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Support mucous-membrane healing by chewing 250 to 500 mg of deglycyrrhizinated licorice (DGL) before meals and bedtime.
Avoid smoking and excessive alcohol to ease irritation that could lead to cancer of the esophagus.
Experiment with your diet to find out what triggers the discomfort; high-fat foods, spicy foods, peppermint, spearmint, chocolate, and acidic beverages are all potential culprits.
Avoid eating prior to exercise and right before bedtime to reduce symptoms.
Aim for a healthy weight to reduce your risk of developing GERD.
Avoid excessive alcohol use that weakens the esophageal sphincter and increases the risk of GERD symptoms.
To reduce the impact of stress on GERD risk, find a program that includes group counseling, instruction in coping skills, relaxation training, and other helpful techniques for stress reduction.
Avoid exposing your infant child to secondhand smoke, as it has been linked with GERD.
See a health professional to find out if your infant child has allergies to milk or other proteins that can increase the risk of GERD.
Gastroesophageal reflux disease (GERD) is a disorder of the esophagus that causes frequent symptoms of heartburn. The esophagus is the tube connecting the mouth to the
stomach. GERD occurs when a muscular ring called the lower esophageal sphincter (LES) is weakened, which
permits irritating stomach contents to pass up into the esophagus, resulting in heartburn.
Sometimes regurgitation of acid and food as high as the mouth can occur. Chronic irritation of the
esophagus by stomach acid can eventually cause ulceration and scarring and might lead to cancer of the esophagus, especially in people who smoke and/or consume large
amounts of alcohol.1
People with GERD have heartburn, which usually feels like a burning pain that begins in the chest and may travel upward to the throat. Many people also feel a regurgitation of stomach contents into the mouth, leaving an acid or bitter taste. Some people with GERD may also have coughing while lying down, increased production of saliva, and difficulty sleeping after eating.
Smoking weakens the LES and is a strong risk factor for GERD.2, 3, 4 A study of infants with GERD found that exposure to cigarette smoke in the environment is associated with reflux, leading the authors conclude that secondhand smoke contributes directly to GERD in infants.5 No similar studies on environmental smoke have been done with adults. Psychological stress and alcohol have also been shown to be associated with the weakening of the LES and symptoms of GERD.6, 7, 8, 9
A number of studies have found that obesity increases the risk of GERD,10, 11 though one study found no association between severe obesity and GERD.12 Obese people tend to have weaker sphincters,13 and they more often develop a condition related to GERD called hiatal hernia, in which the upper part of the stomach protrudes above the diaphragm, resulting in a deformed LES.14 It has been suggested that obesity may contribute to GERD by increasing abdominal pressure, but this mechanism has not been proven.15 The benefit of weight loss for obese patients with GERD is controversial. Some researchers have found that symptoms of GERD are reduced with weight loss,16 while others have seen no change with weight loss and even increased symptoms in patients with massive weight loss.17
Lying down prevents gravity from keeping the stomach contents well below the opening from the esophagus. For this reason, many authorities recommend that people with GERD avoid lying down sooner than three hours after a meal, and suggest elevating the head of the bed to prevent symptoms during sleep.18, 19, 20
GERD occurs more frequently during exercise than at rest, and can be a cause of chest pain or abdominal pain during exertion.21 One study found that increased intensity of exercise resulted in increased reflux in both trained athletes and untrained people.22 In another study, running produced more reflux than less jarring activities, such as bicycling, while weight training produced few reflux symptoms.23 Eating just before exercise has been found to further aggravate GERD.24, 25 On the other hand, a recent survey found that people who participate in little recreational activity were more likely than active people to be hospitalized for GERD.26 It makes sense for people with GERD to use exercise as part of a healthy lifestyle, perhaps choosing activities that are less likely to cause reflux symptoms.
Infants who suffer from GERD may have a true allergy to cows' milk. Some small studies estimate that milk allergy is a cause in about 20% of infants with GERD, but a larger study of 204 infants with GERD diagnosed cows' milk allergies in 41%. For these infants, reflux symptoms improved with elimination of milk products from the diet. Some researchers advise a trial of cows' milk-elimination in all infants suffering from GERD. Infants with a condition known as multiple food protein intolerance in infancy (MFPI) have been shown to have a high incidence of GERD and may only improve when amino-acid based formula is used in place of other formulas.
Eating foods or drinking beverages flavored with spearmint, peppermint, or other spices with strong aromatic oils causes relaxation of the LES and can contribute to symptoms in people with GERD. Chocolate also relaxes the LES and can cause heartburn. Acidic beverages like juices, coffee, and tea have also been linked to increased heartburn pain, as have carbonated drinks, alcohol, and milk.
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Licorice, particularly as chewable deglycyrrhizinated licorice (DGL), has been shown to be an effective treatment for the healing of stomach and duodenal ulcers; in an uncontrolled trial, licorice was effective as a treatment for aphthous ulcers (canker sores). A synthetic drug similar to an ingredient of licorice has been used as part of an effective therapy for GERD in both uncontrolled and double-blind trials. In a comparison trial, this combination proved to be as effective as cimetidine (Tagamet), a common drug used to treat GERD. However, licorice itself remains unexamined as a treatment for GERD.
