The Call-On-Doc Guide to GERD

What causes GERD typically centers around a part of the body called the lower esophageal sphincter, a muscle designed to allow entry into your stomach and remain closed to keep consumed food in, occasionally opening to let out gas in the form of burps. (3) That muscle weakening or getting damaged is the primary cause of GERD, with the most common factors behind that process including: 

Hiatal Hernias: A hiatal hernia occurs when part of the stomach protrudes through the diaphragm into the chest cavity. There are two main types: sliding and paraesophageal. In a sliding hiatal hernia, the stomach and the junction of the esophagus slide into the chest when a person is in a supine position or when intra-abdominal pressure increases, such as during coughing or straining. This displacement of the stomach can weaken the lower esophageal sphincter and allow stomach acid into the esophagus. (9)

Obesity: Obesity is a significant factor in the development and exacerbation of gastroesophageal reflux disease due to the increased pressure put on the stomach by excess body weight. When pressure on the stomach is heightened due to obesity, the LES can weaken, allowing stomach acid to flow back into the esophagus, leading to GERD symptoms. Additionally, obesity may contribute to the formation of hiatal hernias, further compromising the function of the lower esophageal sphincter and increasing the likelihood of acid reflux. (10)

Pregnancy: During pregnancy, the growing uterus exerts increasing pressure on the abdominal cavity, which can lead to displacement of the stomach and relaxation of the lower esophageal sphincter. That is especially the case in the third trimester, with nine out of 10 women experiencing acid reflux during that time in the pregnancy. While common during pregnancy, most women will experience a gradual reduction to an outright return to normal after childbirth. (11)

Smoking: Due to the act of smoking nicotine products relaxing the lower esophageal sphincter and increasing the production of stomach acid, smoking can play a greater role in the development of GERD over time. (12)

Connective Tissue Disorders: Connective tissue disorders are conditions affecting the supportive tissues in the body, including ligaments, tendons, skin, and the lower esophageal sphincter. In the context of GERD, abnormalities caused by connective tissue disorders weaken the lower esophageal sphincter and contribute to or outright result in the reflux of stomach acid up through the esophagus. Connective tissue disorders commonly associated with GERD include: 

• Lupus: Lupus is a chronic autoimmune disease in which the immune system attacks healthy tissues, leading to inflammation and potential damage to various organs and systems in the body. (3)
• Rheumatoid Arthritis: Rheumatoid arthritis is a chronic autoimmune disorder characterized by inflammation of the joints, causing pain, swelling, and potentially leading to joint damage and deformities. (4)
• Scleroderma: Scleroderma is a chronic autoimmune disease characterized by the hardening and tightening of the skin and connective tissues, often involving internal organs. (5)
• Ehlers-Danlos Syndrome: Ehlers-Danlos Syndrome is a group of genetic connective tissue disorders characterized by hypermobility, skin that is easily bruised and hyper-elastic, and joint hypermobility. (6)
• Systemic Lupus Erythematosus: Systemic Lupus Erythematosus (SLE) is a complex autoimmune disease where the immune system mistakenly attacks healthy tissues throughout the body, resulting in inflammation and a wide range of symptoms affecting various organs. (7)
• Mixed Connective Tissue Disease:  Mixed Connective Tissue Disease (MCTD) is an autoimmune disorder exhibiting features of lupus, scleroderma, and polymyositis, involving multiple organ systems and characterized by a combination of symptoms from these distinct connective tissue conditions. (8)

Specific Foods: Whether by relaxing the lower esophageal sphincter, increasing stomach acid productivity, or causing irritation, certain foods will be prone to playing a bigger factor in the development of GERD. While eating these foods in healthy proportions will not necessarily play a significant role in causing acid reflux, consuming large and unhealthy amounts may contribute to GERD symptoms. These foods include: 

• Citrus fruits and juices
• Tomatoes and tomato-based products
• Chocolate
• Peppermint and spearmint
• Spicy foods
• Fried and fatty foods
• Carbonated beverages
• Coffee and caffeinated beverages
• Onions and garlic

Acid reflux can be triggered by the same factors playing into GERD alongside certain habits that may naturally result in a bout of heartburn. Typically, these factors surround a person’s diet, eating habits, smoking, and whether they are overweight or pregnant. For a normal person, acid reflux can be caused by overeating or eating before bed. This is especially the case if the food is greasy, fried, chocolate, or including caffeine. Additionally, overconsumption of caffeinated or carbonated beverages can trigger acid reflux. 

