Gastroesophageal reflux is the passage of gastric contents into the esophagus. It is a normal physiologic process, with most episodes being brief and it may not result in any symptoms or damage to the lining of the esophagus. Gastroesophageal reflux disease, or GERD, is a disorder where the reflux into the esophagus causes symptoms or other complications, such as damage to the lining of the esophagus. Symptoms of GERD include heartburn, regurgitation, coughing, throat clearing, hoarseness, belching, difficulty with or painful swallowing, chest pain or a globus sensation in the back of the throat. GERD can cause direct damage to the esophagus or other organs due to the backflow of acidic contents. Various factors work together to cause GERD, including the condition of the muscle sphincter at the lower esophagus (lower esophageal sphincter, or LES), presence of a hiatal hernia, the ability of acidic contents to pass through the esophagus, and decreased flow of saliva.
What can I do?
Most patients will require long-term medical therapy to treat GERD. However, lifestyle modifications alone may result in the resolution of symptoms in 25 percent of people with symptoms, provided they are compliant and continue their lifestyle changes long-term. In order to remain symptom-free, the goal is to decrease the amount of acidic reflux back into the esophagus.
We do not routinely recommend dietary changes to all patients with GERD. However, in those who can correlate symptoms with certain trigger foods, the elimination of those foods is recommended. Not everyone’s GERD symptoms will be triggered by the same foods,however, it has been noted that certain foods more commonly worsen symptoms. These include fatty foods, milk and cheese products (these have a very high acid content), spicy foods, tomato products, vinegar products (salad dressings), citrus fruit, caffeine, chocolate and carbonated beverages.
Diet modifications and an increase in exercise to promote weight loss is recommended to help reduce symptoms of GERD. A reduction in abdominal girth can decrease the pressure on the LES, reducing reflux.
Changes in how and when meals are consumed can also help reduce reflux symptoms. It is recommended that patients eat more frequent, small meals. Large meals can result in increased pressure on the LES, resulting in backflow of some gastric contents into the esophagus. In addition, it is recommended that people remain upright for two to three hours after meals. This will help prevent backflow of any meal contents by promoting forward movement of stomach contents, as well as decreasing back pressure on the LES. Avoiding carbonated beverages can also help reduce reflux symptoms. Carbonated beverages have a significant amount of air, which can distend the stomach, putting pressure on the LES.
Although not consistently demonstrated to improve reflux, certainly other lifestyle habits do have a physiologic basis in reducing symptoms. Smoking and alcohol consumption weaken the LES. Therefore, smoking cessation and alcohol abstinence can help reduce symptoms by regaining the integrity of that sphincter muscle. In addition, smoking decreases salivation. Saliva and promoting salivation help neutralize the acidic contents of the stomach. Wearing loose-fitting clothes also can help reduce abdominal pressure, which may push gastric contents into the esophagus.
It is important that you discuss any gastrointestinal symptoms you may be experiencing with your doctor. If your symptoms are consistent with GERD, lifestyle modifications under supervision of your physician may be sufficient to help with your symptoms. Should lifestyle changes not help resolve your symptoms, your doctor can help direct further treatment options, and possibly any testing that may be indicated.