Treating Gastroesophageal Reflux Disease (GERD) is not always easy; the sensation of heartburn and chest pain often recurs due to the frequent upward flow of stomach acid, especially after consuming certain types of food.
However, the impact of GERD is not limited to this heartburn alone; it can cause other symptoms such as coughing, nausea, or other issues that disrupt your daily life. So, how can GERD be treated? And what are the best medications to relieve its symptoms?
What is GERD?
Gastroesophageal Reflux Disease (GERD) is a chronic acid reflux into the esophagus. It is considered chronic if you experience it at least twice a week for several weeks. While some people may experience temporary acid reflux, GERD is a persistent mechanical problem, meaning the mechanisms that should keep acid out of the esophagus are not functioning correctly.
Causes of GERD
For acid to reach the esophagus, it must pass through a valve located at the bottom of the esophagus that prevents food or acid from returning upward.
This valve is known as the Lower Esophageal Sphincter (LES), a circular muscle that opens during swallowing and then closes again to keep acid in the stomach. It also opens slightly to allow gas bubbles to escape during burping or hiccups.
GERD occurs when this valve is relaxed most of the time. While certain factors may cause it to relax temporarily—such as lying down after a large meal—in the case of GERD, the relaxation of the valve is persistent. Generally, the causes of GERD include:
1. Hiatal Hernia
A hiatal hernia occurs when the upper part of the stomach pushes upward through the opening in the diaphragm where the esophagus passes.
This causes pressure on the esophagus and traps acid. Additionally, this leads to the movement of the LES above the diaphragm, causing it to lose some muscular support, which facilitates the rise of stomach acid and the onset of GERD symptoms.
2. Obesity
Obesity increases pressure and volume in the abdomen, affecting the LES and potentially weakening it. This abdominal pressure also weakens the diaphragm muscles that support the lower esophageal valve.
3. Smoking
Smoking can contribute to the relaxation of the LES. Even exposure to secondhand smoke can have an effect. Furthermore, smoking leads to coughing, which opens the LES valve.
Over time, smoking and chronic coughing can weaken the diaphragm muscles and contribute to the development of a hiatal hernia. Not only that, but smoking can also slow the digestion process and cause the stomach to produce more acid.
4. Pregnancy
Like obesity, pregnancy causes abdominal pressure that may weaken the diaphragm muscles. However, the addition here is that pregnancy hormones also encourage the relaxation of the LES.
Pregnancy may lead to elevated levels of the hormone relaxin, which relaxes muscles to allow for expansion for the fetus. It also stimulates high levels of estrogen and progesterone, which may further lead to the relaxation of the LES.
5. Other Causes
There are other potential causes for GERD, such as:
-
Connective tissue diseases: Such as scleroderma, which may affect the esophageal muscles.
-
Congenital defects: Such as esophageal atresia.
-
Certain medications: Such as sedatives, calcium channel blockers for high blood pressure, tricyclic antidepressants, nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen, or hormone replacement therapy for menopause.
Which Foods Increase GERD?
Aside from the aforementioned causes, it is common to suffer from GERD symptoms after eating specific foods. Examples of triggers include:
-
High-fat foods, such as fried foods and fast food.
-
Spicy foods.
-
Certain fruits and vegetables, such as pineapple and tomatoes.
-
Citrus fruits, such as oranges.
-
Certain beverages, such as coffee, tea, and carbonated drinks.
-
Chocolate.
-
Mint.
-
Garlic.
-
Onions.
Generally, foods and beverages alone are unlikely to cause acid reflux by themselves, but they contribute to it, especially since some foods may trigger the relaxation of the LES. Others, like fatty foods, increase stomach acid and take longer to digest, providing a greater opportunity for acid to escape into the esophagus.
Symptoms of GERD
Symptoms are what necessitate the treatment of GERD; they go beyond simple heartburn, as shown below:
1. Heartburn
Heartburn is the most common symptom of GERD. The patient feels a burning pain in the chest that starts behind the breastbone and moves upward to the neck and throat. This sensation may last for up to two hours and often worsens after eating.
2. Coughing
Coughing is not just a symptom of respiratory diseases; it can also be a symptom of GERD. The rise of stomach acid into the esophagus and throat can trigger coughing, wheezing, or hoarseness.
3. Chest Pain
Acid reflux can cause a feeling of pressure, squeezing, or pain in your chest, which can mimic the symptoms of a heart attack.
4. Nighttime Symptoms of GERD
GERD can cause distinct symptoms during the night:
-
Persistent coughing.
-
Laryngitis.
