In this article:
- The gastric acid produced by the stomach may move up into the esophagus and cause irritation. This movement is known as acid reflux.
- Gastroesophageal reflux disease (GERD) is a disorder of the digestive system characterized by frequent occurrences of acid reflux.
- Acid reflux may happen due to different lifestyle choices, eating preferences, or medical disorders.
- Several medical therapies, surgical procedures, and home remedies are available for the treatment of acid reflux.
- Changes in lifestyle and diet can help in managing GERD/acid reflux.
- Pregnant women and babies are more susceptible to GERD.
Acid reflux is the backflow of gastric acid from the stomach to the esophagus. The acid causes a burning sensation in the chest, called heartburn.
The esophagus, or the food pipe, is a tube that links the mouth and the stomach. Ingested food goes down this tube through the peristaltic action (involuntary wave-like contractions) of the esophageal muscles.
A valve known as the lower esophageal sphincter (LES) is present at the narrower end of the esophagus, where the esophagus meets the stomach.
The LES only opens when food content has to be deposited into the stomach. The closed position of the valve prevents the backflow of the stomach contents into the esophagus.
The functioning of the sphincter muscles may be compromised due to various causes. When this happens, the valve is unable to prevent the stomach contents from leaking into the esophagus, resulting in acid reflux.
Gastroesophageal reflux disease (GERD) is a chronic problem in which acid reflux happens several times a week. It can occur in individuals of any age and should be treated timely. Untreated cases are associated with health complications, which often require surgery.
Causes of GERD
A faulty lower esophageal sphincter (LES) is the most common reason for acid reflux and GERD. Other reasons that may contribute to the development of GERD include:
- Acid content: An increase in the amount of acid in the stomach can cause GERD. This increase may be due to an overproduction of acid by the stomach or improper emptying of bile juice and acid. Suboptimal levels of acid may also contribute to GERD. (1)
- Diet: Consumption of foods that contain a lot of citrus, fat, or spices can induce acid reflux. Caffeine and chocolate intake may also increase the chances of GERD. An empty stomach for prolonged periods also causes acid reflux.
- Lifestyle: Consumption of a large amount of food at once or eating food right before sleeping can elevate the risk of GERD. Alcohol consumption and smoking can aggravate the problem. Wearing tight clothes can press the stomach and cause acid reflux.
- Hiatal hernia: The esophagus passes through the diaphragm, below which the stomach is present. The diaphragm and the LES are at the same level, which enables the diaphragm to assist in the closing of the LES.
In hiatal hernia, the hole in the diaphragm enlarges, through which the upper portion of the stomach moves into the chest cavity. This repositioning prevents the diaphragm from acting on the LES and impairs the functioning of the LES.
- Obesity: The excessive fat in obese individuals can put pressure on the stomach and may dislocate the LES. It can also put pressure on the valve, forcing it open and causing acid reflux.
- Medications: Acid reflux can be a side effect of the following medications:
- Anticholinergics for seasickness
- Bronchodilators for asthma
- Beta-blockers for heart diseases
- Dopamine drugs for Parkinson’s disease
- Sedatives for insomnia or anxiety
- Calcium-channel blockers for elevated blood pressure
- Tricyclics for depression
- Progestin for birth control
- Diseases: Studies show an association of GERD with diabetes and asthma. The complications of diabetes can impede the emptying of the stomach. This phenomenon is known as gastroparesis and can cause acid reflux. The relationship between asthma and GERD is not well established. (2)(3)
- Problems in the food pipe: In some cases, the food pipe may become extremely sensitive and fail to push down the acids back into the stomach.
Symptoms of GERD
Heartburn is the most prevalent symptom of GERD, and at times, you may feel the presence of acid in your throat. Different symptoms can be observed in varying age groups, along with classic symptoms.
- Bloating due to entrapment of gas in the gastrointestinal tract
- Chronic cough due to acid-induced irritation in the throat or esophagus (4)
- Dysphagia, or difficulty in swallowing, due to pain and a burning sensation in the esophagus
- Chest pain caused by esophageal spasms, which are due to the esophageal damage caused by the action of acid
- Nausea and regurgitation (the reflux of gastric juices and undigested food into the mouth)
- Shortness of breath and wheezing
- Hoarseness and other voice problems
- Lack of appetite
- Nausea and frequent vomiting
- Coughing fits and cold
- Gagging and choking
- Sore throat
- Bad breath
- Ear infections
- Tooth decay
Diagnosis of GERD
A GERD diagnosis can be made based on your symptoms and medical history. If you have typical symptoms, the doctor may recommend specific tests.
The following tests can confirm the diagnosis of GERD:
- Ambulatory acid (pH) probe test: A small tube containing a pH sensor is passed into the esophagus through the nose. The pH sensor sits at the level of the LES and reads the pH for 24 hours.
