Gastric reflux

Heartburn, dyspepsia, indigestion or reflux, call it what you want – that uncomfortable feeling after eating indicates your digestive system is not happy. Reflux is medically referred to as Gastroesophageal reflux disease or GERD. Symptoms can lead to changes in the oestophagus and be associated with other health disorders. Asthma, ear infections, adenoid hypertrophy, colic in babies and allergies are all conditions which may be related to acid reflux.

What is gastric reflux?

Acid reflux refers to the leaking of stomach acid into the gullet (oesophagus). Oesophagitis is inflammation of the lining of the oesophagus – usually caused by reflux of stomach acid. For some people the lining of the oesophagus is more sensitive and unpleasant symptoms can be experience. In some cases, no symptoms are felt but reflux is occurring and causing damage.

GERD – gastroesophageal reflux disease is the term used to describe acid reflux with or without symptoms. 

Common symptoms of gastric reflux

Symptoms may be experienced after eating or from eating certain foods and can come and go - in other words can occur regularly or occasionally. These commonly include heartburn, pain, acidic taste, burping, belching, bloating, hoarseness, cough, wheezing and feeling sick.

• Heartburn is the most common symptom and is described as a burning sensation felt from the upper abdomen, lower chest and throat. Nothing to do with the heart.
• Pain in abdomen and chest (which can cause anxiety due to the close proximity to the heart)

Other less common symptoms include a persistent cough, particularly at night due to acid reflux irritating the trachea (windpipe). Asthma cough or wheeze due to acid reflux. Acid may cause irritation in the gums and mouth, may cause throat to feel dry and sore or a feeling of a lump in the throat. These can be symptoms of other disorders and should be evaluated.

What causes gastric reflux?

Gastric reflux occurs when the acid from the stomach is allowed to leak through the top of the stomach into the gullet (oesophagus). Normally a circular band of muscle (known as a sphincter) at the bottom of the gullet prevents this from happening. In cases of reflux this mechanism does not work as well as it should. Why this happens is not always known, but commonly due to the rise of the stomach putting pressure on the sphincter.

This may occur after a large meal, during pregnancy or when bending forward.

Impaired gastric emptying and constipation can cause many gastrointestinal problems.

Hiatus hernia is a protrusion of the stomach through the diaphragm into the chest. This condition may increase the chances of developing reflux.

Eosinophilic oesophagitis (allergy-related oesophagus) – history of allergic reactions including allergic rhinitis, asthma and atopic dermatitis.

Drug-induced esophagitis is generally the incomplete passage of medication to the stomach.

Smoking. Chemicals found in cigarettes have a relaxing effect on the sphincter at the bottom of the oesophagus.

Obesity. Extra body weight, especially around the midsection, can put pressure on the stomach forcing pressure on the sphincter.

Some Foods and drinks can cause the sphincter to relax - resulting in reflux of stomach contents. Common food culprits include tomatoes, citrus fruits, cucumbers, onions, garlic, peppers, spicy foods, mint, chocolate, coffee, hot beverages and alcohol. Fatty foods may delay stomach emptying and slow digestion.

Tight clothing - pressure on the stomach

Coughing 

Ignoring symptoms

Prolonged symptoms may lead to concerning health conditions such as: oesophagitis, development of peptic oesophageal ulcer, oesophageal stricture (narrowing of the oesophagus), Barrett’s oesophagus and cancer (rare). Barrett’s oesophagus is a condition where abnormal changes have occurred in the lining of the oesophagus and is considered premalignant. The changes are thought to be an adaptive measure to the constant exposure to acid.

Avoiding gastric reflux

Prevention is always better than having to rely on symptom relief, and could be as simple as reducing the size of meals eaten. 

Impaired gastric emptying is a contributor to the pathophysiology of gastrointestinal problems so regular bowel emptying and avoiding constipation is important. Include fibre-filled foods (whole grains, legumes, nuts and seeds), fruit and vegetables in the diet and avoid processed food. 

Add some probiotic foods - such as kefir, yoghurt, kimchi or fermented vegetables for optimal bowel health.

In some cases the use of digestive enzymes are needed to help with the break-down of food. These are taken around the meal time and can be helpful whilst transitioning to a healthier diet. 

