Gastro-oesphageal reflux disease (GERD)

What is gastro-esophageal reflux disease (GERD)?

Gastro-oesophageal reflux disease (GERD) is a common disorder of the digestive system where the oesophagus is exposed to the stomachs contents (partially digested food and stomach acids) through reflux or regurgitation and this causes erosion, ulceration and inflammation to the oesophagus, together with discomfort and pain.

The oesophagus (also known as the gullet) passes from the back of the throat to the stomach and it moves in rhythmic wave-like motion to move food down through it and into the stomach. At each end of the oesophagus there are sphincters – the one near the throat prevents foods from coming back up and the one near the stomach (the lower oesophageal sphincter) keeps the food in the stomach and prevents the food from coming back up the oesophagus

In people with gastro-oesophageal reflux disease (GERD), the lower oesophageal sphincter opens to allow undigested food and acid from the stomach into the oesophagus and this invariable damages the oesophagus since there is no protective lining on the oesophagus to prevent damage from the acidic contents, as there is in the stomach.

Facts about gastro-oesophageal reflux disease (GERD)

• Gastro-oesophageal reflux disease (GERD) is the most common cause of heartburn and indigestion in Western society
• It is estimated that around 25% of the population experiences symptoms from gastro-oesophageal reflux disease (GERD) weekly
• GERD is very common in Western countries where the diet is often rich in fats and high in alcohol and low in fibre
• Drinking excessive amounts of alcohol often causes reflux symptoms associated with GERD
• Caffeine causes symptoms in people with GERD
• GERD is mostly responsible for heartburn symptoms
• Reflux symptoms are very common in babies and toddler and usually does not signify any serious problem

Symptoms of gastro-oesophageal reflux disease (GERD)

The most common symptoms of gastro-oesophageal reflux disease (GERD) are:

• Acid regurgitation
• Chronic cough
• Difficulty swallowing
• Eroded dental enamel
• Heartburn
• Indigestion
• Nausea
• Postnasal drip
• Repeated feeling of needing to clear the throat
• Stomach discomfort or pain

Reflux symptoms are very common in babies and young children and are not usually due to any other factor other than a less than properly functioning digestive system, which will improve as the child gets older. If the reflux (or vomiting) is also associated with a fever or excessive irritability, this could signify an underlying disorder and parents should seek medical advice.

Less common symptoms

There are also other, less common symptoms associated with gastro-oesophageal reflux disease (GERD):

• Asthma-like symptoms
• Burping (belching)
• Chest pain
• Difficulty swallowing (dysphagia)
• Oesophageal bleeding
• Excessive production of saliva (waterbrash)
• Pneumonitis (inflammation of the lungs)
• Severe pain on swallowing (odynophagia)
• Severe stomach queasiness
• Shortness of breath
• Ulceration of the oesophagus

Sometimes reflux symptoms can be confused with a heart attack or angina because it can produce chest pain and other symptoms similar to heart attach or angina. Any chest pain needs to be investigated immediately.

Causes of gastro-oesophageal reflux disease (GERD)

There is no consensus on the cause of gastro-oesophageal reflux disease (GERD), but there are two main theories:

Ineffective lower oesophageal sphincter

When the lower oesophageal sphincter (LOS) does not close properly as it should, this can allow some of the contents of the stomach to escape up and out into the oesophagus and this causes the symptoms associated with this disorder.

There can be increased pressure on the whole oesophagus and subsequently the lower oesophageal sphincter (LOS), which ultimately causes the LOS to be unable to sustain the pressure and it opens up and some of the contents of the stomach to escape up and out into the oesophagus and this causes the symptoms associated with this disorder.

