Gastroesophageal reflux disease (GERD) is a common condition often misunderstood as a simple stomach issue. In reality, GERD is the most prevalent esophageal disorder, responsible for about half of all heartburn symptoms experienced by individuals. Let’s dive deeper into what GERD truly entails, how it happens, its symptoms, and effective treatment strategies.

What is GERD?

GERD stands for gastroesophageal reflux disease. Contrary to popular belief, it’s not just a stomach problem; it primarily affects the esophagus. When stomach acid backs up into the esophagus, it causes irritation and inflammation, resulting in symptoms like heartburn.

How Does It Happen?

Under normal circumstances, stomach acid should remain in the stomach. However, when the lower esophageal sphincter (LES) weakens or relaxes abnormally, it allows excessive acid to flow back into the esophagus. Several factors contribute to this weakening or relaxation of the LES, including certain medications such as aspirin, ibuprofen, calcium channel blockers, nitrates to name a few, smoking, alcohol, obesity, and even stress.  Increased intra-abdominal pressure from straining or heavy lifting can force stomach acid into the esophagus which is one reason pregnant women may  experience GERD symptoms due to increased intra-abdominal pressure from a beautiful growing baby.

Symptoms of GERD

GERD manifests through various symptoms, including:

• Indigestion/heartburn
• Bitter regurgitation
• Sour taste, especially in the morning
• Hoarseness
• Chronic cough

Treatment Strategies

Well if you go to your doctor with the above symptoms more than likely you will be placed on a medication that either blocks the secretion of HCL through proton pumps or histamine receptors. This may be appropriate for acute serious ulcer issue however for “heartburn issues” reducing acid is actually harmful in the long run. Think about it, how long have you been on a PPI such as prilosec, protonix or nexium? These carry many side effects with chronic use (bacterial overgrowth, increased risk of hip and spine fracture, increased risk of pneumonia, decreased vitamin B12). Low stomach acid is detrimental in the long run. Why?

• It prevents bacterial and fungal overgrowth as many of these microbes could not survive very long in an acidic environment. However, when stomach acid is deficient these microbes can thrive and multiply. This leads to heartburn, constipation, diarrhea and susceptibility to infections.
• Stomach acid plays a crucial role in the digestion and absorption of essential proteins, vitamins, and minerals. It activates pepsin, an enzyme necessary for breaking down proteins into amino acids. These amino acids are vital for numerous bodily functions, particularly for brain health. Insufficient stomach acid can contribute to issues such as depression, anxiety, and insomnia.

Managing GERD involves a combination of lifestyle changes and dietary adjustments. Here are some effective strategies:

• Dietary Modifications: Eliminate trigger foods such as sugar, chocolate, mints, alcohol, spicy food, tomato-based food and cow’s milk. Avoid eating large meals, chew slowly and refrain from eating late at night. Drink plenty of water. Stop smoking. Avoid NSAIDS, Tetracycline.
• Herbal Remedies: Incorporate a small amount of bitters before meals (Caraway, Ginger, Peppermint, Fennel, Goldenseal root are a few examples), or herbs like licorice (deglycyrrhizinated licorice) and slippery elm into your diet. These can help soothe the digestive tract and reduce symptoms.
• Supplements: Some individuals with GERD may have low stomach acid. Taking 1-2tablespoons of apple cider vinegar or a vinegar dressing before meals can help determine if this is the case. If you experience less heartburn symptoms then you may benefit from a supplement called Betaine HCL with pepsin prior to meals. Additionally, L-glutamine(energy source for upper GI cells), and vitamin C (can reduce pathogenic bacteria and free radical damage in the stomach) 1-2 grams/day may aid in managing GERD symptoms. Essential fatty acids can help heal gastric and duodenal ulcers, eating cold water fish or supplementation can be beneficial. One interesting treatment option is taking melatonin, this hormone can be produced in our GI tract and help stimulate bicarbonate secretion, heal acute gastric injury and stimulates the lower esophageal sphincter to contract and decrease acid from entering the esophagus. 1-3mg and hour before bedtime may be helpful. You also may need B12 supplementation if stomach acid production has not been normal for a long time.

Red Flags

While occasional heartburn is common, certain symptoms warrant immediate medical attention. Seek medical help if you experience difficulty swallowing, sharp abdominal pain, nausea/vomiting, or notice blood in your stool or dark tarry stool..

In conclusion, GERD is more than just occasional heartburn. Understanding its causes, symptoms, and treatment options is essential for effectively managing this condition and improving overall quality of life. If you suspect you have GERD or experience persistent symptoms, consult with a healthcare professional for proper evaluation and personalized treatment recommendations.

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