Most people have suffered from heartburn at one time or another. In fact, the American Gastroenterological Association reports that more than 60 million Americans experience heartburn/reflux (GERD) symptoms at least once each month.
Heartburn, abdominal pain, cough, regurgitation, sour taste in the mouth, sore throat, hoarseness, a feeling that food is stuck in your throat, tightness in your throat, dental problems, bad breath, wheezing, asthma-like symptoms and sinus irritation are the typical symptoms of GERD. Smoking, pregnancy, obesity, hiatal hernia and even tight-fitting clothes can make these symptoms worse.
Heartburn is typically most bothersome at night, and tends to occur in connection with certain activities, such as: after eating a heavy meal, bending over, lifting, lying down, especially when laying on your back.
Acid reflux occurs when the contents of the stomach escape into the esophagus and beyond, because the group of muscles at the top of the stomach is unable to prevent the stomach’s contents from re-entering the esophagus.
Although it’s still unclear exactly what causes it, several factors have been shown to contribute to and worsen acid reflux. These include:
Hiatal hernia, a condition in which the top of your stomach protrudes above the diaphragm muscle in your chest
Alcohol or caffeine consumption
Eating large meals
Eating before bedtime
Medications such as antihistamines, calcium channel blockers, theophylline, and nitrates
Fatty, fried, and spicy foods; tomato-based foods; citrus fruits; chocolate; mint; garlic; and onions
What do these factors have in common? Increased pressure in the stomach. This is aggravated by the sheer amount of food consumed or a byproduct of digestion, i.e. gas or some external pressure on the stomach.
What about the acid?
Multiple studies have shown that acid production is usually normal, or sometimes even low in patients with reflux. (Hirschowitz BI. A critical analysis, with appropriate controls, of gastric acid and pepsin secretion in clinical esophagitis. Gastroenterology. 1991 Nov;101(5):1149-58,).
So why do we use acid suppressing PPI (like Prilosec, Nexium, Protonix, etc.) or H2 antagonists (like Pepcid, Zantac, etc.)?
While typical GERD symptoms are more common in people who produce normal levels of stomach acid, people with low stomach acid (mostly, these are people taking PPIs) continue to suffer from symptomatic reflux, not produced by acid. Potential triggers for non-acid reflux include caustic bile salts, which are normally produced to help digest fats, and digestive enzymes, particularly pepsin. Bile salts have been linked to heartburn symptoms in at least one study (Siddiqui A,, et al. Esophageal visceral sensitivity to bile salts in patients with functional heartburn and in healthy control subjects. Dig Dis Sci 2005;50:81-85).
How can we treat it?
The current guidelines state: “Routine global elimination of food that can trigger reflux is not recommended in the treatment of GERD.” (Katz PO, et all. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013 Mar;108(3):308-28).
The fact that trigger food diets don't work doesn’t mean that dietary intervention won’t work, so what do the latest studies show?
Recently published research confirms that high-fat/low-carbohydrate diet benefited all women with regard to reducing GERD symptoms and frequency of medication use. (Pointer SD, et all. Dietary carbohydrate intake, insulin resistance and gastro-oesophageal reflux disease: a pilot study in European- and African-American obese women. AP&T.August 2016).
Other recommendations regarding diet include:
limit foods containing lactose, fructose, resistant starch, and sugar alcohols
avoid processed food
select fully ripened fruits and vegetables
cook starchy foods well and consume them fresh
eat more fermented foods, especially fermented vegetables
eat slowly and chew well for maximum salivary amylase function
stay well hydrated, drink water prior to eating
eat small, frequent meals
don’t lie down within 3 hours after eating
lose weight, if necessary
avoid wearing tight clothing, especially around your midsection
practice a relaxation strategy; stress and anxiety can worsen reflux symptoms
practice diaphragmatic breathing
What about supplements?
Alginate therapy is an effective treatment for gastroesophageal reflux symptoms. (A systematic review and meta-analysis, Diseases of the Esophagus, 09/28/2016 Leiman DA, et al.).
Melatonin, and many others. (Mugur N Siddaraju, Shylaja M Dharmesh Inhibition of gastric H+, K+-ATPase and Helicobacter pylori growth by phenolic antioxidants of Zingiber officinale. Mol Nutr Food Res. 2007 Mar;51(3):324-32.).
For more specific recommendations on a healthy lifestyle, please make an appointment with Dr. Koganski at 215-750-7000, or visit www.newtowninternalmedicine.com