Poor gastric digestion

If food is not broken down and digested properly in the stomach, it can start to ferment while it just sits there and this can produce more gas. The gas causes pressure to be built up in the stomach, which may be sufficient to open the lower oesophageal sphincter (LOS) to expose some of the contents of the stomach to the oesophagus. The stomach contents (partially digested foods and stomach juices) are quite acidic, which can cause irritation to the lining of the oesophagus, which is not supposed to be exposed to the stomach’s content. Depending on the pressure of the stomach, its contents can go up the length of the oesophagus and into the throat or even lungs.

Prevention of gastro-oesophageal reflux disease (GERD)

Non-preventable risk factors

GERD may be unpreventable in certain circumstances:

• Babies and infants – reflux symptoms are very common in babies and toddler, are not easy to prevent and usually do not signify any serious problem
• Genetics – some people are just born with a less than properly functioning lower oesophageal sphincter (LOS) which can predispose a person to this condition
• Poor gastric digestion – if the digestion process that begins in the stomach is not happening as it should, this could cause more acid to be produced to try to digest the partially digested food and this causes higher level of gas to be produced. This may cause gastric pressure to rise and enable contents of the stomach to be exposed to the oesophagus and cause symptoms
• Pregnancy – the hormones circulating and extra pressure on the abdominal area can loosen the normal pressure of the lower oesophageal sphincter (LOS) and cause reflux symptoms

Preventable risk factors

There are ways to either reduce symptoms or even prevent GERD from occurring:

• Chew food properly – eating food without chewing it properly puts extra pressure on the stomach to try to break it down, so it produces more acids which produces more gas and this can produce symptoms associated with GERD (and some experts believe it can be a major factor in causing it)
• Less caffeine – a high intake of caffeine is a known factor which puts extra pressure on the lower oesophageal sphincter (LOS). This is another risk factor for triggering symptoms. People who drink a lot of coffee or eat a lot of chocolate often experience worsening of symptoms with an increase in caffeine intake. This is due to caffeine’s effect on reducing the pressure on the lower oesophageal sphincter (LOS)
• Lose weight – being in a normal weight range decreases any extra pressure on the lower oesophageal sphincter (LOS) and may reduce severity and duration of symptoms. Excess weight puts a lot of pressure on the whole digestive system and especially on the lower oesophageal sphincter (LOS) and can cause reflux symptoms. The LOS is the flap that ensures the stomach contents are kept intact and do not rise out
• Reduce alcohol intake – a well known risk factor for triggering symptoms is excessive alcohol intake. This is because alcohol puts pressure on the whole digestive system, but especially the lower oesophageal sphincter (LOS) which can produce quite severe symptoms, depending on the amount of alcohol intake
• Stop smoking – smoking is a known factor which puts extra pressure on the lower oesophageal sphincter (LOS) and this can cause reflux symptoms

Complications of gastro-oesophageal reflux disease (GERD)

There are a number of complications of gastro-oesophageal reflux disease (GERD), some of which are mostly rare, but can occur if symptoms continue unabated and very long term without proper treatment to heal the damage of the oesophagus.

Barrette’s oesophagus

This is a condition which is defined when there are changes in the cells that line the part of the oesophagus which is closest to the stomach. These changes in the cells of the oesophagus are thought to lead to oesophagus cancer.

This condition is normally diagnosed when an endoscopy is performed and a biopsy is taken, although many people with Barrette’s oesophagus do not know they have it. Follow-up endoscopy is recommended on a regular basis for people who have Barrette’s oesophagus (every five year).

Cough and / or asthma

Gastro-oesophageal reflux disease (GERD) is irritating to the oesophagus and this causes a coughing reflex in many people. In more susceptible people, it can even trigger asthma symptoms due to the irritation it causes.

Sore throat and / or pneumonia

If any of the liquid from the stomach rises out through the oesophageal sphincter, up through the oesophagus and into the throat (pharynx) it can cause inflammation to the throat that can make it sore (due to the acidic nature of the liquid).

A sore throat is not the only complication of the refluxed liquid. If any of it rises high enough and passes through the larynx it can enter the lungs, which can infect the lungs severely enough to cause pneumonia, which is a serious infection of the lungs that needs urgent medical intervention.

