Acid Reflux is a condition that approximately 7 million people in the U.S. experience. Sixty percent of the adult population is affected by GERD every year. For many people, heartburn, acid indigestion, and chronic coughing and belching after eating—all symptoms associated with GERD—are a daily battle. The good news is that you don’t have to live with the discomfort.
While GERD (gastroesophageal reflux disease) is a mild condition that causes discomfort, it develop into more serious diseases. So it is important to treat this condition in its early stages.
There are many ways to treat GERD. Most of these treatments are very simple, but you will have to make several adjustments to your lifestyle..
- Eat smaller, frequent meals
- Wait 3 hours after eating before lying down
- Avoid exercise immediately after eating
- Lose excess weight
- Avoid alcohol/coffee
- Stop smoking
Eating smaller-portioned meals, or eating four to five small meals rather than larger ones will help treat GERD. Additionally, waiting a few hours after eating before lying down, gives your food time to digest properly and acid levels will decrease.
Furthermore, avoiding smoking is crucial when treating acid reflux. Nicotine weakens the muscle that controls the opening between your esophagus and your stomach. If it is closed, it keeps acid in your stomach and prevents it from going back up.
Other ways to treat GERD include:
- Raise the head of your bed 5-6 inches
- Avoid spicy, acidic foods, including tomato-based foods, citric foods and fruit juices
- Try avoiding chocolate, mint, and peppermint
- Try avoiding fried or greasy foods
- Over-the-counter medicine
Raising the head of your bed is a common and effective way of treatment. Raising your head to a level that is higher than your feet doesn’t allow acid to back up.
If you are taking antacids three or more times per week, contact your physician. Excessive use of such medications—designed for temporary relief—suggest you may be suffering from an underlying issue. Simple procedures, like an upper endoscopy, will allow your gastroenterologist to get a clear picture of what is going on inside your body and prescribe a comprehensive treatment plan.
If you think you’re experiencing symptoms of GERD or acid reflux please contact a GI expert of SAGA.
Symptoms of GERD
Acid reflux is responsible for the majority of the symptoms and/or damage to the esophagus. Approximately 13-29% of Canadians experience recurring GERD symptoms. GERD has a significant negative impact on wellbeing and quality of life.
Heartburn is the most common symptom of GERD. It usually feels like a burning pain in the chest, beginning behind the breastbone and moving toward the neck and throat. It often worsens after eating and while lying down, and can last for a couple of hours at a time. Pain results from the irritating effects of stomach acid on the inner esophagus wall, which does not have the same natural protection from acid that exists in the stomach lining.
Another common symptom is a sensation of food or liquid coming up into the throat or mouth (regurgitation), especially when bending over or lying down. This can leave a bitter or sour taste in the mouth. While many Canadians experience occasional heartburn or regurgitation, these symptoms are frequent in persons with GERD who are not receiving adequate treatment.
GERD patients can also experience some less common symptoms, including persistent sore throat, hoarseness, chronic coughing, difficult or painful swallowing, asthma, unexplained chest pain, bad breath, a feeling of a lump in the throat, and an uncomfortable feeling of fullness after meals.
Acid erosion of tooth enamel, which a dentist will notice, can be a sign of GERD in someone who is not yet experiencing typical symptoms.
In some cases, the acid may travel all the way up the esophagus past the upper esophageal sphincter (UES) and damage the structures in the throat. Known as laryngopharyngeal reflux disease (LPR), this has now become an important diagnosis for physicians to consider in patients with chronic throat clearing, coughing, and a feeling of a lump in the throat. Sometimes, the acid lingering in the throat is drawn into the lungs, irritating the delicate tissues there and causing symptoms that mimic those common in lung diseases. A person could have LPR without symptoms of heartburn because the larynx is much more sensitive to acid injury than is the esophagus.
Too much stomach acid reflux can result in inflammation of the esophagus (esophagitis), which can lead to esophageal bleeding or ulcers. Chronic scarring may narrow the esophagus and interfere with a person’s ability to swallow, requiring surgery. A few patients may develop a condition known as Barrett’s Esophagus (BE), which is severe damage to the cells lining the bottom of the esophagus. Doctors believe BE may increase the chance of developing esophageal cancer. Please talk to your physician if your GERD symptoms change.
Management of GERD
Dietary and Lifestyle Modifications
Although clinical evidence suggests that dietary and lifestyle modifications are usually not sufficient to bring chronic GERD under control, your physician might suggest a number of dietary and lifestyle changes directed at reducing your symptoms, and adhering to these recommendations might provide some relief. The first goal of treatment is to prevent the reflux of stomach acid into the esophagus. Foods that trigger reflux and its symptoms vary from person to person. By paying close attention to your diet and symptoms, you may be able to identify those foods that repeatedly contribute to reflux. Common trigger foods include alcohol, caffeine, fatty foods, and some spices. Avoiding large portions at mealtime and eating smaller, more frequent meals might aid in symptom control.
Many overweight individuals find symptom relief when they lose some weight, as it seems that the excess pounds, especially around the abdomen, put pressure on the digestive tract, negatively affecting its function. Avoid clothes that fit tightly around the waist, as these also increase abdominal pressure.
Smoking cessation is also important for reducing GERD symptoms, as studies point to relaxation of the LES with smoking.
GERD patients should avoid lying down right after eating and refrain from eating within two to three hours of bedtime.
To reduce nighttime symptoms, elevating the head of the bed about six inches may also help, but make sure to do this by propping up the mattress or bed frame, not by using pillows.
There are two main approaches to treating GERD with medications: neutralizing acid and blocking its production.