During acid reflux, the probe will sense an acidic pH and record it on a small computer attached to your waist. The collected data is used to diagnose GERD.
Another variation of this test involves the use of a wireless pH probe that can be attached to the inner wall of the esophagus. This probe measures the pH and transmits the data to a portable computer. The probe falls off in 2 days and passes in the stool.
- X-ray: This test involves swallowing a chalky-white barium liquid that coats the inner lining of your digestive tract. An X-ray is then taken. The barium absorbs X-rays and appears white on film, giving a clear picture of the insides of the esophagus.
The doctor uses the X-ray report to identify any structural anomalies in the gastrointestinal tract.
- Endoscopy: A thin tube is passed into the esophagus for this test. The tube has a small camera that enables the doctor to look inside the upper digestive tract. The doctor may also collect a sample for biopsy.
- Esophageal motility test (manometry): This test involves the insertion of a thin tube through your nose and into the esophagus to determine the pressure level inside it. It also measures the muscle movement of the esophagus. (5)
Clinical Treatment of GERD
Generally, GERD can be treated with medications. However, the management of GERD may require prolonged use of drugs as it is a chronic condition.
If drug therapy is unable to control GERD, surgical procedures may be required. At times, people who are reluctant to the idea of lifetime medications may opt for surgery. (6) Minor lifestyle changes may also help ease the problem.
1. Drug Therapy
Severe acid reflux needs drug therapy, which involves the use of acid-suppressing medications and prokinetic drugs (medications that enhance esophageal motility).
The following classes of over-the-counter medications can be used for the management of acid reflux:
- Antacids: These medications help in neutralizing the low pH of the stomach. Antacids can be used for rapid relief. However, their effect is only short-lived, and the acid production may increase when the antacids leave the stomach.
Such an increase is a response to hormonal and neural signals that are produced by low levels of acid.
- H2-Receptor Blockers: These medications work by reducing acid production for up to 12 hours. Drugs with a longer-lasting effect can be obtained with a prescription.
- Proton Pump Inhibitors: Like H2-receptor blockers, these medicines block the production of acid. They are stronger and also help in relieving throat damage.
2. Surgical Therapy
If medicines are unable to provide relief, surgery is advised. Complications such as pulmonary disease, growth failure, or esophagitis (damage in the esophagus due to acid exposure) can increase the need for surgery.
GERD is most commonly treated with an antireflux surgery known as fundoplication.
In this operation, part of the stomach (the fundus) is wrapped around the lower part of the esophagus. This can be done by making a large incision or several small incisions (laparoscopic surgery). The stomach may be attached to a feeding tube if necessary.
Self-Care Tips for Acid Reflux and GERD
Small changes in your diet and lifestyle may help in managing acid reflux and GERD. These include:
- Eating habits: Eating healthy foods and avoiding foods that may trigger acid reflux can help in relieving symptoms. Since GERD is associated with obesity, weight loss can help alleviate the problem.
It is advised to consume food in small meals at regular intervals, having only two to three meals where you consume a large amount of food at once increases the chances of acid reflux. Avoid lying down immediately after eating. Give at least 90 minutes before lying down after a meal.
- Avoid smoking and alcohol: The nicotine in tobacco relaxes the muscles of the LES and prevents the closing of the valve. This allows recurrent acid reflux and heartburn. Alcohol intake can aggravate the symptoms of GERD.
- Change your sleeping position: Acid reflux worsens on lying down since the gravitational forces cannot pull the acid downward anymore. Sleeping with your head raised 6 inches can prevent acid reflux. You can also incline your bed by raising its head side by placing blocks under the legs or a wedge below the mattress.
- Reduce pressure on the stomach: Do not wear tight-fitting clothes or lie down immediately after eating. Avoid using multiple pillows under your head as this can also increase the pressure on your stomach.
- Use baking soda: The alkaline property of baking soda can provide temporary relief from acid reflux. It works by neutralizing the acidic pH of your stomach, similar to antacids.
Baking soda should not be used regularly without consultation with a doctor. It has a high sodium level and can inhibit the absorption of other medications.
No studies have verified the use of baking soda for acid reflux treatment. Avoid its usage if you are on a low-sodium diet. Pregnant women should avoid consuming baking soda as it can cause fluid build-up, which may be harmful to the baby.
- Consume apple cider vinegar: Consumption of apple cider vinegar diluted with water can help to lower the acidity in the stomach, although further studies are needed to support this claim. The vinegar should be used in small quantities.
Undiluted vinegar should not be used as the acidity can decay teeth. Diabetic patients should avoid its use, as apple cider vinegar can affect insulin levels.