Strictures

Prolonged and repeated reflux into the oesophagus can damage the cells of the oesophagus and cause scar tissue (or stricture) to form. Strictures can be a serious complication of this condition when food particles get lodged and this can cause choking. While strictures are a very rare complication of gastro-oesophageal reflux disease (GERD), they do occur in a small percentage of people with this condition.

Adenocarcinoma

While it is quite rare, there is a cancer which can occur in people with gastro-oesophageal reflux disease (GERD), especially those who have Barrette’s oesophagus. This type of cancer occurs in the area where the stomach and oesophagus meet.

When to see a doctor about gastro-oesophageal reflux disease (GERD)

People who have any of the symptoms of GERD should see their doctor to properly diagnose their gastric symptoms and get advice on treatment.

The sooner that treatment can begin (even if it is just lifestyle and dietary modifications), the sooner that the worse of symptoms can be avoided or at least greatly limited.

People with gastro-oesophageal reflux disease (GERD) often delay a visit to the doctor for a long time, usually just self-medicating with antacids and other over-the-counter medications.

Babies who have reflux symptoms and also have a fever, are not looking well or not feeding should be taken to a doctor immediately as there may be an underlying condition which needs urgent medical intervention.

Diagnosis of gastro-oesophageal reflux disease (GERD)

Initially, a doctor will perform the following tests to diagnose gastro-oesophageal reflux disease (GERD):

• Medical history – this will consist of of a series of questions about the nature, duration and intensity of the symptoms and also when the symptoms started. The doctor will also ask if any specific activities make the symptoms worse (or reduce them)
• Physical examination – the doctor will examine the stomach area for pain or discomfort, by pressing down (gently to firmly) on various parts of the upper and lower abdomen while the patient is lying down on the examination table

Further diagnostic tests

If warranted, further diagnosis can be undertaken with the following:

• Barium meal – this test is not often performed to diagnosing gastro-oesophageal reflux disease (GERD) as there are other tests which give a better diagnosis, although it used to be. The barium meal involves swallowing a barium liquid, which is then x-rayed as it goes through the oesophagus and stomach. It is used more to determine if there are any strictures present in people who have difficulty swallowing food properly
• Endoscopy (or gastroscopy) – this is a diagnostic test which is performed under light sedation by a gastroenterologist to definitely diagnose the cause of the reflux and the procedure is as follows:
  • The gastroenterologist inserts a sterile, flexible tube with a camera at one end inside the mouth and through the oesophagus into the stomach
  • Images are taken of the stomach lining
  • A small amount of the oesophagus and stomach lining is taken to perform test to determine cause of GERD, to rule out Barrette’s oesophagus and to ensure there is malignancy in the oesophagus
  • The procedure is usually performed on a day patient basis with patients spending only a few hours in the surgery
• Manometry – this test is performed for people who have problems swallowing and pain on swallowing, to determine if the oesophageal nerves muscles are causing the problem. In this procedure, a thin plastic tube is placed through the nose and down the oesophagus, which is used to measure pressure of the oesophageal muscles as food goes down
• pH monitoring – this diagnostic test is only used when endoscopy and medication have been unsuccessful and prior to surgery. This test involves a thin plastic tube through the nose and down the oesophagus. At the end of the tube in the oesophagus measures the amount of acid present over 24 hours
• Video capsule endoscopy – this diagnostic test involves swallowing a small pill-sized camera that goes down the oesophagus and into the stomach in the same path that food normally would. It transmits video images which are reviewed by a gastroenterologist to determine if there is any obvious underlying disorder or if endoscopy with included biopsy is required. This test does not requite preparation or sedation and takes about one minute to complete, but as it is very expensive, it is not routinely performed

Conventional treatment of gastro-oesophageal reflux disease (GERD)

Conventional treatment of gastro-oesophageal reflux disease (GERD) involves treating the symptoms to reduce their effects and is based on a number of approaches used in conjunction.

