Gastro Esophageal Reflux Disease (GERD)

Gastro Esophageal reflux disease, commonly referred to as GERD or acid reflux, is a condition in which the liquid content of the stomach regurgitates (backs up or refluxes) into the esophagus. The liquid can inflame and damage the lining (cause esophagitis) of the esophagus although visible signs of inflammation occur in a minority of patients. The regurgitated liquid usually contains acid and pepsin that are produced by the stomach. (Pepsin is an enzyme that begins the digestion of proteins in the stomach.) The refluxed liquid also may contain bile that has backed-up into the stomach from the duodenum. (The duodenum is the first part of the small intestine that attaches to the stomach.) Acid is believed to be the liquid. Pepsin and bile also may injure the esophagus, but their role in the production of esophageal inflammation and damage is not as clear as the role of acid.
GERD is a chronic condition. Once it begins, it usually lasts for a longer time. If there is injury to the lining of the esophagus (esophagitis), this also is a chronic condition. Moreover, after the esophagus has healed with treatment
Gastro esophageal reflux disease or GERD is a very common disorder and occurs when stomach acid refluxes into the lower esophagus through the lower esophageal sphincter (LES). The LES is a band of muscles that act as a protective barrier against reflux material by contracting and relaxing. If this barrier is relaxed at inappropriate times or otherwise compromised, reflux occurs. Chronic or reoccurring reflux allows prolonged contact of stomach contents with the lower esophagus, leading to the symptoms of GERD.

In general, there are four underlying conditions that are associated with GERD:

1.) Decreased lower esophageal sphincter pressure.
2.) Irritation of the lining of the esophagus by the stomach contents.
3.) Abnormal clearance of esophageal acid.
4.) Delayed stomach emptying.

What are the Treatment options of GERD?

There are four goals in the treatment of the GERD – these are

1.) Reduction of the symptoms or pain or heart burn
2.) Healing of the erosion or esophagitis
3.) Management and/ or prevention of complications
4.) Maintenance of the relief stage for a long period.

What are the Diet modifications recommended for relief from heart burn or acid reflux?

Dietary modifications are recommended to lessen the likelihood of reflux and to avoid irritation of sensitive or inflamed esophageal tissue. Listed below are several recommendations that may help to manage GERD:

Decrease total fat intake – High-fat meals and fried foods tend to decrease LES pressure and delay stomach emptying thereby increasing the risk of reflux.

Avoid large meals – Large meals increase the likelihood of increased gastric (stomach) pressure and reflux.

Decrease total caloric intake if weight loss is desired – Since obesity may promote reflux, weight loss may be suggested by your healthcare provider to control reflux. Reducing both total fat and caloric intake will aid in weight loss.

Avoid chocolate – Chocolate contains methylxanthine, which has been shown to reduce LES pressure by causing relaxation of smooth muscle.

Avoid coffee depending on individual tolerance – Coffee, with or without caffeine, may promote gastro esophageal reflux. Coffee may be consumed if it is well tolerated.

Avoid other known irritants – Alcohol, mint, carbonated beverages, citrus juices, and tomato products all may aggravate GERD. These products may be consumed depending on individual tolerance.

What are the habit modifications for treatment of reflux acidity or heart burn?

These are as follows:
• Maintain upright posture during and after eating.
• Stop smoking.
• Avoid clothing that is tight in the abdominal area.
• Avoid eating within 3 hours before bedtime.
• Lose weight if you are overweight.
• Sleep on your left side. This produces less esophageal acid exposure than lying on the right.
• Chew non-mint gum which will increase saliva production and decrease acid in the esophagus.
• Elevate the head of your bed 4-6 inches by placing bricks under the headboard. Instead, 6 to 7 Pillows can be used to raise the head end of the patient during sleep. Hospital beds where the head end of the bed can be raised can also be used to a great relief to the patient.