In this article:
GERD is a long-term digestive disorder characterized by the frequent backflow of acidic stomach contents into the esophagus, a hollow tube that connects the throat to the stomach.
When you swallow food, the muscular walls of the esophagus or food pipe contract rhythmically to push the food down the throat and into the stomach.
The bottom of the esophagus where it meets the stomach is affixed with a circular, muscular ring known as the lower esophageal sphincter (LES). The LES serves as a valve between the esophagus and the stomach. It remains tightly shut at all times, except to allow the passage of swallowed food into the stomach.
The closing of the LES muscles is important to keep the stomach contents from traveling backward into the food pipe.
How does GERD occur?
GERD occurs when the sphincter muscles become weak or are unable to close properly. This malfunction allows the reflux of stomach acids and digestive juices from the stomach into the esophagus.
The stomach lining is tough enough to resist the erosive action of the stomach acids, but the esophagus has no such protective shield. Thus, when the gastric acids back up into the food pipe, they can cause irritation or inflammation of the esophageal tissue.
It is normal to experience a minimal degree of acid reflux after overeating or eating on an already full stomach.
However, the condition can be quite debilitating if it becomes a regular occurrence and a substantial amount of stomach acids and digestive juices leak back into the esophagus.
GERD is unlikely to cause any visible damage to the esophagus (no ulcers or precancerous lesions). Still, it can be a constant discomfort that can severely hamper your day-to-day life.
Nearly 20% of all adults suffer from acid reflux on almost a weekly basis.
How long does it take for the symptoms of GERD to subside?
Most of the people who experience GERD-like symptoms take over-the-counter medications such as TUMS, Pepcid, Zantac (recalled now due to contamination with a potential carcinogen), and Prilosec.
Typically, symptomatic relief happens within minutes, but to achieve significant improvement, acid reduction therapies (H2 blockers (H2Bs) or proton pump inhibitors (PPIs)) are better. A trial of 2 weeks with H2Bs or PPIs is sufficient to control symptoms in most patients.
However, some may need a longer duration of treatment if symptoms recur/persist or occur with other conditions (hiatal hernia, obesity, delayed gastric emptying, esophageal motility disorders, decreased salivary secretion, etc.) that may continue to worsen acid reflux or its symptoms.
Also, it is important to understand that not all heartburn is from GERD. Several functional gastrointestinal disorders exhibit symptoms that are similar to GERD.
In the right clinical setting, a burning chest discomfort could be an atypical presentation of underlying heart disease and may need a thorough evaluation by your doctor before attributing the symptoms to GERD.
Are there any preventive measures to avoid complications when dealing with GERD ?
Here are some self-care measures that may help reduce the incidence and severity of GERD symptoms:
- Maintain a gap of at least 2-3 hours between your last meal and bedtime.
- Sleeping with your head in a raised position may help keep your food down due to the simple force of gravity. To that end, you can either prop a few extra pillows under your head or elevate the head end of your bed by a 20–30 degree angle.
- Follow an antireflux diet, which is designed following the Gastroesophageal Reflux Disease Handout.
- Consume 4-5 fist-sized meals daily.
- Avoid eating within 4 hours and drinking, even water, within 2 hours of lying down.
- Do not rush through your meals. Take small bites and chew them well, instead of gulping them down.
- Patients with a high BMI (above 25) and abdominal obesity are recommended to lose at least 5-7% of their body weight.
- If you have a history of delayed gastric emptying, eating small, frequent, low-fat meals may help.
- People with diabetes should effectively regulate their blood sugar levels through the necessary dietary control and appropriate lifestyle choices.
- Avoiding foods high in fermentable carbohydrates (high FODMAPs) may help with bloating symptoms, especially in patients who have coexisting functional abdominal disorders.
Controlling long-term GERD is important as unchecked GERD increases the risk of strictures (narrowing) in the esophagus, Barrett’s (precancerous condition) esophagus, and esophageal cancer.
Another important concern is the decreased quality of life with constant symptoms. Prompt referral to a specialist is recommended if any alarming symptoms (swallowing difficulty, weight loss, gastrointestinal bleeding) are noted.
What are the dietary recommendations that one should follow when suffering from GERD?
The following dietary tips can help in the management of GERD symptoms:
- Minimizing the intake of acidic foods may give relief from GERD symptoms, but no scientific data are available to support that they actually cause increased reflux.
- Eating low-fat, fist-sized meals at regular intervals may help, especially if you are diagnosed with gastroparesis and suffer from underlying gastric emptying issues.
- People with diabetes must exercise strict glucose control.
- Avoid fatty foods as they can cause delayed gastric emptying.
- Delay going to bed for at least 2-3 hours after having your last meal or snack of the day.
- Regularize your daily meal patterns.
- Frequent snacking should be avoided as it can stimulate the gastric acid secretion and, thereby, reflux-related symptoms in patients with GERD.
Can spicy foods aggravate the symptoms of GERD?
Spicy foods may appear to trigger the symptoms of GERD. However, this is not backed by scientific evidence.
Several patients who think that they have GERD may have other functional abdominal disorders (epigastric pain syndrome, functional heartburn, post-prandial distress syndrome, irritable bowel syndrome, etc.) that seem to overlap with GERD and may actually worsen an existing GERD.
Does physical activity or exercise worsen GERD?
Physical activity or exercise is unlikely to worsen GERD. In fact, tailored activity to help weight loss may improve overall symptoms.
People who have structural issues such as a large hiatal hernia may experience increased reflux when they bend over. In such situations, surgical repair of the hernia may help.
Will having herbal tea and ginger tea help relieve the symptoms of GERD?
Ginger has been studied and is known to subside GERD symptoms as it helps digest food and stimulate other digestive enzymes. Herbal tea may have other health benefits but it does not directly impact GERD symptoms.
Some other familiar supplements such as peppermint may seem to help by improving IBS symptoms, which may coexist with GERD.
Can probiotics help in the treatment of GERD?
Probiotics have been widely recommended for various gastrointestinal issues by several health entities. To date, no data from a good-quality randomized trial exist to support their effectiveness directly in the case of GERD.
Their perceived effectiveness could be from the placebo effect; in reality, they do not alter acid reflux. The unchecked use of probiotics in the community may be due to their almost negligible side effect profile.
Can GERD be cured permanently?
Reflux of gastric contents into the esophagus happens several times a day in many individuals even though they do not experience the typical heartburn/GERD symptoms.
Most of these small/transient reflux events are cleared and neutralized by the peristaltic activity of the esophagus and swallowed saliva.
GERD is not a disease where specific treatment will cure it. GERD can be controlled but not cured even in patients who undergo antireflux surgeries (Nissen fundoplication, LINX, etc.).
The landmark study LOTUS trial found that there is no difference in the overall outcomes in patients who took PPIs versus patients who underwent antireflux surgery at the end of 5 years. (1)
Also, studies have noted that a significant number of patients who undergo antireflux surgery eventually ended up using long-term PPIs.
Therefore, the role of therapies is only to minimize acid reflux and help heal any erosive damages in the esophagus, thereby decreasing the symptoms and improving the overall quality of life.
The responsibility lies on the patient to follow long-term antireflux measures, such as:
- Have your dinner at least 2 hours before bedtime.
- Sleep with the head end of the bed elevated to a 20 to 30-degree angle.
- Maintain a healthy weight.
- Avoid snacking at bedtime.
- Limit your consumption of cheese, wine, and decaffeinated drinks.