For neutralizing acid, over-the-counter medications such as Maalox®, Tums®, and Pepto-Bismol® may subdue symptoms. Another product, Gaviscon®, neutralizes stomach acid and forms a barrier to block acid rising into the esophagus. Some find that these non-prescription antacids provide quick, temporary, or partial relief but they do not prevent heartburn. Consult your physician if you are using antacids for more than three weeks.
Two classes of medication that suppress acid secretion are histamine-2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs).
- H2RAs work by blocking the effect of histamine, which stimulates certain cells in the stomach to produce acid. These include cimetidine (Tagamet®), ranitidine (Zantac®), famotidine (Pepcid®), and nizatidine (Axid®). H2RAs are all available by prescription and some are accessible in a lower dose non-prescription formulation.
- PPIs work by blocking an enzyme necessary for acid secretion and have the best effect when taken on an empty stomach, a half-hour to one hour before the first meal of the day. PPIs include omeprazole (Losec®), lansoprazole (Prevacid®), pantoprazole sodium (Pantoloc®), esomeprazole (Nexium®), rabeprazole (Pariet®), and pantoprazole magnesium (Tecta®). Dual delayed release PPI capsules, in the form of dexlansoprazole (Dexilant®), deliver the medication at two intervals. PPIs have emerged as the most effective therapy for relieving symptoms and improving quality of life, as well as healing and preventing damage to the esophagus in persons with GERD. In Canada, PPIs are available only by prescription. Longer-term and multiple daily dose PPI therapy may be associated with an increased risk for osteoporosis-related fractures of the hip, wrist, or spine.
Treatments that reduce reflux by increasing LES pressure and downward esophageal contractions are metoclopramide and domperidone maleate. A plant-based prokinetic agent, Iberogast®, helps regulate digestive motility and improve GERD symptoms.
All of the medications discussed above have specific treatment regimens, which you must follow closely for maximum effect. Usually, a combination of these measures can successfully control the symptoms of acid reflux.
Some other medications and/or supplements may aggravate GERD. Be sure to ask your pharmacist or physician if any products you are currently taking could be affecting your symptoms.
Acid reflux symptoms
Many people refer to acid reflux as heartburn.
Heartburn is a burning sensation in the stomach and behind the chest area that improves with taking anti-acid medication.
Anti-acid medications stop and suppress acid production.
Have you had any heartburn in the past? Do you remember experiencing a sour or bitter taste in your throat or mouth?
Things that you should avoid
2) Large meals
3) Eating too late at night
8 foods and beverages you should avoid or at least limit
1) Citrus fruits
4) Carbonated drinks
5) Fatty foods
One more interesting thing
Did you know that exercising and bending forward could worsen the heartburn symptoms?
Yes, it can happen because exercise and bending forward increase the pressure inside the abdomen and push up stomach acid.
Medications that could worsen your heartburn
1) Aspirin and all other NSAIDS (e.g. Advil, Exedrine, Aleve)
2) Anticholinergic drugs, these drugs inhibit the action of acetylcholine (a neuro-transmitter). The most commonly known and prescribed anticholingeric drugs are as follows,
- Meclizine (Antivert)
- Oxybutinin (Ditropan)
Following are few medications with mild anticholinergic effects,
- Cetirizine (Zyrtec)
- Furosemide (Lasix)
- Alprazolam (Xanax)
3) Nitrates (mostly used in patient complaining of chest pain)
4) Calcium channel blockers (e.g. verapamil), this group of medication treats high blood pressure and/or fast or irregular heart rate.
Remedies for acid reflux symptoms
There are different approaches to acid reflux treatment, but in my opinion the first and most important primary approach to this problem is to identify the reasons for acid reflux.
The reasons for acid reflux are mostly preventable. It means that if you change a few things your heartburn symptoms could improve.
In most cases how and what we eat could cause or worsen acid reflux, other factors are smoking, alcohol and most importantly stress.
Eating smaller amount of foods, chewing well and avoiding food intake at least four hours before bedtime could be of major help in managing acid reflux symptom management.
Elevating the back of the bed when lying down can reduce the intensity of the symptoms.
“A Simple Guide to Secrets of Healthy Eating”
and learn more.
Medications that are used to treat acid reflux symptoms
There are three common anti-acid medications,
1) Anti-histamines or histamine 2 blockers (e.g. ranitidine, famotidine, cimetidine)
2) PPIs or proton pump inhibitors (e.g. omeprazole/Prilosec, Nexium, Protonix, Prevacid, …)
3) Aluminum hydroxide (e.g. Maalox)
Did you know that to get the most benefit from PPIs such as Omeprazole, Nexium, Prevacid, they should be taken 30 to 45 minutes before meal?
How do the histamine 2 blockers work?
Histamine stimulates acid production in the stomach and consequently inhibiting the histamine production by histamine 2 blockers reduces the acid production.
Lower acid production will result in improvement of heartburn.
How do the PPIs work?
PPIs reduce acid production in the stomach by inhibiting the proton pump function in the stomach.
PPIs are stronger, more effective and logically more expensive than histamine 2 blockers.
How does aluminum hydroxide work?
This medication reduces the exposure of the stomach tissue to already existing acid and thus protects the stomach lining from getting damaged. It doesn’t reduce or limit the acid production.
How to get rid of acid reflux?
Now that you know little more about heartburn and acid reflux disease, you should work on followings to improve your symptoms and hopefully prevent future heartburn attacks,
1) Look for reasons that make heartburn occur.
2) Find out which behavior or foods make your symptoms worse.
3) Familiarize yourself with the acid reducing medication you are planning to take.
4) Make sure that you contact your doctor if the symptoms don’t improve even after taking the acid reducing medication.
5) Last but not least don’t disregard the effect of stress on your stomach health.