Gastroesophageal Reflux Disease (GERD)

Gastroesophageal Reflux Disease (GERD)

Gastrooesophageal means stomach and esophagus. Reflux refers to flow back or return. Therefore, Gastroesophageal reflux disease refers to the return of the stomach’s contents back to the esophagus.

At the entrance of the stomach, there is a valve which is a ring of muscle called the lower esophageal sphincter. Normally this sphincter closes as soon as the food passes through it. If it does not close or remains open, acid produced in the stomach move up in the esophagus. This causes burning chest pain. If this symptom happen more than twice a week, then the patient experiences acid reflux disease, which is known as gastroesophageal reflux disease (GERD).

So GERD is defined as the chronic condition of mucosal damage caused by stomach acid coming up from the stomach into the esophagus. If it occurs occasionally it causes heartburn but if it occurs repeatedly it causes esophagitis and sometimes Barrett’s esophagus.

CAUSES

One common cause of acid reflux or GERD is the hiatal hernia. This occurs when the upper part of the stomach and LES move above the diaphragm, a muscle that separates stomach from chest. The diaphragm performs the function of keeping the acid level in the stomach. But if one has hiatal hernia, acid can move up into the esophagus and cause symptoms of acid reflux disease.

Other symptoms include:

  • Being overweight or obese
  • Eating large meals or taking rest after meal
  • Snacking close to bedtime
  • Drinking beverages like alcohol, carbonated drinks, coffee or tea
  • Eating certain foods like citrus, tomato, chocolate, mint, garlic, onion or spicy or fatty foods.
  • Smoking
  • Being pregnant
  • Taking aspirin, ibuprofen, certain muscle relaxers or blood pressure medications
  • Zollinger –ellison syndrome, which can be present with increased gastric acidity due to gastrin production
  • A high blood calcium level, which can increase gastrin production leading to increased acidity
  • Scleroderma and systemic sclerosis
  • Prolonged intake of prednisolone medicine
  • Visceroptosis in which the stomach has sunk in the abdomen upsetting the motility and acid secretion of the stomach

SYMPTOMS

Common symptoms seen in adults of acid reflux include :

  • A burning pain or discomfort that may move from your stomach to abdomen or chest or even up to the throat
  • Regurgitation: a sour or bitter tasting acid backing up into the throat or mouth
  • Bloating
  • Bloody or black stool or vomiting
  • Burping
  • Dysphagia
  • Hiccups
  • Nausea
  • Weight loss without any reason
  • Wheezing, dry cough, hoarseness or chronic sore throat
  • Reflux esophagitis – necrosis of esophageal epithelium causing ulcers near the junction of the stomach and esophagus
  • Esophageal strictures- persistent narrowing of the esophagus caused by reflux induced inflammation
  • Barrett’s esophagus – intestinal changes of the epithelial cells from squamous to intestinal columnar epithelium of the distal esophagus
  • Esophageal adenocarcinoma- a form of cancer
  • Sinusitis, recurrent ear infections and idiopathic pulmonary fibrosis

GERD may be difficult to detect in children and infants. Although symptoms vary from typical adult symptoms. GERD in children may cause:

  • Repeated vomiting
  • Effortless spitting up
  • Coughing and other respiratory problems such as wheezing
  • Inconsolable crying
  • Refusing food
  • Failure to gain appropriate weight
  • Bad breath
  • Burping

AYURVEDIC VIEW

According to Ayurveda, acid reflux is a result of aggravation of pitta dosha. Pitta is an ayurvedic word that symbolizes heat or fire. It is hot, intense, acidic and pungent in nature and is mainly situated in the stomach. Aggravated pitta leads to increase of acidic contents in the stomach fluids. Actually the reflux of the stomach’s liquid contents into the esophagus occurs in most normal individuals. In such patients, refluxed liquid contains acid more often due to aggravated pitta which leads to acid reflux.

DIET AND LIFESTYLE ADVICE

  • Avoid tea, coffee and carbonated or alcoholic beverages
  • Avoid processed and fermented foods
  • Avoid using garlic, ginger, onions, tomatoes and vinegar in cooking
  • Avoid sour, salty and spicy food
  • Curd should also be avoided
  • Take meals in a relaxed atmosphere and at regular intervals
  • Practice Yoga and Pranayam such as Vajrasana, Bhujangasan, Salabhasan, Bhastrika Pranayam, Shitali Pranayam and Shitkari Pranayam
  • Diet should consist of milk with sugar and a little old rice
  • Barley, wheat, cucumber, bitter gourd, pumpkin, pomegranate and cow’s milk
  • Eat dinner 2-3 hours before sleeping time as it keeps one healthy
  • Fiber rich diet is essential as it helps in digestion
  • Eat small meals more often as it helps in digestion
  • Avoid eating the next meal until the prior meal has been digested
  • Avoid foods that are rich in oils and fats. These foods are difficult to digest so they may make the stomach release more acids
  • Avoid eating excessive fried, fatty, junk foods
  • Avoid taking Maida or bakery products
  • Avoid taking frozen foods and chilled drinks
  • Avoid drinking water after meals

HERBAL REMEDIES

  • Make a powdered mixture of equal parts of rock candy (mishri), fennel and green cardamom. Whenever you feel heartburn, mix 1 teaspoon of powdered mixture in a glass of cold milk and drink.
  • Mix together equal parts of powdered fennel, licorice root, basil leaves and coriander seeds. Have half teaspoon of this mixture with half teaspoon of powdered rock candy (mishri) 15 minutes before lunch and dinner.
  • Grind two cardamom. Add 250 ml water to it. Boil the mixture for 15 minutes. Sieve and drink the water.
  • Chew 5-6 basil leaves after meals
  • Chew a clove to lessen the discomfort
  • Drink a glass of chilled milk to get rid of the burning feeling of severe acid reflux
  • Take ginger root extracts mixed with honey. This provides great relief in GERD
  • Mix 1 teaspoon cumin powder in one glass of water and drink early in the morning. This controls the gas formation and prevents GERD
  • Soak 5-7 almonds in water overnight. In the morning, remove the skin and eat the almonds
  • Intake of Aloe Vera juice is quite effective

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