Dietary modifications

It is well documented that some foods can make reflux symptoms worse, but not everyone will have the same reaction to these foods every time.

The best way to determine which foods cause exacerbation of symptoms, keep a dairy of symptoms and remove these foods from the diet (or strictly limit them) and re-introduce them, one food at a time later to see if they still cause symptoms.

Lifestyle modifications

The following lifestyle modifications are recommended to reduce severity and duration of symptoms:

• Add fibre to the diet – it is really important to add some fibre to the diet, especially soluble fibre in the form of oat bran, psyllium, as it helps the digestive system become more healthy by reducing the pressure in the digestive system. Fibre also helps to reduce constipation symptoms
• Avoid large meals or eating late at night – large meals cause a lot of pressure on the digestive system as it needs to break down, digest and absorb the food that has been eaten. Digestion involves producing stomach acids and the more foods that are eaten, the more stomach acids that need to be produced, which can cause reflux symptoms to get worse. Eating late at night is not advised, because the digestive system needs a few hours to properly digest food and eating late does not give adequate time for this to occur and this can increase reflux symptoms and discomfort and inability to get to sleep
• Avoiding lying down after meals – this can cause a great deal of reflux symptoms as it becomes very easy for the sphincter to allow stomach acids up the oesophagus as there is no gravity to prevent it
• Avoid wearing tight clothes – especially tight pants, tight tops and tight belts and this is because these tight clothes can constrict the gastro-oesophageal area, which may be inflamed and cause it to further become more inflamed and worsen symptoms
• Check medications – some medications are known to have side effects which cause reflux or make reflux symptoms worse. The most common medications to cause this are: heart medication, Parkinson’s disease medication, aspirin, non-steroidal anti-inflammatory medications (NSAIDs). People taking these types of medications and who also have GERD should ask their doctor if there are alternatives that do not aggravate their symptoms
• Elevate pillows – this is useful when the reflux symptoms occur later at night and sleep is difficult. Elevating the pillows will elevate the head, the upper part of the torso and subsequently the oesophagus so that reflux symptoms are less likely to occur
• Maintain a healthy weight – being overweight can put more pressure on the whole digestive system and cause a worsening of symptoms from the excessive fat
• Reduce alcohol intake – all alcohol, but especially red wine can make reflux symptoms much worse as they have a very low pH (too acidic)
• Reduce caffeine intake – a known trigger for causing worsening of symptoms is caffeine (from coffee, chocolate, tea or even energy drinks) and intake should be reduced to prevent symptoms
• Stop smoking – it is essential to stop smoking as studies show that smoking makes reflux symptoms worse and smoking also increases the risk of cancer of the throat and oesophagus

Medication

Gastro-oesophageal reflux disease (GERD) is treated by two different groups of medications:

• Over-the-counter medications – these medications can be purchased at a pharmacy and do not require a prescription from a doctor (although often a doctor may recommend them):
  • Antacids – as the name suggests, these medications work by reducing the amount of acid in the stomach which prevents reflux symptoms. Antacids are available in liquid, lozenge and tablet form. Common examples are: Gaviscon, Mylanta, Rennie
  • Histamine H2-receptor antagonists (H2RAs) – these medications decrease the production of acid in the stomach by suppressing the action of histamine on the parietal cells in the stomach (which normally produce the stomach acids). These medications should not be used long term as this can cause possible complications. Common examples are: Gaviscon Advance, Pepcidine, Zantac
• Prescribed medications – these are prescribed to heal the inflammation in the oesophagus and give relief from reflux symptoms. There are two classes of medications which are prescribed for this condition:
  • Proton pump inhibitors (PPIs) – this class of medications work on the reducing the pump mechanism action that produces acid in the parietal cells in the stomach and this reduces the amount of acid produced and helps to reduce reflux symptoms. This medication is usually prescribed to be taken at a higher dose at first and then tapered down for maintenance. Common examples are: Losec, Pariet, Nexium, Zoton
  • Prokinetics – this class of medications are used to help quicken the emptying of the stomach contents, so less acid is required and this helps to reduce incidence of reflux symptoms. These medications work on the nerves in the stomach, by promoting the signal to empty the stomach contents more quickly. This medication is normally taken longer term, but can be used as often or as little as required. Common examples are: Maxalon, Motilium