Other herbs traditionally used to treat reflux and heartburn include digestive demulcents (soothing agents) such as aloe vera, slippery elm, bladderwrack, and marshmallow. None of these have been scientifically evaluated for effectiveness in GERD. However, a drug known as Gaviscon, containing magnesium carbonate (as an antacid) and alginic acid derived from bladderwrack, has been shown helpful for heartburn in a double-blind trial. It is not clear whether whole bladderwrack would be as useful as its alginic acid component.
Hydrochloric acid and digestive enzymes are sometimes recommended by practitioners of natural medicine in the hope improved digestion will help prevent reflux. However, these therapies have not been researched for their effectiveness.
1. Gignoux M, Launoy G. Recent epidemiologic trends in cancer of the esophagus. Rev Prat 1999;49:1154-8 [in French].
2. Castell DO. Physiology and pathophysiology of the lower esophageal sphincter. Ann Otol Rhinol Laryngol 1975;84:569-75 [review].
3. Stanghellini V. Relationship between gastrointestinal symptoms and lifestyle, psychosocial factors and comorbidity in the general population: results from the Domestic/International Gastroenterology Surveillance Study (DIGEST). Scand J Gastroenterol Suppl 1999:231:29-37.
4. Locke GR 3rd, Talley NJ, Fett SL, et al. Risk factors associated with symptoms of gastroesophageal reflux. Am J Med 1999;106:642-9.
5. Alaswad B, Toubas PL, Grunow JE. Environmental tobacco smoke exposure and gastroesophageal reflux in infants with apparent life-threatening events. J Okla State Med Assoc 1996;89:233-7.
6. Castell DO. Physiology and pathophysiology of the lower esophageal sphincter. Ann Otol Rhinol Laryngol 1975;84:569-75 [review].
7. Stanghellini V. Relationship between gastrointestinal symptoms and lifestyle, psychosocial factors and comorbidity in the general population: results from the Domestic/International Gastroenterology Surveillance Study (DIGEST). Scand J Gastroenterol Suppl 1999:231:29-37.
8. Rodriguez S, Miner P, Robinson M, et al. Meal type affects heartburn severity. Dig Dis Sci 1998;14:157-9.
9. Locke GR 3rd, Talley NJ, Fett SL, et al. Risk factors associated with symptoms of gastroesophageal reflux. Am J Med 1999;106:642-9.
10. Halsted CH. Obesity: effects on the liver and gastrointestinal system. Curr Opin Clin Nutr Metab Care 1999;2:425-9 [review].
11. Locke GR 3rd, Talley NJ, Fett SL, et al. Risk factors associated with symptoms of gastroesophageal reflux. Am J Med 1999;106:642-9.
12. Lundam L, Ruth M, Sandberg N, Bove-Nielson M. Does massive obesity promote abnormal gastroesophageal reflux? Dig Dis Sci 1995;40:1632-5.
13. Fisher BL, Pennathur A, Mutnick JL, Little AG. Obesity correlates with gastroesophageal reflux. Dig Dis Sci 1999;44:2290-4.
14. Wilson LJ, Ma W, Hirschowitz BI. Association of obesity with hiatal hernia and esophagitis. Am J Gastroenterol 1999;94:2840-4.
15. Merced CD, Rue C, Hanelin L, Hill LD. Effect of obesity on esophageal transit. Am J Surg 1985;149:177-81.
16. Fraser-Moody CA, Norton B, Gornall C, et al. Weight loss has an independent beneficial effect on symptoms of gastro-oesophageal reflux in patients who are overweight. Scand J Gastroenterol 1999;34:337-40.
17. Kjellin A, Ramel S, Rossner S, Thor K. Gastroesophageal reflux in obese patients is not reduced by weight reduction. Scand J Gastroenterol 1996;31:1047-51.
18. Kitchin LI, Castell DO. Rationale and efficacy of conservative therapy for gastroesophageal reflux disease. Arch Intern Med 1991;151:448-54. [review]
19. Galmiche JP, Letessier E, Scarpignato C. Treatment of gastro-oesophageal reflux disease in adults. BMJ 1998;316:1720-3.
20. Piesman M, Hwang I, Maydonovitch C, Wong RKH. Nocturnal reflux episodes following the administration of a standardized meal. Does timing matter? Am J Gastroenterol 2007;102:2128-34.
21. Shawdon A. Gastro-oesophageal reflux and exercise. Important pathology to consider in the athletic population. Sports Med 1995;20:109-16. [review]
22. Soffer EE, Wilson J, Duethman G, et al. Effect of graded exercise on esophageal motility and gastroesophageal reflux in nontrained subjects. Dig Dis Sci 1994;39:193-8.
23. Clark CS, Kraus BB, Sinclair J, Castell DO. Gastroesophageal reflux induced by exercise in healthy volunteers. JAMA 1989;261:3599-601.
24. Yazaki E, Shawdon A, Beasley I, Evans DF. The effect of different types of exercise on gastro-oesophageal reflux. Aust J Sci Med Sport 1996;28:93-6.
25. Clark CS, Kraus BB, Sinclair J, Castell DO. Gastroesophageal reflux induced by exercise in healthy volunteers. JAMA 1989;261:3599-601.
26. Ruhl CE, Everhart JE. Overweight, but not high dietary fat intake, increases risk of gastroesophageal reflux disease hospitalization: the NHANES I Epidemiologic Followup Study. First National Health and Nutrition Examination Survey. Ann Epidemiol 1999;9:424-35.
Last Review: 06-08-2015
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