- Drink ginger tea: Ginger is used for relieving many stomach disorders, including stomachache and acid reflux.
Boiling ginger roots in water for half an hour and consuming this tea before any meal can help in managing GERD. Do make sure you are not allergic to ginger before consuming ginger tea.
Home Remedies for Acid Reflux and GERD
1. Aloe Vera Juice
Aloe vera is widely known as a medicinal plant. Its active compounds can moderate genetic and metabolic activities. This plant has been used as a therapeutic agent for the prevention and control of several diseases for a long time.
A randomized controlled trial tested the efficacy of aloe vera for GERD treatment. Seventy-nine patients were given a dosage of aloe vera syrup for 4 weeks. Results showed that the aloe vera treatment was effective and safe in relieving the symptoms associated with GERD. (7)
Consuming 1/4 cup of aloe vera juice before every meal can help in managing GERD. Avoid overuse as it can act as a laxative.
Further research is required to assess the role of aloe vera in treating GERD. Aloe vera should not be used as the sole therapy. Seek medical help if the symptoms do not subside.
An imbalance in the commensal bacteria living in the gut can contribute to acid reflux. Probiotics, which are bacteria that are beneficial to the digestive system, can help in restoring the balance of gut flora.
Acid reflux of acid or the extended use of medications for treating GERD can also disturb the gut microflora and cause digestive problems, such as functional dyspepsia. (8) To prevent this, a regular intake of probiotics is recommended.
Probiotics are available as supplements. Natural yogurt and kimchi are also probiotic-rich foods that can be consumed daily. However, the overuse of probiotics can increase digestion and cause discomfort.
It is recommended to seek medical help if you have a complaint of frequent acid reflux.
3. Chewing Gum
Chewing gum helps in increasing saliva production. Excess saliva can help in neutralizing and washing down the acid and soothing the esophagus. The use of peppermint-flavored gum should be avoided as it can trigger heartburn.
A study conducted in 2015 evaluates the use of Gutsy Gum, which is made especially for the relief of GERD symptoms. The gum comprises of licorice extract, calcium carbonate, apple cider vinegar, and papain. (9)
In this placebo-controlled, double-blind trial, 24 patients with GERD were given a reflexogenic meal, followed by either a Gutsy Gum or a placebo gum. The outcomes of the study supported the use of chewing gum to help subside the symptoms of GERD. Gutsy Gum gave better results than the placebo gum. (9)
Chewing sugarless gums or cinnamon gums after meals can provide relief from acid reflux. Avoid mint-flavored gums as mint helps relax the LES.
Clinical treatment is necessary to alleviate the problem of acid reflux since chewing gum only acts on its symptoms.
Diet Changes for Acid Reflux Management
Certain food groups can help in alleviating the symptoms of GERD. There are also foods that can trigger acid reflux.
Foods that provide relief from acid reflux include:
- Bananas have low acid content and are rich in fiber. It can coat the esophageal lining and relieve irritation and discomfort. The fiber in bananas can help in fighting indigestion.
- Melons are rich in magnesium, which is widely incorporated in medications used to treat acid reflux. Like bananas, melons are also alkaline.
- Oatmeal has high fiber content and enhances digestive health. It helps in combatting reflux and constipation. It makes your stomach feel full. As a result, you avoid overeating, thus preventing regurgitation.
- Green vegetables such as kale, spinach, asparagus, and Brussels sprouts have low fat and sugar content, which prevents the overproduction of acid in the stomach. These vegetables also help in relieving acid reflux as they are highly alkaline.
- Milk and milk products can be consumed to provide relief. Consumption of yogurt helps in balancing the gut flora.
- Protein-rich foods, such as beans, lean meat and substitutes, soft flaked fish, and eggs, are beneficial to people suffering from acid reflux.
- A gluten-free diet is recommended for the alleviation of symptoms associated with GERD. It also helps in preventing acid reflux that can cause intestinal damage in patients who have celiac disease. (10)
Foods to be avoided when you suffer from GERD:
- Citrus fruits, such as oranges, and tomatoes have high acid content, which can trigger acid reflux.
- Fatty foods, such as cheese, prime rib, pizza, and fries, can cause heartburn. The high-fat content can also cause obesity, which increases the pressure on your stomach and the LES.
- Spicy foods can worsen the symptoms associated with GERD. It is recommended to avoid garlic and onion as well.
- Coffee can induce acid secretion and can also hamper the function of the LES.
- Alcohol and chocolates can relax the muscles of the LES and induce acid reflux.
- Carbonated drinks can cause bloating in the stomach and increase the pressure on the LES.
GERD and Pregnancy
The development of GERD during pregnancy is very common. Pregnant women often experience heartburn, and the symptoms of GERD may worsen with time.
