Do you experience heartburn from time to time? I’ve come across many patients who assume that just because they have heartburn, they have gastroesophageal reflux disease (GERD). Relax — that is not true. While heartburn is a symptom of GERD, it is not the only symptom, nor is it always necessary to experience heartburn to be diagnosed with GERD.
In this article, I will discuss some of the myths surrounding GERD and give some tips on how to manage this condition better, including altering your sleeping position.
1. GERD is prolonged heartburn
A telling sign of GERD is frequent acid reflux (about more than twice a week). Acid reflux occurs when acid in your stomach comes up through the valve between your stomach and your esophagus, also known as the lower esophageal sphincter (LES). This causes a burning chest discomfort, or what we know as heartburn. Some patients may also experience regurgitation, where contents of the stomach such as partially digested food or acid travels up to the mouth or upper portion of the esophagus.
While it’s true that heartburn is an indicator of GERD, it may also represent other medical conditions. Similarly, you can also have GERD without experiencing heartburn. Why? Because GERD consists of several other symptoms, such as:
- Chest pain
- Chronic cough
- Difficulty swallowing
- Dental decay
2. Anyone can take over-the-counter medications for GERD unmonitored
There are several medications doctors including myself prescribe to temporary heartburn relief. These medications can easily be bought at your local pharmacy too. They include:
- Proton pump inhibitors (PPI), such as omeprazole
- H2 blockers
All 3 work to reduce your stomach’s exposure to acid. PPIs and H2 blockers block acid secretion in the stomach, and antacids neutralise acid in the stomach. Often, patients self-medicate without checking in with a doctor. While you don’t necessarily need to be under a doctor’s supervision every time you take medication for heartburn or GERD, it is beneficial to track how often you find yourself needing these medications. Are you taking them more than twice a week, or taking them more frequently than usual? If so, please consult a doctor or specialist, as long term use of certain GERD medications can result in side effects.
For instance, prolonged use of antacids can cause diarrhoea, altered calcium metabolism and a buildup of magnesium in the body. In general, it is not a good idea to be on medication unmonitored as it is important for a doctor to first identify if you’re really suffering from GERD or some other condition. He/she will then recommend a treatment plan to alleviate symptoms.
3. Only medication can fix GERD
Medication is a common way to handle GERD, but doctors usually advise dietary and lifestyle changes first before going ahead with medication. This is because for patients with GERD, the root of the issue stems from the mechanics of their body. I usually suggest patients to:
- Lose weight if they are overweight — research has shown a strong correlation between obesity and GERD. So out of all the lifestyle changes you can make, losing weight is most likely to be most effective.
- Avoid food that increases the stomach’s level of acidity, such as spicy food and caffeinated beverages.
- Avoid food that decreases pressure in the lower esophagus, such as alcohol, fatty foods and peppermint.
- Avoid food that affect peristalsis, such as coffee and alcohol
- Eat smaller meals especially before bed
- Quit smoking as smoking weakens the LES
- Sleep on your left — if you are prone to acid reflux at night, you should sleep on your left. This is because the stomach is located on the left of the oesophagus, which makes it hard for acid to flow out of the stomach and into the oesophagus.
Only when dietary and lifestyle changes fail to work or make much of a difference is medications prescribed. If even medications don’t completely resolve symptoms and the symptoms severely interfere with your life, surgery may be recommended.
There are two types of surgery to resolve GERD –
- Fundoplication, which involves wrapping the upper part of the stomach to strengthen the LES
- LINX device, which is a ring placed at the lower end of the esophagus to prevent acid from going up the esophagus
Regardless of the solution, GERD should never be ignored as if left untreated can lead to more serious issues, including esophageal cancer.
I hope I managed to clear some misconceptions you have about GERD. Feel free to contact me if you have any questions!
- Dağlı, Ü., & Kalkan, İ. H. (2017). The role of lifestyle changes in gastroesophageal reflux diseases treatment. The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology, 28(Suppl 1), S33–S37. https://doi.org/10.5152/tjg.2017.10
- Hart A. M. (2013). Evidence-based recommendations for GERD treatment. The Nurse practitioner, 38(8), 26–35. https://doi.org/10.1097/01.NPR.0000431881.25363.84