Everyone experiences the unexpected heartburn of reflux every now and then. Whether you were slamming down an ice cold beer or your mama’s spaghetti, no food or beverage is impervious to the burning pain and discomfort of acid reflux. But when a few isolated experiences of reflux evolve into one of those recurring health problems that just won’t disappear, it may be time to consider a diagnosis of gastroesophageal reflux disease (GERD).
Casually referred to as reflux, heartburn, or acid indigestion, gastroesophageal reflux disease affects an estimated 11.6% of people in Australia. That’s without including the presumably large bracket of people living with undiagnosed GERD. For that, meta-analysis data suggests the community prevalence of GERD is 10-20% of the population in the Western world.
Since giving up the favourable pastime of eating will lead to side effects more disastrous than heartburn and indigestion, let’s find out the symptoms, causes, and treatments for reflux. Because we know you want to have your cake, and eat it without nasty side effects, too.
What is GERD?
Gastroesophageal reflux disease is a chronic gastrointestinal condition characterised by a noticeable regurgitation of gastric acid and contents from the stomach into the oesophagus, the tube connecting your throat to your stomach (aka the food pipe). The upward flow of acid backwash commonly causes heartburn and a sour taste in the throat and mouth.
Reflux is completely normal and happens to everyone at one point or another. When reflux occurs more than twice per week over a period of a few weeks, it can be considered a chronic condition of gastroesophageal reflux disease. At this stage it’s important to seek treatment to relieve symptoms via a healthcare professional. If left untreated, GERD can damage the digestive system and manifest into more serious health problems.
What are the main symptoms of reflux?
Globally there are more than half a million people living with reflux, and each one of those people will present with a unique set of reflux symptoms to them. The most common symptoms of acid reflux include:
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Heartburn
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Regurgitation (food travels back into your mouth via the oesophagus)
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Chest pain
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Sore throat and/or hoarseness
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Burning sensation in the chest or throat
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Frequent sour taste in your throat or mouth
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The feeling of food caught in your throat, or a lump in your throat
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Coughing (persistent cough or dry cough)
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Asthma symptoms
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Difficulty swallowing
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Belching
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Vomiting
GERD can also cause other health issues, like:
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Nausea
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Wheezing
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Tooth decay
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Gum disease
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Bad breath
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Bloating
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Laryngitis
What is heartburn?
Heartburn is the most common symptom of gastroesophageal reflux disease. Characterised by a painful burning sensation that targets the middle of the chest, heartburn occurs when stomach acid causes an irritation of the lining of the esophagus.
The burning pain associated with heartburn can happen at any time, but can worsen immediately after eating, or when taking a horizontal position of lying down after eating.
What causes GERD?
When it comes to gastroesophageal reflux disease, most cases are caused by a problem with one of the esophageal muscles called the lower esophageal sphincter (LES). Located at the southern end of the food pipe, the lower esophageal sphincter has the job of keeping stomach contents from rising back up through the oesophagus. And you can bet it’s this small muscle that’s responsible for the heartburn and GERD symptoms you experience after each meal.
That’s because the lower esophageal sphincter functions like a valve. When it loses its ability to close properly, gastric acid from the stomach flows back up into the esophagus causing heartburn, belching, chest pain, and sometimes more severe symptoms of GERD.
Why does the lower esophageal sphincter weaken? The reasoning isn’t medically clear however there is an increased risk of a weakened LES in people who:
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Are overweight or obese
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Consume a high-fat diet (the stomach takes longer to process stomach acids after a fatty meal)
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Consume tobacco, alcohol, coffee, or certain foods such as chocolate (these substances relax the LES to make GERD worse)
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Smoke cigarettes
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Experience stress or anxiety (reminder: there are strategies to manage stress and anxiety)
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Regularly take certain medications, like aspirin
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Have connective tissue disorders
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Have a hiatal hernia
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Have a condition called gastroparesis (common in people with diabetes)
How is GERD treated?
There are a number of options available to treat gastroesophageal reflux disease (GERD), ranging from:
Prescription medications
The main prescription drug treatments for people living with persistent heartburn and acid reflux are proton pump inhibitors (PPIs) and H2 blockers. A proton pump inhibitor works by reducing stomach acid production and potential damage caused by acid reflux. H2 blockers function similarly to proton pump inhibitors, however they’re less commonly prescribed.
Both of these prescription medications are considered safe and effective for people living with reflux disease, but like any medications they can cause side effects. Always consult with your doctor if side effects arise.