Lifestyle and eating habits are very important and are easy modifications:

• Reduce the amount eaten at one meal and avoid eating late at night.
• Enjoy your meal, chewing well and eating slowly.
• Remain upright after eating.
• Avoid irritating foods – the list is long and individual. Let food be your guide.
• Supplement with digestive enzymes and probiotics to support digestion
• Stop smoking. If you need another reason.
• Reduce weight.
• Avoid exercising close to eating.
• Eat more alkaline foods – these include vegetables, non-acidic fruits and fibre foods.

Symptom relief 

Alginate, pectin and carbenoxolone (a synthetic derivative of glycyrrhizin) are compounds when introduced to gastric acid form polymers and float to the surface of the stomach - forming a raft, effectively providing a barrier that protects the oesophagus from acid reflux.

Slippery elm (Ulmus rubra) forms a gel which coats and soothes the inflamed mucosa whilst forming a barrier against acidity and stimulating the production of mucous.

Turmeric (Curcuma longa) can offer a wide range of benefit to the gastrointestinal tract offering protection against gastric mucosa damage.

Therapeutic applications of curcumin include:

• Prevention of reflux oesophagitis (GORD)
• Protect against damage from the use of NSAIDs
• Prevention of Barrett’s oesophagus
• Anti- helicobacter pylori activity (a bacteria associated with stomach ulcers and cancer which resides in the acidic environment of the stomach)
• Accelerate gastric ulcer healing

Note: Avoid using turmeric with black pepper (often included in supplements) due to the possible irritation.

Quercetin may reduce oesophageal inflammation and decrease acid and the production of pepsin in the stomach.

Chamomile (Matricaria chamomilla) offers an anti-inflammatory action helpful for the relief of symptoms of reflux and aids in the digestive process.

Liquorice (Glycyrrhiza glabra) use as an anti-inflammatory has been documented since ancient times. It is beneficial for its soothing and healing action on the mucosa. It aids the healing of gastric and duodenal ulcers, reduces spasms and gastritis and prolongs the life of stomach surface cells (antipepsin effect).

Ginger can help prevent dyspepsia. It offers a carminative action and helps by decreasing pressure on the lower esophageal sphincter, helps accelerates gastric emptying and reduces intestinal cramping. 

Melatonin is synthesised in the gastrointestinal tract and increases after eating. It has been identified as an important gut motility signal and an effective signalling molecule between the gut and the liver. Significant amounts have been found in the oesophagus mucosa. Melatonin stimulates microcirculation and modulates nitric oxide production and prostaglandin E2, both of which protect the mucosa from damage. It inhibits the production of gastric acid, has been found to reverse inflammatory lesions and reduce lipid peroxidation, which can occur as a result of gastric juice and bile.The amount of melatonin in supplements found to be affective was 6mg.

Vitamin E alpha-tocopherol. Lowers acid production and reduces inflammation.

References

1. https://www.msdmanuals.com/professional/gastrointestinal-disorders/esophageal-and-swallowing-disorders/gastroesophageal-reflux-disease-gerd?query=reflux
2. https://www.mayoclinic.org/diseases-conditions/esophagitis/symptoms-causes/syc-20361224
3. In-vivo Anti-Reflux and Raft Properties of Alginates https://pubmed.ncbi.nlm.nih.gov/2129648/
4. Gastroesophageal Reflux Disease (GERD): A Review of Conventional and Alternative Treatments http://www.altmedrev.com/archive/publications/16/2/116.pdf
5. ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus https://journals.lww.com/ajg/Fulltext/2016/01000/ACG_Clinical_Guideline__Diagnosis_and_Management.17.aspx
6. Curcumin: A Potent Protectant against Esophageal and Gastric Disorders https://www.mdpi.com/1422-0067/20/6/1477
7. Chamomile: A herbal medicine of the past with bright future https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2995283/
8. Liquorice (Glycyrrhiza glabra): A phytochemical and pharmacological review https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7167772/
9. Integrative Medicine for Gastrointestinal Disease https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5605819/
10. Ginger in gastrointestinal disorders: A systematic review of clinical trials https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6341159/