GERD symptoms often manifest in the mouth, throat, and chest. These symptoms are frequently exacerbated when lying down, following a substantial meal, consuming fatty foods, bending over, and engaging in activities like smoking or drinking. (13) Noticeable GERD symptoms will most often include: 

• Heartburn: A burning sensation or discomfort in the chest, often after eating or when lying down.
• Regurgitation: The feeling of stomach contents (acid or food) coming back up into the throat or mouth.
• Acid Indigestion: Discomfort or pain in the upper abdomen, often accompanied by a sour taste in the mouth.
• Difficulty Swallowing: Known as dysphagia, this can be a sensation of a lump in the throat or difficulty passing food through the esophagus.
• Chronic Cough: A persistent cough, often worse at night, which may be caused by stomach acid irritating the airways.
• Sore Throat: Irritation and inflammation of the throat due to acid exposure.
• Laryngitis: Inflammation of the voice box, leading to hoarseness or changes in the voice.
• Chest Pain: Chest discomfort that may be mistaken for a heart-related issue. It is important to rule out other potential causes of chest pain.

When it comes to getting the final GERD diagnosis for a patient, healthcare providers will typically take a multifaceted approach. Due to it mostly involving symptoms that cannot be seen and examined through the normal consultation process, additional tests may be opted for depending on the severity. The GERD diagnosis process typically will include: 

• Clinical Evaluation and Medical History Overview: A healthcare provider will review the patient's symptoms, asking about the nature, frequency, and duration of symptoms like heartburn, regurgitation, and difficulty swallowing. During this visit, the doctor will also gain an understanding of your lifestyle, dietary habits, habits, and explore what might be potentially factoring into the condition. 
• Physical Examination: When in person, the doctor will review any signs that can be seen. Additionally, signs that can be indicated from the patient to the doctor will also be communicated. 
• Trial of Empirical Treatment: In some cases, healthcare providers may recommend a trial of acid-suppressing medications to see if symptoms improve. This can help confirm the suspicion of GERD.
• Upper Endoscopy (Esophagogastroduodenoscopy or EGD): This procedure involves the insertion of a flexible tube with a camera into the esophagus to visually inspect the lining for signs of inflammation, irritation, or complications like Barrett's esophagus.
• Esophageal pH Monitoring: This test measures the acidity in the esophagus over a 24-hour period. It helps determine the frequency and duration of acid exposure, confirming the diagnosis of GERD.
• Esophageal Manometry: This test assesses the function and coordination of the muscles in the esophagus, helping to identify motility issues that may contribute to GERD.
• Barium Swallow Radiography: This imaging test involves swallowing a contrast material (barium) while X-rays are taken. It can reveal structural abnormalities and the presence of a hiatal hernia.

While it is often used in the evaluation of the esophagus for a GERD diagnosis, an endoscopy is not always necessary to establish treatment for the condition. Many cases of GERD can be diagnosed based on a patient's medical history, characteristic symptoms such as heartburn and regurgitation, and response to acid-suppressing medications. In instances where symptoms are mild and uncomplicated, healthcare providers may opt for less invasive diagnostic approaches, such as esophageal pH monitoring or imaging studies, to assess acid exposure and rule out other potential causes. However, if symptoms persist, are severe, or if there are concerns about complications like Barrett's esophagus, an endoscopy may be recommended to visually examine the esophagus and confirm the diagnosis while also assessing the extent of any damage or abnormalities. (14)

There are a number of approaches to GERD treatment that cover everything from lifestyle changes and prescriptions to endoscopic procedures and surgical interventions. For some, a doctor may just advise habits to adopt and over-the-counter medications. For others, prescribed medications and eventual surgery may be required. In both cases, GERD treatment can include: 

Medications

• Antacids: These over-the-counter medications provide quick relief by neutralizing stomach acid. They are often used on an as-needed basis.
• H2 Blockers: These medications reduce the production of stomach acid. They are available over-the-counter or as prescription strength.
• Proton Pump Inhibitors (PPIs): These are potent acid-reducing medications that are often prescribed for more severe or persistent GERD symptoms. They are typically taken before meals.

Prokinetic Agents

• Medications like metoclopramide can improve the motility of the esophagus and stomach, helping to reduce reflux.

