By Jacquie Eubanks BSN, RN
Gastro esophageal reflux disease, commonly known as GERD, is characterized by regular episodes of acid reflux, the backward flow of stomach acid into the esophagus. The primary cause is a faulty valve, known as the lower esophageal sphincter (LES), located between the stomach and the esophagus. When the LES muscle does not function properly, digestive acids and foods can be regurgitated and tasted at the back of the mouth and throat. If stomach acid comes in contact with the esophagus, it can cause a burning sensation in the chest or throat called heartburn or acid indigestion. While millions of Americans report experiencing acid reflux at least once per month, for most, it is just a mild annoyance. GERD, however, is a persistent reflux that occurs more than twice per week that can lead to serious health problems.
The sensitive lining of the esophagus can be injured when stomach acids continually back up. This injury, called esophagitis, is a painful inflammation. Esophagitis can cause ulcers and bleeding that can pass into the digestive tract. Long term acid exposure can cause Barrett's esophagus, a condition where new abnormal cells form to replace damaged cells. This can potentially lead to esophageal cancer. Over time, damage to the esophagus can lead to scarring which can narrow the passage ways and make swallowing difficult. GERD has also been linked to respiratory illnesses such as asthma, emphysema, recurrent pneumonia and chronic bronchitis. Conditions that can cause acid reflux include hiatal hernia, obesity, pregnancy and alcohol abuse.
Common symptoms experienced with GERD are:
- Feeling that food is stuck behind the breastbone
- Heartburn, made worse by eating or lying down
- Nausea after eating
- Regurgitation
- Hoarseness or sore throat
- Dry cough or trouble swallowing
- Antihistamines
- Nitrates
- Calcium Channel Blockers
- Bronchodilators
- Sedatives
- Tricyclic Antidepressants
- Aspirin and Ibuprofen
- Parkinson's Medications
- Beta Blockers
- Overeating
- Smoking
- Inactivity
- Dining too close to bedtime
- Eating foods known to aggravate heartburn symptoms
- Exercising too soon after eating
- Excessive use of alcohol
- Avoid late night eating. Give your stomach a chance to digest and empty before lying down. Try to wait at least 3 hours after a meal before going to bed. Raise the head of the bed by using 6 - 8 inch blocks under the bedposts. Attempting to elevate your head with pillows puts more pressure on the abdomen making heartburn worse. Sleeping on your left side, rather than your back, aids digestion and can help minimize reflux.
- Reduce portion size. Large meals and a full stomach can overwhelm the stomach and the esophageal sphincter. Eating smaller meals more often can help.
- Avoid foods that trigger symptoms. Caffeinated beverages, alcohol, chocolate, peppermint, citrus fruits, fried and fatty foods, spicy foods, and foods with high acidity such as tomatoes and onions are all considered problematic.
- Don't exercise on a full stomach. Exercises such as ab crunches increase abdominal pressure. Headstands and other yoga inversions can reverse the natural flow of stomach juices. Bouncing exercises, such as jogging or aerobics, jostle the contents of your stomach and can cause acid to rise up into the esophagus. Wait at least 2 hours after eating to begin your exercise routine.
- Chew sugarless gum. Chewing gum increases saliva production which has alkaline properties that help neutralize acid.
- Wear loose clothing and belts. Tight clothing can contribute to acid reflux by putting pressure on the abdomen.
- Don't lie down after meals. Standing up straight not only improves your posture, it allows food to remain in the stomach. Gravity helps to keep stomach juices from backing up and assists the flow of food and digestive juices from the stomach to the intestines.
- Stop smoking. One more reason to quit, nicotine relaxes and can weaken the LES, allowing stomach acid to enter the esophagus. Cigarette smoking slows the production of saliva, one of the body's best defenses against damage to the esophagus. Smoking stimulates stomach acid production and promotes the movement of bile salts from the intestines to the stomach which makes stomach acids more harmful. Smoking slows digestion, thereby increasing the amount of time food stays in the stomach.
- Lose weight. Overweight people with a high body mass index (BMI) have more severe GERD. Obesity increases abdominal pressure which can push stomach contents up into the esophagus. As little as a 10% weight decrease can improve symptoms.
- Drink less alcohol. Alcohol increases the production of stomach acid and makes the esophagus more sensitive to the acid. To minimize alcohol's affect on the digestive system, drink moderately, opt for white rather than red wine and dilute beverages with water or club soda.
- Stress aggravates heartburn. Try to find ways to alleviate stress by getting enough sleep, eating balanced meals, and taking mental breaks to help you relax.
- Herbal supplements such as licorice root, slippery elm and turmeric may offer protection by creating a coating that lines the esophagus.