All medications can produce side effects and any concern about these should be discussed with a medical doctor. With the prescription medications for GERD, the PPI’s cause few side effects and are well tolerated by most people, but the prokinetics can sometimes cause side effects.

Surgery

Surgery is not often recommended for gastro-oesophageal reflux disease (GERD) and the only people who are advised to have surgery are those with very severe symptoms that cannot be adequately controlled with medication and if these symptoms cause a major impact to quality of life. Other diagnostic tests need to be performed first before surgery can be done to ensure that this type of surgery is actually warranted.

The only surgical procedure recommended is:

• Nissen fundoplication – this procedure involves keyhole surgery that wraps some of the top of the stomach around the lower end of the oesophagus and is very effective to help prevent future reflux symptoms. Sometimes complications arise if the wrapping is too tight or if swallowing becomes difficult (but these are able to be remedied)

Alternative / complementary treatment of gastro-oesophageal reflux disease (GERD)

There are a number of alternative / complementary treatment strategies which can be initially used to try to treat GERD symptoms and prevent recurrence of symptoms.

Herbs

There are a number of excellent herbs which may help to provide relief for symptoms:

• Chamomile – the herb chamomile has calming and anti-inflammatory properties which can be used in cases of mild to moderate GERD to relieve symptoms and relax the inflamed oesophageal tissue
• Marshmallow – a mucilaginous herb which provides protection of the stomach lining in the same way as slippery elm does; one caution is that it can lower blood sugar levels and cause “avitaminosis” (prevent proper absorption of vitamins and minerals) if used for prolonged periods
• Slippery elm – this is an excellent herb which provides a protective mucilaginous (mucous-like, moist and sticky) layer around the stomach lining, protecting it from the acid in the gastric juices and greatly relieving symptoms and allows the stomach lining to heal and can assist with all types of GERD, from mild to severe. Slippery elm is available in tablet or powder form – the powder needs to be mixed with water (or a little juice) and quickly drank to get the most benefits. This is a very safe herb that is not known to produce any adverse side effects when it is used correctly

Vitamins

There are a number of vitamins which may help to provide relief for symptoms:

• Vitamin A – the antioxidant vitamin A is essential in keeping the mucous membranes of the stomach lining as well as the membranes of the oesophagus healthy, which may be damaged by the gastric acids and so supplementation may be necessary
• Vitamin C – the antioxidant vitamin C is lowered when conventional medication is used to treat GERD that is caused by helicobacter pylori. In addition to this, supplementation is advised as this vital nutrient may help to heal the tissues of the stomach and oesophagus lining more effectively and more quickly. Studies have shown that vitamin C (together with the bioflavonoids) can heal GERD caused by helicobacter pylori in some people who may not be absorbing enough of this vitamin in the first place
• Vitamin E – studies have shown that vitamin E may be beneficial in preventing malignancies of the gastrointestinal tract, which may be particularly useful in people with chronic GERD as it is associated with (possible but rare malignant) changes in the oesophagus

Minerals

There are a number of minerals which may help to provide relief for symptoms:

• Magnesium – this is an excellent mineral to calm muscles and other body tissue, which are inflamed and may be tense due to GERD. Magnesium is required not just by the stomach, but every smooth muscle in the body, in order to function properly
• Zinc – the antioxidant mineral zinc has been shown in studies to help promote quicker healing of GERD symptoms and also any associated ulceration of the oesophagus and it also provides a quicker reduction in symptoms, especially if it is combined with carnosine

