The omnipresent heartburn…

July 21, 2023

Acidity or heart burn is so common that unless its really distressing, we dont find the patients consulting us. And still it is so underestimated, that its effect on the quality of life is ignored. While an occasional gastritis can be attributed to external factors such as sleeep deprivation, food and lifestyle habits etc; its more significant variant GERD, is a different ball game altogether.

Gastroesophageal reflux disease (GERD) occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of your esophagus leading to a group symptoms that commonly present as heartburn.

A circular ring of muscles (Lower Esophageal Sphincter aka LES) at the junction of food pipe (esophagus) and the stomach ensures unidirectional (from esophaugus towards stomach) flow of food consumed. If the LES relaxes, there is reversal in the direction of persistalis leading to symptoms of GERD.

Asthma and GERD are known to coexist in the same patient. An Asthma episode leads to relaxation of LES, thus aggravating the sympotms of GERD. Simultaneously, GERD acts as a trigger factor for asthma due to irration of lungs and airways by the regurgitant stomach contents.

Risk factors

Conditions that can increase your risk of GERD include:

  1. Obesity
  2. Bulging of the top of the stomach up into the diaphragm (hiatal hernia)*
  3. Pregnancy
  4. Connective tissue disorders, such as scleroderma
  5. Delayed stomach emptying

*Hiatus Hernia needs a special mention here. The diaphragm is a respiratory muscle and also acts as a anatomical separation between the chest and abdominal cavity. It has an opennig through which the esophagus passses and joins the stomach at the LES. Hiatus Hernia occurs when upper portion of the stomach pushes through this esophageal opening in the diaphragm into the chest cavity.

Hiatus Hernia

Factors that can aggravate acid reflux include:

  1. Smoking
  2. Eating large meals or eating late at night
  3. Eating certain foods (triggers) such as fatty or fried foods
  4. Drinking certain beverages, such as alcohol or coffee
  5. Taking certain medications, such as aspirin

Common signs and symptoms of GERD include:

Everyone has experienced the symptoms are gastroesophageal reflux.The burps, pain in the middle of the chest, bitter taste at the back of your mouth are all indicators of reflux. However it is when these symptoms persist, interfering with daily routine, that a physician's visit is called for and the physician will categorise this as a disease i.e. GERD.

  1. A burning sensation in your chest (heartburn), usually after eating, which might be worse at night
  2. Chest pain: retrosternal chest pain, typically causing chest tightness
  3. Difficulty swallowing
  4. Regurgitation of food or sour liquid
  5. Sensation of a lump in your throat
  6. bad breath
  7. excessive burping
The omnipresent heartburn

If you have night time acid reflux, you might also experience:

  1. Chronic cough
  2. Laryngitis
  3. New or worsening asthma
  4. Disrupted sleep
  5. throat irriation, espicially early morning

GERD - Non medical management

Diet and Lifestyle Changes

  1. Avoid foods and beverage that act as triggers: Stay away from foods that can relax the LES, including chocolate, peppermint, fatty foods, caffeine, and alcoholic beverages. One should also avoid foods and beverages that can irritate a damaged esophageal lining if they cause symptoms, such as citrus fruits and juices, tomato products, and pepper.
  2. Eat smaller servings: Eating smaller portions at mealtime may also help control symptoms. Also, eating meals at least 2 to 3 hours before bedtime lets the acid in your stomach go down and your stomach partially empty.
  3. Eat slowly: Take your time at every meal. Chew your food thoroughly. It may help you remember to do this if you set your fork down after you take a bite. Pick it up again only when you’ve completely chewed and swallowed that bite.
  4. Quit smoking: Cigarette smoking weakens the LES. Cessation of smoking is important to reduce GERD symptoms.
  5. Elevate your head while sleeping: Raising the head of your bed on 6-inch blocks or sleeping on a specially designed wedge lets gravity lessen the reflux of stomach contents into your esophagus. Don’t use pillows to prop yourself up. That only puts more pressure on the stomach.
  6. Maintain a healthy BMI: Being overweight often worsens symptoms. Many overweight people find relief when they lose weight.
  7. Wear loose clothes: Clothes that squeeze your waist put pressure on your belly and the lower part of your esophagus.

Medical management of GERD:

This includes:

  1. OTC antacids and medications such as H2 blockers /PPIs.
  2. Severe cases/refractory to medications are advised surgery.

Our Dr Arun Kumar has made a video on acid reflux please have a look