GASTROESOPHAGEAL REFLUX DISEASE (GERD): JUST A NUISANCE OR A SERIOUS DISEASE?

Gastroesophageal Reflux Disease (GERD): Just a Nuisance or a Serious Disease?

Pat Stricker, RN, MEd

Healthcare Consultant

Former SVP of TCS Healthcare Technologies

By Pat Stricker, RN, MEd
It’s that time of year again when holiday parties are occurring and food and drinks are readily available.
It’s a great time of year for getting together with family and friends and enjoying all different kinds of foods during meals and for snacks. We know we will probably eat more than normal and eat foods that will not agree with us, but it all looks so tempting. It’s hard to resist. However, that can come with a price.
Deviating from good dietary habits, making unwise food choices, and overeating can result in heartburn. This is usually more of a nuisance, but ongoing, chronic, severe heartburn (acid reflux), known as gastroesophageal reflux disease (GERD), increases risk factors, and can lead to more serious complications and possibly esophageal cancer. So that is serious. Our goal is to be aware of heartburn, how often it occurs, how severe it is, and make sure we or our patients are evaluated if it occurs frequently.

Heartburn is the primary symptom associated with GERD. It occurs when the lower esophageal sphincter (LES), between the stomach and the esophagus, opens, allowing gastric contents to leak back into the esophagus, thereby irritating the esophageal lining. The regurgitation of this acid (acid reflux) creates the heartburn symptoms: an uncomfortable feeling of fullness; burning in the throat or chest; hoarseness, sore throat, or dry cough; difficulty swallowing (dysphagia); nausea; chest pain; or pain when lying down too soon after eating.

Heartburn is commonly experienced by 60 million Americans each month, and 15 million experience it daily. And, since there are antacids readily available over the counter that help relieve the symptoms, people dismiss it as a “common nuisance – nothing to worry about.” But is that true?

Actually, that is far from the truth. Chronic heartburn can cause more serious complications and lead to chronic, severe GERD and possibly to esophageal cancer, so these symptoms should not be ignored. Medical evaluation is needed to evaluate and treat this chronic condition, if it occurs weekly and the symptoms become severe.

GERD QUIZZES, FACTS, AND STATISTICS

Before we get too far into discussing this topic, let’s step back and test our knowledge of GERD. Take a quiz on the More Than Heartburn website, which was developed by a national community of gastroenterologists specializing in the prevention and treatment of GERD, Barrett’s esophagus and other digestive conditions. Their goal is to raise the awareness of GERD and stress the need for more research into this disease. This website has a wealth of information related to these topics and can be used as a great educational tool. Take a few moments to review the website to get an idea of the valuable content.

Other healthcare systems and professional organizations have also developed GERD quizzes to help individuals self-test for symptoms or to help healthcare professionals assess patients. This is a list of quizzes, and these are four examples of the quizzes developed by healthcare organizations:

For more detailed information, this is an article from Healthline discussing GERD facts, statistics and costs.

THE RISKS OF UNTREATED GERD

Heartburn symptoms will affect nearly everyone at some point in their life. However, for some individuals it becomes chronic, which then results in GERD, a digestive condition that affects 15 million Americans, with most being over the age of 40.

Although anyone can develop GERD, certain risk factors increase the odds of developing it. These include:

Overeating
Smoking
Being overweight, obese, or pregnant
Having asthma, diabetes, peptic ulcers, a hiatal hernia, dry mouth syndrome, or a connective tissue disorder, such as scleroderma

If left untreated GERD can cause:

Reflux esophagitis and possible permanent damage to the esophageal tissue.
Difficulty swallowing (dysphagia) caused by the narrowing of the esophagus due to the creation of scar tissue caused by gastric acid.
Esophageal ulcers, which are open sores in the esophagus that can bleed and cause pain and/or difficulty swallowing.
Barret’s esophagus, pre-cancerous changes in the lower esophagus, associated with a risk of esophageal cancer.
Other long-term digestive issues.

So, as you can see, heartburn is not something to ignore. It affects over 60 million people each month, and if it becomes chronic and severe, it can lead to GERD and possibly esophageal cancer, which has a high mortality rate. Therefore, heartburn can be a significant risk factor. It is definitely a condition that needs to be evaluated by a physician.

TIPS TO AVOID HEARTBURN

Now that we know we need to be more careful about avoiding foods, drinks, and behaviors that invite heartburn, let’s take a look at what we can do to help us get through this holiday season.

We usually know instinctively which foods and drinks will cause problems — those that are greasy, spicy, fatty, fried, or acidic. We also know there are certain trigger foods and drinks that can cause the lower esophageal sphincter (LES) to receive more pressure or become more relaxed, thereby making it less effective and allowing stomach acid to flow back into the esophagus, irritating the esophageal lining.