The hormonal changes associated with pregnancy can weaken the digestive system and can slow down the peristaltic movement of the esophagus. Also, an increase in the size of the uterus builds pressure on the stomach, driving the acid into the esophagus.
While experiencing GERD is common during pregnancy, it rarely develops any complications. Generally, the symptoms subside after delivery. (11)
GERD in Infants
Reflux, or spitting up, in babies is common. However, some infants may suffer from pediatric GERD, which presents the following symptoms:
- Improper feeding
- Breathing problems
If your child shows these symptoms, consult a pediatrician at the earliest. The doctor may suggest simple changes in the routine and certain medications that can easily combat the disease.
Potential Complications of GERD
A severe case of GERD with frequent acid reflux can cause complications, including:
- Esophagitis: Frequent acid exposure can cause inflammation in the esophagus, also known as esophagitis. The acid produces breaks in the lining of the esophagus and causes ulcers. If not treated, esophagitis can increase the risk of cancer.
- Esophageal strictures: An abnormal narrowing of the esophagus due to fibrosis, inflammation, or neoplasia is known as an esophageal stricture, which causes problems in swallowing. Esophageal strictures should be treated immediately, as they can damage the mucosal and submucosal layers.
- Barrett’s esophagus: A prolonged inflammation of the esophagus caused by GERD can result in the development of Barrett’s esophagus, wherein the lining of the esophagus slowly modifies and starts to resemble the lining of the small intestine.
Risk Factors for GERD
Specific factors that increase the risk of GERD in individuals include:
- Hiatal hernia
- Cystic fibrosis
- Alcohol intake
- Consumption of fatty and spicy foods
- Abnormalities of the digestive system caused by systemic scleroderma
- Eating habits such as consuming food before bedtime and eating large portions at once
Is GERD genetic?
GERD is associated with many risk factors, including genetic factors. Genes play a major role in the development of GERD and related complications, such as esophageal adenocarcinoma and Barrett’s esophagus. (12)
A study in 2002 investigated the influence of genetic makeup on GERD. A higher incidence of GERD among monozygotic twins, in comparison to dizygotic twins, proves the association of GERD with genes. (13)
More studies are needed to evaluate the role of the identified genes. A detailed study of these genes can help in developing screening tools or biomarkers. It will also provide new therapeutic approaches to combat the disease. (12)
What is the difference between GERD and heartburn?
The upward movement of acid from the stomach to the esophagus is termed reflux. Heartburn is a burning sensation in the chest due to the presence of acid and is a symptom of reflux. GERD is a chronic condition wherein frequent acid reflux occurs.
Studies have shown that obesity increases the chances of developing GERD. The complications associated with GERD, including erosive esophagitis, esophageal adenocarcinoma, and Barrett’s esophagus, also have a high incidence in obese individuals. Weight loss may help in managing GERD, although this claim has not been proved yet. (14)
How does GERD affect sleep?
Lying down on the bed during reflux may cause the stomach contents to backflow up to the mouth. The presence of acid in the throat while lying down causes irritation and disturbs sleep. Epidemiological data also shows that GERD causes sleep disturbance. (15)
This backflow is prevented in the daytime by the action of the gravitational force while sitting and standing upright. Gravity pulls down the stomach contents and prevents it from going higher than midchest during reflux.
Do GERD cause cough and sore throat?
Acid reflux during the night may reach the throat and cause irritation and soreness, which induce coughing (a reflex action to clear the throat).
It is recommended to avoid late-night eating and drinking to prevent sore throat and coughing caused by acid reflux.
When to See a Doctor
Acid reflux can usually be managed with lifestyle changes, diet modulation, and the use of over-the-counter medications. If these therapies fail to relieve the symptoms, it is recommended to seek medical help.
Also, if your symptoms are frequent and worsen with time, seek immediate medical care. Mention all the associated problems, such as sleep disturbance or insomnia, so that the doctor can prescribe appropriate treatment.
What you may ask your doctor:
- Is my acid reflux severe?
- How do I differentiate between chest pain and heartburn?
- Do I need to get tested?
- Will the prescribed medicines cause any side effects?
- Are there complications associated with my problem?
What your doctor may ask you:
- When did you first start experiencing the symptoms?
- Have you undergone any treatment?
- How would you rate your chest pain?
- Have you been diagnosed with GERD before?
- Are you expecting a child?
- Do you have any other medical problems?
GERD is a common disease and may be due to smoking, excessive alcohol intake, poor eating habits, and constant stress. While occasional heartburn is not a cause for concern, GERD can cause severe complications.
However, GERD can be easily managed with drug therapies, surgery, and simple lifestyle changes. It is vital to be treated at the earliest.