GERD

Summary

Location: esophagus and upper stomach

GERD, also known as Gastroesophageal Reflux Disease, is the chronic condition where acid from the stomach refluxes into the esophagus, causing inflammation and the resulting painful symptoms like heartburn, chest pain, and difficulty swallowing. These symptoms are the result of the inflammation within the esophagus (called esophagitis). In a normal situation, food travels through the mouth, down the esophagus and into the first part of the stomach. Then the lower esophageal sphincter (LES) keeps food and stomach components like acid in the stomach, as opposed to leaching backwards into the esophagus. This occurs by the amount of pressure being exerted on the LES.

Occasional reflux and heartburn (acute esophagitis) is not a sign of any serious condition. Certain medications or foods can cause acute esophagitis. Chronic reflux, however, is technically termed GERD (the disease state, rather than just experiencing occasional reflux symptoms). GERD and constant reflux increases ones risk for Barret's esophagus (see definition below), a precancerous condition that occurs due to the repeated inflammation and destruction of the esophagus tissue.

As previously mentioned, a properly functioning LES works to allow food to enter the stomach and keep food and other components (like acid) in the stomach once it passes. However, there are many factors that influence the LES:

Foods that stimulate gastric acid production: black and red pepper, coffee, alcohol, meals of larger size, rapid gastric emptying, increased gastric secretions, and smoking.

Foods and behaviors that decrease LES pressure (a decrease in LES pressure causes the LES to open and acid from the stomach leaches back into the esophagus):

  • peppermint/spearmint (and mint oils)
  • chocolate
  • fried foods (high fat)
  • alcohol
  • smoking
  • coffee, and caffeine
  • raw onions
  • cucumber
  • radishes
  • peppers
  • overeating (causes high pressure on the stomach)
  • drinking during meals (also causes high pressure on the stomach)
  • certain medications

Hormones that influence the LES ability:

  • Progesterone (pregnancy, late phase of menstrual cycle)

Medications that influence the LES:

  • Anticholinergics and Bronchodilators 

Two general reasons LES may also fail to function properly include 1) structural damage from constipation and 2) temporary weakening (due to a secondary health condition or foods). A common cause of GERD is hiatal hernias.

Treatment & Nutrition Intervention - 

Alternatives:

  • Do not lie down after eating (wait a few hours! Another reason why we should not eat too close to bed time!)
  • Elevate the head of the bed
  • Limit or avoid smoking
  • Use medications such as antacids, H2 receptor antagonists, and PPIs. See note. 
  • Weight loss (overweight contributes to reflux and hiatal hernias)
  • Wear loose-fitting clothing (avoid tight)

Diet to prevent reflux:

  • Eat small, frequent meals
  • Avoid large meals
  • Avoid single high-fat meals
  • Eat low-fat, higher protein meals
  • Limit alcohol
  • Avoid certain foods that effect you: common foods include chocolate, coffee, mints, garlic, onions, cinnamon
  • Avoid drinking liquids with meals - drink in between meals instead

During acute esophagitis:

  • Avoid acidic foods like citrus fruits and tomatoes)
  • Avoid spicy foods
  • Follow a bland and soft diet
  • Eat small, frequent meals

All factors listed above will be different for everyone. Some people are very sensitive to raw onions while others sensitive to alcohol instead. These factors are simply the most common due to their effect on the LES. Find out your sensitivities and determine what works best for you.  

Note: Chronic use of acid-reducing medications may interfere with the absorption and metabolism of several nutrients such as folate, B12, iron, calcium, zinc, and magnesium. Always try dietary and lifestyles changes before relying on supplements or medications. When the above listed treatment methods have failed, surgery may need to be considered.

Resources:

Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/gerd/symptoms-causes/syc-20361940

Medline Plus: https://medlineplus.gov/gerd.html

National Institutes of Health: https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults

International Foundation for Functional Gastrointestinal Disorders: https://www.aboutgerd.org/what-is-gerd.html

Barret's Esophagus:

The tissue of the esophagus is replaced by tissue similar to the intestinal lining; abnormal cell growth of the esophagus marked by a dramatic discoloration of the tissue; considered to be premalignant โ€“ esophageal adenocarcinoma: cancer of the lower esophagus. More on Barret's Esophagus here: https://www.niddk.nih.gov/health-information/digestive-diseases/barretts-esophagus