GERD

Understanding gastro-esophageal reflux disease, (GERD): Symptoms, Diagnosis, and Treatment Options

Do you ever feel a fiery sensation creeping up into your chest after a hearty meal? Do you experience a cough or hoarseness that just won’t go away? If so, you might be dealing with GERD, a common yet often misunderstood condition. Let’s define what GERD is, its symptoms, and how it’s diagnosed. Then we’ll look at treatment options available, both traditional and alternative, along with essential self-care measures for relief and prevention.

Understanding GERD:

Historically, what we call GERD today was commonly known as “Agita”. Agita is an Italian word that means agitate, and often referred to heartburn, anxiety, and agitation.

GERD is a chronic condition where stomach acid flows back into the esophagus, due to a slackening of the lower esophageal sphincter, (LES). The LES is the sphincter between the esophagus and the stomach. This reflux can cause irritation and inflammation. 20% of adults and 10% of children are afflicted with GERD.

Occasional acid reflux usually occurring shortly after meals is normal. In healthy individuals the reflux clears within 1-2 minutes thanks to salivation and esophageal peristalsis. Being upright also helps. GERD occurs when these episodes become frequent or severe, leading to discomfort and potential complications.

Symptoms:

GERD can present as chest pain, burning, regurgitation, difficulty swallowing, belching, persistent cough, hoarseness, nausea, and vomiting. It can be worse at night due to the fact that we are lying down and we produce less saliva while we sleep. In fact, episodes of reflux at night are less frequent than during the day, but they can last much longer. Up to 60 minutes in some cases. Coughing, particularly at night, is a classic symptom of GERD, as acid particles enter the bronchi and cause irritation, mimicking asthma.

A lesser known sign of GERD is tooth sensitivity and loss of tooth enamel due to direct exposure to acids or acidic vapors rising into the oral cavity. Your dentist or hygienist may be the one to alert you to this.

Some reflux has more of an impact on the upper end of the esophagus. This is considered laryngo-pharyngeal reflux or LPR. It is also called “silent reflux”. It often occurs without symptoms of burning or regurgitation. Patients with this condition report feeling like they have something stuck in their throat and are constantly trying to clear their throat. They may also complain of hoarseness, laryngitis, and chronic sore throats. Symptoms may persist even after the reflux is resolved. It can take up to a month for irritation to the larynx and vocal cords to heal.

Diagnosis:

Diagnosing GERD typically involves a combination of medical history review, symptom assessment, and diagnostic tests.

Physicians may order tests such as an upper endoscopy to examine the esophagus and stomach lining for signs of inflammation or damage. X-rays can detect a hiatal hernia, a condition that occurs when the  top portion of the stomach protrudes up through the opening in the diaphragm, often aggravating reflux. pH monitoring where a small device is inserted into the esophagus to measure acid levels, can also be helpful in confirming acid reflux episodes.

Traditional Treatments:

The primary goal of traditional treatments for GERD is to reduce acid production, alleviate symptoms, and prevent complications. This often involves medications such as:

1. Proton Pump Inhibitors (PPIs): These drugs block acid production in the stomach, providing relief from symptoms and promoting healing of the esophagus.
2. H2 Receptor Blockers: These medications reduce the amount of acid the stomach produces, helping to alleviate symptoms like heartburn and acid reflux.
3. Antacids: Available over-the-counter, antacids provide quick relief by neutralizing stomach acid.

These medications can be prescribed temporarily to allow irritated tissues to heal, while proper lifestyle and dietary changes are adopted to resolve the cause of reflux. In severe cases or when medication and lifestyle changes fail to provide relief, surgical interventions like fundoplication can repair a hiatal hernia, strengthen the lower esophageal sphincter and prevent acid reflux.

Alternative Treatments:

Several alternative therapies and lifestyle modifications can complement traditional treatments or be used independently for managing GERD.

Avoiding triggers such as spicy or acidic foods, caffeine, nicotine, alcohol, and certain medications can help reduce symptoms. Opting for smaller, more frequent meals and avoiding lying down after eating can also be beneficial. Avoid wearing restrictive clothing.

Some herbs like ginger, licorice, and chamomile are believed to have anti-inflammatory properties that may help soothe the digestive tract and alleviate symptoms. Some studies have shown that ingestion of Aloe Vera juice can reduce symptoms of reflux.

Certain medications such as sedatives, calcium channel blockers, tricyclic anti-depressants that treat depression and pain, as well as NSAIDs and Hormone Replacement have been linked to a slackening of the lower esophageal sphincter, (LES), contributing to reflux. Your physician may be aware of other pharmaceutical options available to you that don’t exacerbate your reflux symptoms. 

Acupuncture, which involves inserting thin needles into specific points on the body to restore balance and alleviate symptoms can be helpful with GERD. Reflux, in Chinese medical terms is considered “rebellious qi”. Stomach qi is responsible for  directing the foods we eat downward through our digestive tract. Acupuncture can help calm rebellious, upwardly moving stomach qi, (reflux), to promote proper digestion.

Self-Care and Prevention:

In addition to medical treatments and alternative therapies, adopting healthy lifestyle habits can play a crucial role in managing GERD and preventing flare-ups:

1. Maintain a Healthy Weight: Excess weight can put pressure on the abdomen, leading to increased risk of acid reflux. Losing weight through a balanced diet and regular exercise can help alleviate symptoms.
2. Elevate the Head of Your Bed: Sleeping with the head of your bed elevated can help prevent acid reflux at night by gravity.
3. Quit Smoking: Smoking can weaken the lower esophageal sphincter, making it easier for stomach acid to reflux into the esophagus. Quitting smoking can significantly reduce GERD symptoms.
4. Stress Management: Stress can exacerbate GERD symptoms. The use of relaxation strategies such as deep breathing, meditation, yoga, massage, and acupuncture can help reduce stress and alleviate symptoms.

Conclusion:

GERD is a chronic condition that requires long-term management to alleviate symptoms and prevent complications. With a combination of traditional treatments, alternative therapies, and lifestyle modifications, individuals can effectively manage GERD and improve their quality of life. If you suspect you have GERD or are experiencing persistent symptoms, it’s essential to consult with a healthcare professional for proper diagnosis and personalized treatment recommendations. Remember, taking proactive steps toward self-care and prevention can make a significant difference in managing GERD symptoms effectively.

Sources:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3238367/. GERD & Tooth Erosion

https://my.clevelandclinic.org/health/diseases/17019-acid-reflux-gerd

https://my.clevelandclinic.org/health/diseases/15024-laryngopharyngeal-reflux-lpr

https://pubmed.ncbi.nlm.nih.gov/26742306/  Aloe Vera & reflux

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4991651/  Nutritional Interventions

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10282137/  Acupuncture & GERD