Other nutrients

There are a number of other nutrients which may help to provide relief for symptoms:

• Bromelain – this is an enzyme which is found naturally in pineapples and can help with proper digestion. Bromelain is found to reduce stomach pain and other GERD symptoms, especially if it is used with other digestive enzymes
• Carnosine – the amino-acid like substance carnosine has been shown in studies to be effective at healing GERD symptoms and also any associated ulceration of the oesophagus and it also provides a quicker reduction in symptoms, especially if it is combined with zinc
• Digestive enzymes – these enzymes may be beneficial to assist with digestion in the stomach and intestine
• Essential fatty acids – the essential fatty acids omega 3 and GLA especially, provide anti-inflammatory properties to reduce severity of symptoms and promote healing
• Probiotics – the ratio of “good” and “bad” bacteria may be disturbed by GERD and supplementation is required to rebalance the intestinal flora with the probiotic acidophilus

Dietary modifications

There are a number of dietary modification strategies which may help to provide relief for symptoms:

• Add fibre to the diet – it is really important to add some fibre to the diet, especially soluble fibre in the form of oat bran, psyllium, as it helps the digestive system become more healthy by reducing the pressure in the digestive system. Fibre also helps to reduce constipation symptoms
• Avoid large meals or eating late at night – large meals cause a lot of pressure on the digestive system as it needs to break down, digest and absorb the food that has been eaten. Digestion involves producing stomach acids and the more foods that are eaten, the more stomach acids that need to be produced, which can cause reflux symptoms to get worse. Eating late at night is not advised, because the digestive system needs a few hours to properly digest food and eating late does not give adequate time for this to occur and this can increase reflux symptoms and discomfort and inability to get to sleep
• Avoiding lying down after meals – this can cause a great deal of reflux symptoms as it becomes very easy for the sphincter to allow stomach acids up the oesophagus as there is no gravity to prevent it
• Cabbage juice – the juice of cabbage contains “substance U” which has proven ulcer healing properties and it can help to reduce the ulceration of the stomach (or even oesophagus) mucosa and provide relief for symptoms, reducing their severity and duration
• Chew food properly – chewing allows the food to be broken up into smaller portions which do not require as much gastric juices to be produced in the stomach to break them down further for absorption
• Eat easily digested foods – to prevent high acid production in the stomach, it is advised to eat foods which are easily digested – bananas, rice, thin porridge, toast, crackers – while symptoms are at their worst
• Eat smaller meals – while the stomach lining is inflamed it is recommended to eat small meals to prevent the high and prolonged acid production required to break down a large meal
• Limit liquids with meals – do not drink lots of water with a meal, drink it about 15 minutes before or 30 minutes after the end of a meal; the excessive water may dilute gastric juices which can cause insufficient digestion and abortion which can cause chronic GERD and other digestive disorders
• Maintain a healthy weight – being overweight can put more pressure on the whole digestive system and cause a worsening of symptoms from the excessive fat
• Reduce alcohol intake – all alcohol, but especially red wine can make reflux symptoms much worse as they have a very low pH (too acidic)
• Reduce caffeine intake – a known trigger for causing worsening of symptoms is caffeine (from coffee, chocolate, tea or even energy drinks) and intake should be reduced to prevent symptoms
• Reduce intake of fatty foods – the types of foods which can make symptoms worse are: deep fried foods, high fat foods, highly processed foods, animal fat. These foods cause pressure on the stomach to break them down, especially when intake is high and this can cause symptoms to get worse

Lifestyle modifications

There are a number of lifestyle modifications which may help to provide relief for symptoms:

• Avoid wearing tight clothes – especially tight pants, tight tops and tight belts and this is because these tight clothes can constrict the gastro-oesophageal area, which may be inflamed and cause it to further become more inflamed and worsen symptoms
• Check medications – some medications are known to have side effects which cause reflux or make reflux symptoms worse. The most common medications to cause this are: heart medication, Parkinson’s disease medication, aspirin, non-steroidal anti-inflammatory medications (NSAIDs). People taking these types of medications and who also have GERD should ask their doctor if there are alternatives that do not aggravate their symptoms
• Elevate pillows – this is useful when the reflux symptoms occur later at night and sleep is difficult. Elevating the pillows will elevate the head, the upper part of the torso and subsequently the oesophagus so that reflux symptoms are less likely to occur
• Stop smoking – it is essential to stop smoking as studies show that smoking makes reflux symptoms worse and smoking also increases the risk of cancer of the throat and oesophagus

Alternative treatments

• Naturopath – a naturopath can provide a regimen of dietary and lifestyle changes, as well as a herbal tincture (or tablets) to help heal symptoms. Each person’s symptoms are different, so you will need to consult a naturopath in person, to get a proper diagnosis and be provided treatment options

Always ensure that you notify your medical practitioner of any supplements that you want to take – it may interfere with other medication or conditions you have. Confirm with your doctor it is safe to take before you try it.

Living with gastro-oesophageal reflux disease (GERD)

Gastro-oesophageal reflux disease (GERD) requires some diligence to try to reduce symptoms and some supplementation may be required to help heal the digestive system and reduce severity and duration of symptoms. The following are the strategies most recommended to achieve this:

• Avoid cigarette smoke – people who smoke have to give up. This is just another reason to help with the decision to stop smoking. Cigarette smoke causes a number of problems with digestion and should be avoided. People who do not smoke should avoid exposure to second hand smoke from people who smoke around them
• Avoid coffee – it is advisable to avoid coffee as it can cause abdominal cramping and diarrhoea in many people with diverticulitis. There are a number of alternatives to coffee which are actually good for the digestive system (such as roasted dandelion root)
• Digestive and pancreatic enzymes – the digestive and pancreatic enzymes are released by the digestive to help digest foods that are eaten so that their nutrients can be absorbed through the bloodstream. Digestions starts mainly in the stomach and ends in the small intestine. The digestive and pancreatic enzymes help to increase the amount of food digested by reducing the load on the digestive system
• Essential fatty acids – the essential fatty acids, especially the omega 3 (DHA/EPA) and omega 6 (GLA) are vital for a properly functioning gastrointestinal system as they reduce inflammation that may be associated with this digestive disorder and this reduces severity and duration of symptoms. The best way to get adequate levels of the essential fatty acids is to eat 3-4 servings of oily fish each week and ensure it is deep ocean, wild fish (not farmed). The fish with the highest levels of omega-3 fatty acids are: mackerel, salmon, sardines, trout, tuna. People who cannot eat fish should try a supplement with balanced levels of each of the essential fatty acids and ensure it has been tested for mercury
• Fibre – increasing the amount of fibre in the diet is vital for ensuring healthy digestion. The best types of soluble fibres is psyllium, which helps the intestinal flora digest food properly. The best ways to add psyllium or slippery elm to the diet are in: smoothies, milkshakes, sauces, yoghurt, breakfast cereal, muesli, dips. Suggested dosage is up to 2-3 teaspoons per day, but add it gradually if fibre hasn’t been an integral part of the diet previously, start with 1/2 teaspoon for a few days and add another 1/2 teaspoon every 4 days until at the 2-3 teaspoons a day level
• Limit alcohol – it may be necessary to stop drinking any alcohol while the stomach, oesophagus and lower oesophageal sphincter (LOS) and the rest of the digestive system are in the process of healing and this is because alcohol is known to irritate and put pressure on these tissues and cause worsening of symptoms
• Probiotics – the “good” bacteria may be in short supply in the digestive system which could be contributing to the symptoms. Acidophilus and other probiotic bacteria are required to help re-populate the intestines with “good” bacteria, which help to properly digest foods and reduce the amount of undigested food that escapes the gut. People who are not lactose intolerant should also include yoghurt that has live cultures
• Reduce stress and relax – prolonged and unrelenting stress is not good for healthy digestion. While stress is not known to cause leaky gut syndrome, it certainly can make symptoms worse because it causes the parasympathetic nervous system to remain in stress mode, which means digestion and absorption is not effective as the nerve that controls it prevents it from happening properly. Effective stress reduction techniques are needed to reduce stress and reduce symptoms
• Slippery elm – the herb slippery elm is necessary for intestinal health as it is required to heal the intestinal mucosa by providing a mucilaginous layer over the intestinal wall, which reduces the stress on the intestines and helps to heal the intestines more quickly
• Smaller meals – eat smaller meals to help reduce the load on the digestive system, which is not working properly and cannot handle larger meals, which can cause worsening of symptoms when the stomach and intestines struggles to handle the large amount of food eaten. Aim to have around 6 smaller meals each day