-
Asthma that appears suddenly or worsens.
-
Sleep problems.
5. Other Symptoms
-
Nausea.
-
Shortness of breath.
-
Difficulty swallowing.
-
Vomiting.
-
Bad breath.
-
Dental enamel erosion.
-
A sensation of a lump in the throat.
Complications of GERD
It doesn't stop at symptoms; without treatment, GERD can lead to several complications:
-
Esophagitis: Inflammation of the esophageal lining, which can cause pain and chronic complications like esophageal ulcers.
-
Barrett's Esophagus: A change in the tissue lining the esophagus to resemble the lining of the intestine. This occurs after long-term exposure to acid and inflammation and is a risk factor for esophageal cancer.
-
Esophageal Stricture: Scar tissue may form over time to protect the esophagus from chronic inflammation, leading to a narrowing of the esophagus and subsequent difficulty swallowing.
-
Laryngopharyngeal Reflux (Silent Reflux): The reflux travels to the throat and seeps in during sleep, which may cause swelling and hoarseness.
-
Asthma: Acid in the airways can also exacerbate asthma or cause asthma-like symptoms in people without pre-existing respiratory diseases.
Treatment of GERD
The goal of treating GERD is to reduce the amount of refluxed acid or minimize the damage to the esophageal lining. Available treatment options include:
1. Antacids
These medications help neutralize the acid in the esophagus and stomach, reducing heartburn. They are over-the-counter (OTC) drugs that provide temporary or partial relief.
However, long-term use of antacids can lead to side effects like diarrhea, altered calcium metabolism, and magnesium accumulation in the body. If you need to take antacids for more than two weeks, talk to your doctor first.
2. H2 Histamine Blockers
A doctor may recommend these drugs to reduce acidity in the stomach. They help prevent acid secretion by blocking H2 histamine receptors. Examples include:
-
Famotidine.
-
Nizatidine.
3. Proton Pump Inhibitors (PPIs)
These are the primary choice for treating GERD and are effective in 90% of cases. They block the protein needed to make stomach acid, reducing GERD symptoms and allowing the esophageal lining to heal. Examples include:
-
Esomeprazole.
-
Lansoprazole.
-
Omeprazole.
-
Rabeprazole.
-
Pantoprazole.
What is the best medicine for GERD?
There is no single medicine that is definitively the "best" for everyone; the choice depends on the severity of symptoms and a doctor's recommendation. Al Jawaher Al-Mutamayza Pharmacies provides a range of GERD medications under Stomach & Colon Medications Section that can be used after consulting your doctor to determine what is most suitable for you:
1. Pantozol 40 mg
Pantozol 40 mg contains the active ingredient "Pantoprazole," a PPI that reduces stomach acid secretion.
2. Risek 20 mg
Risek 20 mg contains "Omeprazole," a PPI that treats GERD symptoms by reducing stomach acid.
3. Peptazol 30 mg
Peptazol 30 mg contains "Lansoprazole," a PPI that helps reduce stomach acid secretion.
4. Esopol 40 mg
Esopol 40 mg contains "Esomeprazole," a PPI that reduces stomach acid and GERD symptoms.
5. Gaviscon Advance (Peppermint flavor)
Gaviscon Advance treats indigestion and acidity, which are prominent symptoms of GERD, and is known for its fast action in relieving heartburn.
Can GERD be permanently cured?
Yes, it is possible for GERD to be permanently cured, but it requires some trial and error, lifestyle changes, and commitment to the treatment plan prescribed by your doctor.
Effective Tips for Preventing GERD
Certain lifestyle changes, alongside prescribed medications if needed, can help reduce the frequency of GERD symptoms:
-
Avoid trigger foods: Such as chocolate, fatty foods, coffee, citrus fruits, and tomato products.
-
Eat smaller portions: This can help reduce symptoms compared to eating one large meal.
-
Do not sleep immediately after eating: You should wait at least two to three hours to allow stomach acid to settle and the stomach to partially empty.
-
Chew food thoroughly and eat slowly: Putting your spoon down between bites can help you chew and swallow completely before taking another bite.
-
Quit smoking: This is essential for reducing GERD symptoms.
-
Elevate your head: Raise the head of your bed by 15 cm (6 inches) using blocks or sleep on a specially designed wedge pillow. This allows gravity to lessen the reflux of stomach contents.
-
Maintain weight: Lose excess weight through a healthy diet and regular exercise.
-
Wear loose clothing: Avoid clothes that press on the waist, as they put pressure on the abdomen and LES, contributing to reflux symptoms.