Endoscopic Procedures

• Endoscopic Fundoplication: This minimally invasive procedure involves using an endoscope to tighten the LES, reducing the likelihood of reflux.

Surgical Interventions

• Laparoscopic Fundoplication: In this surgical procedure, the top of the stomach is wrapped around the lower esophagus to reinforce the LES.
• LINX Device: This is a small, flexible ring of magnetic beads implanted around the LES to prevent stomach acid from refluxing into the esophagus while allowing the passage of food.

If GERD goes untreated, it can lead to various complications and negatively impact the quality of life. Chronic exposure of the esophagus to stomach acid can result in inflammation, erosions, and the development of Barrett's esophagus, a precancerous condition. Over time, untreated GERD may contribute to the formation of strictures (narrowing of the esophagus) and an increased risk of esophageal cancer. Persistent symptoms can also impair daily activities, disrupt sleep, and affect overall well-being. (15)

Alongside GERD treatment that includes prescription medications, management will primarily focus on dietary changes and lifestyle modifications. These can include: 

Lifestyle Modifications

• Weight Management: Achieve and maintain a healthy weight to reduce pressure on the stomach.
• Elevating the Head of the Bed: Raise the head of the bed or use a wedge pillow to prevent nighttime reflux.
• Avoiding Late-Night Eating: Allow a few hours between eating and lying down to minimize nighttime reflux.
• Smoking Cessation: Quit smoking, as smoking weakens the lower esophageal sphincter (LES) and contributes to reflux.
• Stress Management: Practice stress-reducing techniques such as deep breathing, meditation, or yoga.

Dietary Changes

• Smaller, More Frequent Meals: Opt for smaller, well-balanced meals throughout the day to prevent overeating.

Avoiding Trigger Foods

• High-Fat Foods: Limit intake of fried and fatty foods.
• Citrus Fruits: Minimize consumption of oranges, lemons, and other citrus fruits.
• Tomatoes and Tomato-Based Products: Reduce or avoid tomatoes and tomato sauces.
• Chocolate: Limit or eliminate chocolate intake.
• Caffeine: Decrease consumption of coffee, tea, and caffeinated beverages.
• Spicy Foods: Minimize the use of spicy seasonings.

Low-Acid Diet

• Lean Proteins: Choose lean meats, poultry, and fish.
• Whole Grains: Opt for whole grains like brown rice, quinoa, and oats.
• Non-Citrus Fruits: Include fruits such as bananas, melons, and apples.
• Vegetables: Select non-acidic vegetables like broccoli, cauliflower, and leafy greens.
• Non-Caffeinated Beverages: Drink water, herbal teas, or non-citrus, non-mint-infused water.

Alongside normal GERD management, those who are pregnant can also adopt habits that will help to curb or reduce acid reflux. While a doctor should be consulted during pregnancy when GERD becomes difficult to manage, there are methods like the following that can be adopted for some relief:

• Ginger: Ginger may help ease nausea and is considered safe during pregnancy. Try ginger tea or ginger candies.
• Papaya Enzymes: Papaya contains enzymes that aid digestion. Eating ripe papaya or taking papaya enzyme supplements may be beneficial.
• Chewing Gum: Chewing sugar-free gum after meals can stimulate saliva production, which helps neutralize stomach acid.
• Almond Milk: Almond milk is a non-citrus, non-dairy alternative that may help neutralize stomach acid.

While it may not be entirely avoidable, adopting certain lifestyle habits can significantly reduce the risk of developing GERD (gastroesophageal reflux disease). Maintaining a healthy weight through a balanced diet and regular exercise, avoiding trigger foods that contribute to reflux, and practicing portion control with smaller, more frequent meals can be beneficial. Lifestyle choices such as not lying down immediately after eating, elevating the head of the bed to prevent nighttime reflux, and managing stress through relaxation techniques can also contribute to prevention. Quitting smoking, limiting alcohol intake, and wearing loose-fitting clothing are additional measures that may help reduce the likelihood of developing GERD. While not foolproof, incorporating these practices into daily life can contribute to overall digestive health and minimize the risk of experiencing chronic acid reflux symptoms

Those struggling with GERD can get relief and support through CallOnDoc, just by completing our GERD evaluation consultation. Get a diagnosis and long term relief today with a same day prescription online!

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