids, back up from the stomach into the esophagus. GERD affects people of all ages—from infants to older adults. The leading cause of GERD stems from a dysfunction of the lower esophageal sphincter (LES), a muscle ring separating the stomach and the esophagus.
When this sphincter doesn't close properly, the stomach's contents can leak back into the esophagus, causing symptoms like heartburn, regurgitation, and discomfort in the chest. Various factors can contribute to weakening the LES, including obesity, smoking, certain medications, and consumption of trigger foods like high-fat foods and alcohol.
The associated signs and symptoms of GERD
The associated signs and symptoms of GERD can vary in intensity and frequency, and they often worsen after meals or during the night. The most common symptom is heartburn, an uncomfortable burning sensation behind the breastbone that may rise to the throat and often worsens when lying down or bending over.
Other symptoms may include regurgitation of food or sour liquid, difficulty swallowing, chronic cough, laryngitis, new or worsening asthma, and disrupted sleep. Although less common, some people with GERD may experience nausea, chest pain, dental erosion, or bad breath. It's essential to consult a healthcare provider if you experience persistent symptoms of GERD, as long-term, untreated GERD can lead to more severe complications such as esophageal ulcers or Barrett's esophagus.
How to diagnose GERD
GERD is primarily diagnosed based on the presence of characteristic symptoms the patient describes. However, a more definitive diagnosis might require further investigations to rule out other potential causes of the symptoms, assess the severity of the disease, or detect any complications. These include:
- Upper endoscopy: A doctor might use a unique tube with a camera to look inside your stomach and esophagus. This procedure can detect inflammation, ulcers, or other complications.
- pH monitoring: This test measures the acidity in your esophagus via a tube placed through the nose into the esophagus or via a small capsule attached to the esophagus during an endoscopy. It's usually done over 24 hours.
- Esophageal manometry: This test measures the rhythm and force of esophageal contractions and the coordination and force exerted by the esophagus muscles.
- Barium swallow (esophagram): This involves swallowing a barium solution that coats the lining of the esophagus, allowing it to be visible on an X-ray. This can help identify any abnormalities in the esophagus.
- Biopsy: A biopsy can be performed during an endoscopy to check tissue samples under a microscope for infection or abnormalities.
It's important to remember that a diagnosis of GERD should be made by a healthcare provider based on a thorough evaluation of your symptoms and medical history. If you are experiencing persistent heartburn or other GERD symptoms, seeking professional medical advice is vital.
Treatment options for managing GERD symptoms
The treatment of GERD primarily involves a combination of lifestyle modifications, medication, and, in some cases, surgery.
1. Lifestyle modifications: These can significantly alleviate GERD symptoms. They include maintaining healthy body weight, avoiding trigger foods and drinks (such as fatty or fried foods, coffee, alcohol, chocolate, and mint), eating smaller meals, not lying down for at least two hours after eating, and elevating the head of the bed.
2. Medications: Over-the-counter medications are the first line of treatment. These include antacids (which neutralize stomach acid), H-2-receptor blockers (which reduce acid production), and proton pump inhibitors (which block acid production and heal the esophagus). If these do not provide sufficient relief, your doctor may prescribe more substantial doses of these drugs or other medications.
3. Surgery and other procedures: If lifestyle changes and medications do not effectively manage GERD symptoms or want to avoid long-term medication use, surgical and other procedures may be considered. These options include fundoplication (surgery to create a new valve at the top of the stomach to prevent acid reflux) or a LINX device (a ring of tiny magnetic beads that is wrapped around the junction of the stomach and esophagus to keep the stomach acid from refluxing).
Everyone is unique, and what works for one person may not work for another. Working closely with your healthcare provider to design a treatment plan best suited to your symptoms and lifestyle is crucial.
Nutrition tips to help manage GERD symptoms
Proper nutrition plays a significant role in managing GERD symptoms. Here are some tips that can guide your dietary choices:
1. Limit Trigger Foods: Certain foods and drinks can trigger GERD symptoms by relaxing the lower esophageal sphincter, increasing stomach acid, or causing bloating that increases pressure on the sphincter. Common culprits include citrus fruits, tomatoes, onions, spicy foods, peppermint, chocolate, fatty or fried foods, caffeinated or carbonated beverages, and alcohol. Try to identify your triggers and limit or avoid them.
2. Eat Smaller, Frequent Meals: Larger meals can cause the stomach to secrete more acid. Instead of three large meals, try eating five or six smaller ones daily to reduce GERD symptoms.
3. Don't Skip Breakfast: A good breakfast can help control your hunger and reduce the urge to overeat later in the day, which can worsen GERD symptoms.
4. Stay Hydrated: Drink plenty of water throughout the day, but avoid drinking large quantities at meal times, as this can dilute stomach acid and trigger heartburn.
5. Choose Lean Proteins: Lean proteins like chicken, turkey, fish, and eggs are less likely to trigger GERD symptoms than higher-fat proteins.
6. Include Fiber-rich Foods: Foods rich in dietary fiber, like whole grains, fruits, vegetables, and legumes, can help control your weight and reduce GERD symptoms.
7. Avoid Late Night Eating: Try to finish eating at least 2-3 hours before bed to give your stomach time to empty before you lie down.
Remember that what works best can vary from person to person, so monitoring your symptoms and adjusting your diet is critical. I would also like to point out that working with a registered dietitian or nutritionist who can help you devise a personalized meal plan that addresses your unique dietary needs and preferences is also important. At Needham Gastroenterology Associates, we pride ourselves on being experts who can help you if you think you are struggling with GERD or looking for a plan to treat it. Our experienced physicians are here to answer questions or provide treatment if needed – schedule an appointment.