Remember that office party and how we had so much heartburn from all that pizza and chocolate cake? We felt that burning all night. For some of us, this is a rare occurrence. But for others, this is a daily routine. Oftentimes the word GERD (Gastroesophageal Reflux Disease) is thrown around. But what is GERD? What causes it? And can we live with it?
At the gastroesophageal junction, where our esophagus meets our stomach, is a sphincter called the lower esophageal sphincter. It’s not exactly a valve that flaps back and forth. Rather, esophageal muscle fibers, the diaphragmatic cura, and a structure called the phrenoesophageal ligament make up this lower esophageal sphincter. The diaphragmatic crura and the phrenoesophageal ligament mechanically create an extrinsic pinch such that the gastroesophageal junction isn’t always open. From time to time, the lower esophageal sphincter relaxes. When this occurs, stomach contents, which tends to be acidic, can reflux up towards our esophagus. We do need some acid to digest our food, so our stomach is accustomed to acid exposure. However, our esophagus is not. Too much acid in our esophagus can give us heartburn. The lower esophageal sphincter relaxes when we’re swallowing food. However, even when we’re not eating, the sphincter can transiently relax. We all have a normal degree of these transient lower esophageal sphincter relaxation events. However, some people have more relaxation events than others – beyond what is considered normal – thus leading to more acid exposure time, more heartburn, and more GERD.
Some lab studies show that tobacco smoking, peppermint, alcohol, greasy foods, carbonated beverages, and chocolate may reduce the lower esophageal sphincter pressure. Other lab studies show that acidic foods (examples include citrus and tomato-based products), caffeinated items, and spicy foods do not actually affect the lower esophageal sphincter. However, these products tend to be more irritating in general, thereby causing more GERD symptoms of heartburn. For these reasons, avoiding excess intake of alcohol, tobacco smoking, peppermint, chocolate, fatty foods, caffeine, spicy foods, and acidic foods may help with GERD.
Being overweight can also increase the risk of having GERD. Carrying a little extra love (or an abdomen of wisdom as my husband likes to call it) around our belly area causes mechanical compression upon our stomach such that the lower esophageal sphincter may relax more. So, losing some of that love may help with GERD. Sitting up straight for 3-4 hours after eating or sleeping on our left side may help with GERD because gravity is more on our side then.
So, can we live with GERD? Yes, a lot of us do. Some of us do fine with lifestyle strategies. Others need the occasional antacid. Still others take antacids on a more chronic basis. I like to say if we can get off medications, that’d be ideal. However, we may need them for a quality of life such that we’re not suffering from all that reflux.