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CAUSES AND DIETARY MANAGEMENT OF GERD

CAUSES AND DIETARY MANAGEMENT OF GERD

by Dietitian Zoya Faisal on January 27th,2022

Our digestive system is one of the most important part of our body and involves various organs and associated structures which helps in maintaining the metabolism of body and helps the digestive system to work properly. Without a healthy digestive system, it is not possible for us to survive in a healthy way. Sometimes our behavioral and dietary habits upset the mechanism of digestive system which provokes various health related issues such as GERD and esophagitis. So let’s discuss the causes and dietary management of GERD.

Gastroesophageal reflux disease (GERD) is a condition in which the lower esophageal sphincter relax transiently and permits the contents to enter the esophagus. Regurgitation and spitting up of components are the main symptoms of GERD. GERD is totally treatable disease and can be treated through adopting various behavioral and dietary modifications.

Photo Credits: Cleveland Clinic

Etiology of GERD

It is a normal physiologic process that occurs several times a day in infants (healthy), children, and adults. We can associate this condition with transient relaxing of the (LES) lower esophageal sphincter (permit contents to enter the esophagus). In about 50% of infants, regurgitation and spitting up are the main symptoms. In simple words, we can say that this condition arises when the reflux of gastric contents in the esophagus occurs (it can also reflux back and go to the oral cavity/lungs). HEART BURNING is more prevalent in developed countries than in ASIA. Esophagogastroduodenoscopy (EGD) helps in identifying different types of GERD. GERD can be classified as the presence of symptoms without abnormalities or erosions on endoscopic examination (non-erosive disease or NERD) or GERD with symptoms and declines present (ERD). 

(ERD) has more severe symptoms than (NERD). There is a condition called nocturnal GERD in which patients experience symptoms more at night time than in day time. Nocturnal GERD leads to esophagitis (inflammation) of the esophagus and the patient has difficulty sleeping. (ERD) is more common in men, and (NERD) is more common in women. GERD is also linked with obesity. Different studies show that GERD is more common in those with high BMI. GERD is also common in pregnancy and can occur in any trimester. 

Coming towards its pathophysiology

GERD has a complex pathophysiology. Read the table below to know the possible causes.

       Let’s try to find out the mechanisms involved in the cause of GERD.

  • You can get this condition when your saliva is decreased
  • Transient lower esophageal sphincter relaxation is a cause of GERD
  • When (LES) pressure is down, you can get GERD
  • Impaired esophageal acid clearance
  • An increase in the sensitivity of one’s esophagus leads to GERD
  • Acid pocket (during the postprandial period)
  • Growth in the intraabdominal pressure leads to this condition
  • Delayed gastric emptying

The esophagogastric junction has three components: (LES) a 3-4 cm segment made by smooth muscles, the crural diaphragm, and the anatomic flap valve. (Anti-reflux barrier)

The tone of (LES) varies. 

The gastric distension enhances the relaxation of (LES). On average, transient (LES) relaxations persist for about 20 seconds, significantly longer than the typical swallow-induced relaxation. The reflux occurs when the pressure in the proximal stomach increases. Patients with (COPD) are at more risk as their intraabdominal pressure is high. It is the same case with the pregnant population and obese persons. The erosive esophagitis leads to hypersensitivity. It is also caused by impaired mucosal barrier function. The studies show us that delayed gastric emptying ultimately leads to GERD. Some studies support that this relationship has nothing to do with developing this condition (GERD). We have to overcome the complications. 

Behavioral modifications (Esophagitis) 

We should avoid

  • Eating within three to four hours of retiring
  • Lying down after meals
  • Tight-fitting garments
  • Cigarette smoking  

Nutrition management of GERD

Firstly we have to set our small and short-term goals. We have to decrease the exposure of the esophagus to gastric contents. We have to reduce the acidity of gastric secretions. We have to prevent pain and irritation. There are certain things which we have to avoid. 

  1. Large meals
  2. Fat (dietary)
  3. Alcohol 
  4. Coffee more than one cup in a day
  5. Fermented alcoholic beverages
  6. Any food that the patient feels exacerbate their symptoms

Dietitian Zoya Faisal is a freshly graduate nutrition student and is clinical internee at Farooq hospital, Lahore. She can be reached at @doctors_and_dietitians

Disclaimer: The information in this article is not intended as sound medical advice for your particular illness; rather, it is meant to increase awareness of common health issues. Before implementing any recommendations made in this article or choosing a treatment plan based on its contents, you should always speak with a qualified healthcare professional.

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