Over the counter medications
For people who experience heartburn, indigestion, or minor reflux infrequently, over the counter medications called antacids provide rapid, short-term relief by decreasing the acidity of stomach contents.
Efficacy of antacids will vary from person to person, and regular usage should be discussed with your doctor as continued use can lead to nutritional deficiencies.
Alginate drugs (Gaviscon)
You’re probably familiar with well-known heartburn treatment, Gaviscon. Admittedly we’ve all seen the ads on TV. Gaviscon is a type of alginate drug that works by creating a barrier against acidic stomach contents.
By forming a foamy gel of alginic acid at the top of the gastric pool, Gaviscon removes the power of reflux. Anything that passes through will consist of alginic acid rather than the damaging stomach acid.
Lifestyle changes
Gastro oesophageal reflux disease treatment can be as simple as making a few minor lifestyle modifications, such as improving your posture, wearing loose-fitting clothing, losing weight if overweight or obese, maintaining a healthy weight, avoiding increased pressure on the abdomen (from exercising or wearing tight pants or belts), quitting smoking, eating small meals, and avoiding certain trigger foods if they’re known.
How do I prevent symptoms of GERD (chronic acid reflux)?
If you’re concerned about your digestive health, or acid reflux is getting you down, try these lifestyle changes and tips to prevent GERD symptoms from occurring or worsening into more serious symptoms:
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Maintain a healthy body weight, or try to lose weight if overweight
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Make an effort to eat small, frequent meals rather than large meals
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Reduce the consumption of fatty foods, including butters, oils, gravies, processed meats, and full-fat dairy products
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Avoid eating too close to bedtime
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Take your time when consuming meals, rather than eating too quickly which can cause trouble swallowing
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Maintain an upright position when eating, and for up to an hour afterwards
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Quit or limit smoking
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Seek out acid-reducing medications and take them as directed
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Remove potential trigger foods from your diet
What foods should I avoid if I have GERD?
Minor dietary adjustments can provide a quick and simple fix to relieve heartburn and other symptoms of reflux. Certain foods that are considered trigger foods of reflux include:
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Spicy foods
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Deep fried foods
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Fatty foods
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Tomatoes and tomato-based sauces
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Garlic and onions
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Citrus fruits
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Chocolate
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Peppermint
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Coffee
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Carbonated drinks
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Too much alcohol
Logging your meals in a food journal will help to track what foods are causing gastroesophageal reflux, so you can refer back at any time.
Is GERD (chronic acid reflux) dangerous or life-threatening?
The occasional case of reflux isn’t concerning. Without treatment, constant exposure to acid reflux can cause damage to the esophagus and serious long-term health complications, including:
Esophagitis
A health condition where the lining of the esophagus becomes inflamed to the point of causing irritation, bleeding, and ulceration.
Esophageal Strictures
Over time, chronic inflammation and scar tissue that develop in the esophagus can cause a narrowing of the food pipe and problems with swallowing.
Esophageal ulcers
A painful condition of stomach acid wearing away the tissue lining of the esophagus to cause the formation of a sore. Esophageal ulcers can bleed and cause difficulty swallowing.
Barrett’s esophagus
One of the more serious health conditions to develop from untreated reflux disease, Barrett’s esophagus results from repeated stomach acid exposure that causes changes to cells and tissue lining the esophagus. Barrett’s is an associated risk factor of esophageal cancer.
Esophageal cancer
A serious health condition to result from untreated GERD symptoms, esophageal cancer is associated with prolonged esophagitis and Barrett’s esophagus.
How is GERD diagnosed?
Heartburn and reflux are relatively easy to self-diagnose. For gastroesophageal reflux disease, the leading sign of diagnosis relies heavily in noticing no improvement in symptoms of GERD despite trialling acid reflux medications, and lifestyle changes.
Consulting with a doctor or gastroenterologist will help you achieve a formal diagnosis. These medical specialists will investigate your symptoms of GERD via:
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Upper endoscopy, a medical procedure where a tiny fibre-optic camera is used to look closely at the esophagus, stomach and part of the small intestines
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Biopsy, a medical procedure where a small tissue sample is retrieved for further laboratory analysis
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Barium X-ray, a medical procedure where a chalky liquid is swallowed to provide contrast on imaging of the esophagus, stomach, and upper parts of the small intestines
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Impendance monitoring, a medical procedure where rate of fluid movement along the esophagus is measured
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pH monitoring, a medical procedure where acidity is measured
Wherever your symptoms sit on the scale of acid reflux, we’re here to help! Start a conversation about reflux with one of our trusted doctors today.