These trigger foods and drinks should be avoided:

Chocolate, caffeine, and peppermint can relax the LES, allowing acid to flow back into the esophagus.
Donuts, cake, butter cookies and other fatty desserts
Fruits and vegetables that are highly acidic, pickled, or hot and spicy
Gas-producing foods such as garlic, onions, and cruciferous vegetables. The gas creates extra pressure in the stomach, making it more likely that the sphincter will open and release acid back into the esophagus.
Citrus fruits, rich foods, tomato-based foods, and sugary desserts also make the sphincter less effective.
Mashed potatoes and potato salads that may contain fats and oils can increase gastric juices. Use alternatives for the oils and fats whenever possible.
Fatty, fried, and high-fat dairy products. These take more time to digest so they stay in the stomach longer, causing the stomach to distend and putting more pressure on the LES.
High-fat snacks, such as potato chips or corn chips that can produce more acid.
Acidic fruit juices, tomato juice, lemonade, coffee, and tea
Soft drinks can cause the LES to have more pressure on it due to the distention of the stomach caused by the bubbling effect of the carbonation. This can cause the LES to open or leak, releasing acid and stomach contents back into the esophagus.
Alcohol, wine, and beer may relax the sphincter and cause more acid production, which may produce burning in the throat or chest. Air and bubbles from the carbonation in beer may result in distention of the stomach, causing acid and stomach contents to be released into the esophagus.
Dairy products - Use low-fat alternatives or lactose-free versions of the product instead.

Changing dietary habits to include low-fat, low-acid foods will also help to reduce the occurrence of heartburn. Foods, such as the following, should be eaten to alleviate heartburn:

Fresh fruits and lean proteins
Vegetables like leafy greens, asparagus, cucumbers, potatoes, and green beans are gentle and rarely cause heartburn.
Whole grains, such as oatmeal, absorb gastric acid.
Egg whites provide protein without including the fat (and heartburn) that is in the yolk.
Poultry and seafood, such as low-fat chicken, turkey, fish and seafood should be used as protein sources. Prepare by poaching, roasting, or baking, instead of frying.
Season foods with herbs, olive oil, and a dash of salt and pepper instead of using sauces and gravies with higher fat content.
Use fat-free, plain yogurt or Greek-style yogurt instead of sour cream in casseroles and dips.
Instead of using citrus juice, use citrus zest and replace the liquid with vegetable stock or apple juice.
Steam vegetables and season with olive oil instead of butter.
Serve low-acid desserts or recipes using figs, Asian pears, pineapples, bananas, melons, dates, or persimmons, instead of chocolate, peppermint, or high fat desserts.

Lifestyle changes can also be helpful. The holidays often cause us to overeat, take more naps, and eat unhealthy snacks, which all increase the likelihood of acid reflux. Simple lifestyle changes can be helpful in reducing the risk of heartburn. We should focus on:

Eating a healthy, more plant-based diet. One way to do that is to try to eat more meals at home where you can control what you eat and how it is prepared. The More Than Heartburn website has healthy recipes available that will reduce heartburn symptoms. This link will take you to the recipes, but you can also find them later by entering “recipes” into the search tab from any screen.
Performing a daily exercise routine. This will help aid digestion and weight loss. Even losing 5 pounds can reduce the pressure put on the LES, reducing the chance for stomach acid to seep back into the esophagus.
Avoiding late night eating. All meals should be finished at least 2-3 hours before going to bed to allow food to digest. Lying down on a full stomach enables gastric regurgitation.
Avoiding spicy, acidic, and other foods and drinks that are known to be heartburn triggers.
Using a wedge pillow to elevate the upper body for sleeping. This reduces the pressure that is placed on the LES when lying in a supine position.

One of the last steps to consider is developing a “Holiday Eating Plan” that will help avoid heartburn and allow you to enjoy the season.

Avoid trigger foods that we discussed earlier. While this may be difficult, since they will look very appealing, they will also be prone to produce heartburn.
Eat smaller portions and eat slowly. Using a smaller appetizer plate instead of a large dinner plate will also help you eat smaller portions.
Practice your willpower before you even get to the party. You know things will look appetizing, so make sure you know what you will definitely refuse to eat. Plan on eating salads, fruits, and vegetables first so you are “almost full,” before then allowing yourself to take a small “taste” of cheeses, dips, or desserts. Remember to do this in moderation.
Avoid after-dinner mints, as they can cause heartburn. Try cinnamon or fruit-flavored gum instead.

And last but not least, don’t forget that stress and anxiety are also linked to heartburn. (And what part of the year gives us more anxiety and stress than the holidays?) Physiologically, anxiety causes blood vessels to constrict, blood pressure to increase, and stomach muscles to tighten. This tightening of the stomach can push the contents back up against the sphincter, forcing it to open and send acid back into the esophagus. So try to eat a healthy diet and engage in daily exercise to reduce as much stress and anxiety as possible. Even small changes to the diet can make a big difference, especially over time. Keep track in a journal of which foods caused problems and which foods do not create any heartburn.

Re-learning to eat is a priority and even more important as you get older. You are not able to eat the same things you did in your twenties or thirties. A lot of this information is probably not new to you, but it is a reminder that even small changes can make a big difference.

We have to remember that heartburn is NOT an insignificant nuisance. It is something we need to be mindful of. It is something that can become chronic and cause more serious problems, if it is not addressed early. We should not consider heartburn as being just a common, everyday occurrence. It can be much more serious than that. Remember, occasional heartburn is not a cause for concern and can usually be treated with lifestyle and over-the-counter medications, such as antacids. However, chronic, severe acid reflux or GERD can lead to serious, and even life-threatening conditions. If heartburn occurs weekly or it is severe, it should be evaluated by a gastroenterologist.

Just keep these things in mind for the holidays and the coming year. You don’t need to avoid everything on the trigger lists, but just be aware that you may have problems if you eat or drink them. If you feel like you want or need to try some of the foods or drinks, do so, but do it in moderation. And remember to note in your journal the ones that caused a problem.

Enjoy! And have a Happy, Healthy Holiday and New Year!