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Gastroesophageal Reflux Disease
Table of Contents
1. What is the significance of reflux disease
Reflux disease, also known as gastroesophageal reflux disease, is a chronic condition in which the contents of the stomach return to the esophagus due to weakening of the lower esophageal sphincter (LES). The pressure in the stomach is higher than in the esophagus, so in case of excessive relaxation of the LES, the stomach contents move back into the esophagus, causing a range of unwanted symptoms.2. What are the symptoms of GERD?
The symptoms of gastroesophageal reflux disease (GERD) can be divided into esophageal symptoms such as heartburn, regurgitation, dysphagia (difficulty swallowing), dyspepsia (indigestion), and chest pain, often burning; and extraesophageal symptoms such as cough, hoarseness, and throat clearing. These symptoms are often confused with other disorders, such as cough with respiratory diseases and indigestion with normal overeating. Similarly, chest pain is often attributed to a cardiological disorder rather than an identification with GERD. Therefore, it is important to conduct a thorough medical history, order appropriate tests, and practice self-observation.3. Identification of the disease
If any of the aforementioned symptoms occur, it is advisable to seek medical advice to determine their origin. Based on the interview, the doctor may recommend the following: gastroscopy, pH measurement in the esophagus (assessment of pH in the esophagus), esophageal pressure measurement (assessment of esophageal pressure), swallowing impedance measurement (evaluation of swallowing motor function and type of reflux: acidic/non-acidic). Based on this, the doctor can rule out or confirm the presence of a reflux disease and choose the best form of treatment.4. Therapeutic procedures
Therapeutic procedures are multifaceted, and in order to be effective and reduce the symptoms of reflux, they must include: the use of medicines to reduce gastric secretion, modification of the patient's lifestyle, including dietary habits, and in particularly severe cases surgical treatment.5. What alterations in lifestyle and diet are necessary
Lifestyle and dietary habits play a significant role in the treatment and prevention of reflux disease. The recommendations from physicians and nutritionists include:6. Reduction of body mass
Significantly aids individuals struggling with overweight and obesity, particularly those with the so-called abdominal type, also known as the apple type. In this case, body mass exacerbates the symptoms of the disorder. An excessive amount of adipose tissue leads to an increase in intraabdominal pressure, which in turn leads to an aggravation of reflux symptoms. Studies have shown that individuals afflicted with reflux who have reduced their body mass have experienced a significant alleviation of symptom distress.7. Cessation of smoking
Consumption of cigarettes lowers the degree of LES tension due to its soothing effect. Consequently, smoking can result in an excessive amount of gastric content seeping into the esophagus, thereby intensifying the symptoms.8. Restriction of alcohol intake
Alcohol, similar to cigarettes, decreases the pressure of the lower esophageal sphincter (LES) and contributes to the worsening of reflux symptoms. Additionally, it increases the amount of salty acid secreted in the stomach, which, in excess and in the absence of concurrent food intake, leads to irritation of the gastric mucosa and an escalation of the symptoms, and can even be the cause of the formation of ulcers and, in the future, stomach cancers.9. I modify my positioning throughout rest and sleep
Throughout rest and sleep, it is essential to ensure a slight elevation so that your head and body are positioned above your stomach. This allows gravity to hinder the regurgitation of stomach contents, enabling easier esophageal cleansing and reduced symptoms.10. Modifications in diet encompass:
– Consuming small meals at regular intervals. It is recommended to consume 5-6 meals per day at regular intervals of 3-4 hours; – in case of reflux disease in highly athletic individuals, it is possible to consume more meals in order to provide adequate calorie intake; – slow eating, thorough chewing to facilitate gastric digestion. In case of fast meals, large amounts of air should also be ingested, which increases intra-abdominal pressure and thus increases the effects of gastric reflux; – large amounts of fluid should not be consumed during meals to avoid diluting stomach acids and thus impairing digestion; – after eating, it is recommended to avoid lying down for at least 2 hours. The last meal should be consumed approximately 3-3.5 hours before going to bed, as the cleaning of the esophagus in the lying position is less effective; – adequate fluid intake – it is recommended to consume at least 1.5 liters of still, low-mineralized mineral water; – it is not recommended to drink citrus juices, as they can exacerbate the occurrence of reflux symptoms. It is also worth avoiding strong coffee and tea drinks and carbonated beverages, as they can act irritatingly on the gastric mucosa. Some recommend consuming milk to reduce the symptoms of reflux. Unfortunately, excessive intake of milk has the opposite effect, increases the production of stomach acids, and thus exacerbates the symptoms. It is recommended to drink no more than 1-2 glasses of milk per day; – proper selection of meals and their preparation – it is recommended to consume steamed, cooked, fried, or stewed meals without added fat. Reducing the intake of fat in the diet allows for reducing the number of self-initiated LES relaxations and thus reducing the symptoms of reflux. Reducing the intake of fiber reduces the irritation of the mucosa, which also has an impact on reducing the discomfort. It is worth noting that in case of introducing exclusions of products, it is worth consulting with a specialist to discuss the introduction of appropriate supplementation to compensate for deficiencies in macro- and micronutrients.11. Comprehensive list of products that exacerbate reflux symptoms:
Beverages: coffee, tea, alcohol, carbonated drinks, citrus juices, tomato juice, butter stew, hot chocolate; Cereal products: coarse-grained cereals such as grits; Dairy - full-fat milk, melted cheese, feta, blue cheese, sour cream, cream, scrambled eggs fried in fat; Meat - canned meats, pâté, fatty pork, duck, goose, bacon; Fats - lard; Vegetables - onion-like, legume-like, leek, artichokes, garlic, asparagus; Fruits - citrus fruits such as orange, tangerine, kumquat, lime; Spices - chili, horseradish, black pepper, curry, ginger, mustard; Sauces - mayonnaise, mustard, or based on full-fat cream; Sweets - chocolate and high-fat baked goods. In cases of individuals with pronounced reflux symptoms or those engaged in competitive sports, a visit to a qualified dietitian is necessary to establish the most optimal diet plan based on the collected history, the sport practiced, and the degree of disease progression.12. How to reconcile physical activity with reflux disease
Reflux disease is particularly burdensome for physically active individuals. Very intense physical exertion aggravates the symptoms of reflux and effectively hinders the execution of training. Exertion of low and moderate intensity is highly recommended to strengthen the abdominal muscles, especially the digestive tract, which may reduce the anxiety associated with the disease. We should consider the most intense physical exertion with the symptoms of reflux and the most physically inactive dietary exercise so far. We must take into account the physiological and hygienic implications of exercise: walking, jogging, swimming, walking, and jogging.