Caring for someone with gastro-oesophageal reflux disease (GERD)

Partner

The best way to help a partner with GERD is to be supportive and sympathetic, but also the following can be helpful too:

• Avoiding smoking inside – people with GERD need to be away from any cigarette smoke, as it can exacerbate their symptoms
• Eating smaller meals – help your partner to eat smaller meals by joining them in eating smaller meals, as this helps support your partner a great deal. Cooking and eating smaller meals is one way to help reduce the load on the digestive system by reducing the amount of food that needs to be digested and absorbed
• Encourage a healthy diet – a healthy diet is one which has adequate amounts of fresh fruit and vegetables, whole grains, legumes, protein and healthy fats and has little or no processed foods
• Encourage exercise – going for walks (or joining a gym together) with your partner is a great way to bond. Exercise helps to improve circulation, reduces stress and encourages better health overall

Friends

People who have a friend who has GERD can support their friend by the following:

• Dinner parties – if you invite your friend to a dinner party, try to ensure there is food that they can eat. The best way to do this is to ask what foods are off limits for them and ensure to let them know beforehand which foods they should avoid
• Discourage alcohol – if your friend has GERD, they should be limiting alcohol intake as it can cause a worsening of symptoms, so try to make your social meetings ones that are alcohol free

Parents

Parents of a child who has GERD can support their child by:

• Avoid smoking inside – people with GERD need to be away from any cigarette smoke, as it can exacerbate their symptoms
• Cooking smaller meals – this is one way to help reduce the load on the child’s digestive system by reducing the amount of food that needs to be digested and absorbed and possibly reduce symptoms
• Probiotics – introduce some probiotics to the child’s diet, preferably in powder form as it can be more easily assimilated into other foods, but the tablets can also be taken if this is not successful
• Psyllium – find creative ways to add psyllium to foods (smoothies, breakfast cereal, muesli, sauces, shakes) in the child’s diet. Psyllium is a soluble fibre which has a gel-like consistency in the digestive tract and helps to promote the health of the whole gastrointestinal system
• Simple strategies for babies – putting a baby on its side when feeding is a simple way of reducing reflux symptoms; thickening the feed in older babies (older than four months) with non-GMO maize flour. Slightly raise the head of the cot to have gravity help reduce reflux symptoms
• Slippery elm – find creative ways to add slippery elm to foods (smoothies, breakfast cereal, muesli) in the child’s diet. Slippery elm is one of the herbs most beneficial for any type of digestive disorder, but especially one in which there is irritation and damage to the intestinal wall and the intestinal mucosa

References

• Osiecki H. The Physicans Handbook of Clininical Nutrition, 6th Edition. Bioconcepts Publishing QLD, 2001
• Tratter R, Jones A. Better Health Through Natural Healing: How to Get Well Without Drugs or Surgery, 2nd Edition. McGraw Hill, 2001

Last reviewed and updated: 5 May 2025