Acid reflux, also known as heartburn or gastroesophageal reflux, is a common digestive condition where stomach acid flows back into the oesophagus. This backward flow of acid irritates the lining of the oesophagus leading to symptoms such as a burning sensation in the chest, and regurgitation of sour liquid or food. 

Occasional acid reflux is normal and can often be managed with lifestyle changes or over-the-counter medications. 

In chronic conditions managing acid reflux involves lifestyle modification, dietary modifications, medications, and surgical interventions. 

Early diagnosis and effective management are important in reducing the symptoms, preventing complications, and improving overall well-being. 

This blog gives an idea of the symptoms, causes, treatment, and tips to reduce the symptoms of acid reflux. 

What is acid reflux?

Acid reflux – Gastroesophageal reflux (GER) is when the stomach contents come up to your oesophagus. A more severe and chronic condition is gastroesophageal reflux disease (GERD), where the GER symptoms repeat many times and lead to complications. A heartburn (burning sensation) is felt when the stomach contents come up.

How does acid reflux happen?

Hydrochloric acid is a strong acid that breaks down food particles and helps digestion. It also protects the body against pathogens that enter along with food. 

The stomach lining is adaptable to protect itself from the acid but the oesophagus lining is not protected. Stomach contents can irritate the lining of your oesophagus. When acid reflux occurs often, it irritates the oesophagus lining and leads to GERD. 

Prevalence 

The most common gastrointestinal disorder is GERD. 20% of the adults in Western countries have GERD. The occurrence of GERD is more common in men than women. 

Symptoms of GERD

• Heartburn – A burning sensation felt in the centre of the chest, that spreads to the throat. Occurs usually after a meal. 
  
  
• Regurgitation – When stomach acid comes up to the throat or mouth, sometimes undigested food. 
  
  

Other symptoms include:

• Nausea 
• Vomiting (sometimes contains blood)
• Chest pain
• Stomach pain 
• Dysphagia (difficulty swallowing)
• Stool with blood
• Weight loss
• Loss of appetite
• Sore throat 
• Coughing 
  
  

Causes of GERD

• Hiatus hernia 
  
  
• Overweight and obese
  
  
• Pregnancy
  
  
• Sedentary lifestyle
  
  
• Delayed gastric emptying
   
• Smoking
  
  
• Eating large meals
  
  
• High intake of chocolates, fatty foods, coffee and alcohol.
  
  
• Connective tissue diseases.
   
• Eating before bedtime
  
  
• Medications
  
  

Diagnosis of GERD

• Proton pump inhibitor 

Most patients can be started on proton pump inhibitors as a medical therapy. GERD is diagnosed in patients with symptoms like heartburn and regurgitation.

• Oesophagogastro duodenoscopy (OGD) 

Patients with alarm symptoms like dysphagia, odynophagia, anaemia, weight loss, and hematemesis can be evaluated with OGD. Patients having symptoms of non-cardiac chest pain which can be due to GERD should be evaluated by OGD. 

• Radiographic studies 

Studies like barium radiography can diagnose severe conditions like oesophagitis, oesophageal strictures, hiatal hernia, and tumours but there are limited studies on the evaluation of GERD.

• Ambulatory oesophageal reflux monitoring

Ambulatory oesophageal reflux monitoring can diagnose the connection of the symptoms with abnormal acid exposure. Ambulatory reflux monitoring helps with the use of a telemetry pH capsule or a trans-nasal catheter. It helps in identifying the pathological acid exposure and number of reflux episodes. 

Complications of GERD 

• Erosive oesophagitis (EO)

Erosions or ulcers of the oesophageal mucosa are called erosive oesophagitis. It can be asymptomatic or can have worsening symptoms of GERD. 

• Oesophageal strictures 

Scarring of the oesophagus leading to the formation of peptic stricture can be due to the irritation of exposure to chronic acid. The symptoms can be due to oesophageal dysphagia or food impaction. 

• Barrett oesophagus

Barrett’s oesophagus occurs due to chronic exposure to acid. This leads to changes in the distal oesophageal mucosa. It is more commonly found in caucasian males over the age of 50, obese individuals have a history of smoking and any predisposes of oesophageal adenocarcinoma. 

• Risk of oesophagus cancer 

The risk of oesophageal cancer is likely to be high in the case of Barrett’s oesophagus. The symptoms include swallowing difficulty and chest pain. 

• Tooth decay

Stomach acids can remove the enamel of the teeth. This leads to the weakening of the teeth and develops cavities. 

Treatment 

Management of GERD includes diet therapy, lifestyle modification, medical management, and surgical therapy. 

Lifestyle modification 

Lifestyle modification can improve symptoms. Making simple changes like weight loss in obese individuals, sleeping in an elevated position, avoiding going to bed immediately after meals, and keeping in mind portion sizing. 

Medications 

Acid production is suppressed in the treatment of GERD medications. Effective medication is proton pump inhibitors, they help in erosive and non-erosive GERD. Other medications include H2 blockers, Antacids, and prokinetics. 

Surgical options

Fundoplication and endoscopic procedures are the available surgical options.

Dietary modification 

To reduce the symptoms of GERD, the meal plan should be personalised to an individual’s needs. The portion size, timing of meals, and composition of macronutrients are important, and avoid eating late at night. 

• Carbohydrates – Include complex carbohydrates such as whole grains, millet, pulses, and legumes. It delays gastric emptying and feels satiated for a long time, this automatically reduces the portion size and is less likely to cause heartburn.
  
  

• Fat – High-fat food like fried or greasy food causes heartburn. Consuming a low-fat diet will help with reducing the symptoms. Studies show no significant difference between fat type and clinical importance.  
  
  

• Dietary fibre – A fibre-rich meal delays the digestion process and is less likely to eat less. This reduces symptoms of GERD, the same as carbohydrates. Include oatmeal, brown rice, carrots, beets, broccoli, bean varieties, and asparagus. 
  
  

• Protein – Studies show that intake of protein resulted in GERD symptoms, but when taken with a high-fibre diet there was no difference.
  
  

Foods to avoid 

• Fried food
• Fast food
• Processed snacks
• Fatty meat
• Cheese
• Citrus fruits/juices
• Carbonated beverages 
• Spicy food
  
  

Foods that help with symptoms 

• Alkaline foods – Higher pH food is alkaline and helps in suppressing strong stomach acid.
  These foods include – Bananas, watermelons, muskmelon, nuts, and fennel seeds. 
  
  

• Watery foods – Consuming water-rich foods helps weaken stomach acid. High-water-containing foods include celery, cucumber, lettuce, watermelon, herbal tea, and broth-based soups. 
  
  

Tips to reduce symptoms

Follow these simple tips to reduce GERD symptoms:

• Healthy weight – Maintaining a healthy weight reduces the pressure on the abdomen, and stomach which causes acid reflux. 
  
  

• Quit smoking – The function of the lower oesophageal sphincter is decreased due to smoking.
  
  

• Do not lie down after a meal – Do not go to bed immediately after meals, should wait for 3 hours after meals. 
  
  

• Elevate the head of your bed – Elevating your head while sleeping can help ease symptoms. Raise your head by 6 to 9 inches. 
  
  

• Eat food slowly and chew – Take enough time in between each bite. Chew the food, swallow, and go for the next bite. 
  
  

• Avoid foods and drinks that trigger reflux – It is best to avoid foods that cause triggering such as alcohol, fried foods, caffeine, and peppermint. 

 Kripa N,
Senior Clinical Dietitian, Simplyweight