I find myself frequently explaining to people nowadays that the medications they take for heartburn can actually be harmful and do not solve the underlying issue; they merely alleviate the unpleasant symptoms. That’s why I decided to write about it separately. It is often challenging for people to accept the fact that something that provides instant relief can pose a real danger. So, let’s delve into the matter in detail.
What is acid reflux or GERD?
At the core of acid reflux is a malfunctioning lower esophageal sphincter (LES), which is supposed to close as soon as food passes through it.
Let me reiterate: it’s not an issue of excessive stomach acid production but rather a problem with the sphincter that connects the esophagus and the stomach.
If it doesn’t close completely, stomach acid (pH 1-2) can flow back into the esophagus and cause a multitude of problems.
What are the symptoms of GERD?
The most common symptoms of GERD include:
- Heartburn: Typically described as a burning sensation in the center of the chest that sometimes extends to the throat. It often occurs after eating.
- Regurgitation: This is when the contents of the stomach (acid mixed with undigested food particles) flow back into the mouth or throat.
Other GERD symptoms may include:
- Upper abdominal pain
- Chest pain
- Difficulty swallowing or pain while swallowing
- Persistent laryngitis/hoarseness due to acid irritating the vocal cords
- Chronic throat pain or coughing
- Feeling of a lump in the throat
- Nausea and/or vomiting
Over time, GERD can lead to complications. Additionally, some of the symptoms associated with GERD may be caused by other problems, which are better identified as early as possible. For instance, cardiovascular issues.
A Glimpse into Canadian Statistics:
- Approximately one-quarter of the population (24% of Canadians) experience heartburn daily or more frequently.
- 2 out of 5 GERD patients struggle with sleep issues.
- 43% of individuals feel tired and exhausted.
- One-third of GERD patients delay seeking medical attention, assuming their problem is solely due to poor diet.
- Canadian surveys indicate that the quality of life for GERD patients can be compared to that of individuals who have experienced an acute coronary event.
- Canadian research reveals that GERD patients lose 16% of their work time due to symptoms.
- Proton pump inhibitors are among the most commonly prescribed medications in Canada, with over 11 million prescriptions issued nationwide in 2012.
- In 2017, expenditures on proton pump inhibitors under Canadian government drug programs reached $198.2 million, ranking it as the seventh highest drug expenditure under such programs.
Potential Complications of GERD:
If left untreated, chronic acid reflux can cause serious harm. Complications associated with GERD include:
- Erosive esophagitis, where the esophagus is damaged by stomach acid, leading to ulcers that may bleed, eventually resulting in anemia.
- Esophageal stricture, where acid-induced scarring and narrowing of the esophagus cause blockages, leading to food or pills getting stuck in the esophagus. Scarring occurs due to repeated damage and healing of ulcers in the esophagus.
- Throat issues, as stomach acid regurgitating into the throat can cause inflammation of the vocal cords, throat pain, or hoarseness.
- Lung problems, as acid can enter the lungs and trigger symptoms of pneumonia or asthma. Prolonged acid exposure in the lungs can lead to irreversible lung damage.
- Dental problems, as recurring episodes of acid reflux can erode tooth enamel.
- Barrett’s esophagus, where normal cells lining the lower part of the esophagus (known as squamous cells) are replaced by a different type of cells (known as intestinal cells). This process usually occurs as a result of repeated damage to the esophageal lining. Barrett’s esophagus is the most common complication of GERD and typically develops 5 years or more after the onset of initial symptoms.
- Intestinal cells carry a slight risk of transforming into cancerous cells over time. As a result, individuals with Barrett’s esophagus are recommended to undergo periodic upper endoscopy to detect early warning signs of cancer.
How is GERD typically treated?
As already mentioned, temporary relief of GERD symptoms through the use of medications (both prescription and over-the-counter) is not a cure. Although it provides relief and protects the esophagus from long-term issues, there are many pitfalls to consider.
What problems can cause GERD?
You may experience problems that lead to reflux, and it is better to address and correct these issues rather than relying on medications for years that neutralize or prevent stomach acid production. Here is a list of potential problems that can contribute to GERD:
- Presence of H. pylori in the stomach – this bacterium leads to excessive stomach acid production.
- Excess weight – it puts additional pressure on the sphincter, leading to reflux.
- Use of stimulants (coffee, smoking, alcohol).
- Undiagnosed food intolerances.
- Certain foods can relax the sphincter: menthol, chocolate, tomatoes, fatty foods, citrus fruits, certain spices, etc.
- Pregnancy – excess estrogen can increase sphincter mobility. Typically, this resolves after childbirth, and complications are rare.
- Hiatal hernia – a condition in which part of the upper stomach protrudes upward through the diaphragm (a large flat muscle at the base of the lungs). The diaphragm has an opening through which the esophagus passes before connecting to the stomach (known as the “hiatal opening”); individuals with a hiatal hernia also have part of their stomach pushed through this opening.
- Consequence of certain conditions: diaphragmatic injury, scleroderma, etc.
- Side effects of certain medications: opioids, nitroglycerin, beta blockers, etc.
Is GERD inherited ?
There are studies suggesting a genetic predisposition to this condition. It could be an anatomical predisposition or hormonal factors that result in less tight closure of the sphincter. Twin and family studies have found approximately 31% heritability of the disease.Natural Alternatives to Control GERD Symptoms.
Natural alternatives for controlling GERD symptoms
As you may have already understood, medications should not be the first line of treatment that you turn to for managing GERD. Initially, it is important to strive for safer methods to alleviate symptoms and reduce the frequency of acid reflux episodes. Here are some approaches:
- Lifestyle changes: Certain lifestyle and dietary changes can often help alleviate GERD symptoms.
- Weight loss if you are overweight.
- Elevate the head of your bed by six to eight inches. While most people experience heartburn within 2-3 hours after eating, some wake up at night with heartburn. People with nighttime heartburn can raise the head of their bed, elevating their head and shoulders above the stomach, allowing gravity to prevent acid reflux. You can raise the head of the bed by placing wooden blocks under the bed’s legs or using a wedge under the mattress. Using extra pillows is not recommended as it can cause an unnatural body curve, increasing pressure on the stomach and worsening acid reflux.
- Avoid foods that trigger symptoms. Certain products can also relax the lower esophageal sphincter, leading to acid reflux. Excessive consumption of caffeine, chocolate, alcohol, mint, and fatty foods can cause unpleasant acid reflux in some individuals. If you notice that your symptoms worsen after consuming certain foods or beverages, limit or avoid them.
- Quit smoking. Saliva helps neutralize acid, and smoking reduces the amount of saliva in the mouth and throat. Smoking also lowers the pressure in the lower esophageal sphincter and induces coughing, leading to frequent episodes of acid reflux in the esophagus.
- Avoid late-night meals. Sleeping with a full stomach can increase the risk of acid reflux. If you eat two to three hours before bedtime, you can reduce symptoms.
- Wear loose, comfortable clothing. Tight-fitting clothes can intensify discomfort and increase pressure in the abdominal cavity, which can lead to reflux.
- Visiting an osteopath can help address minor issues related to hiatal hernia.
- Consulting a naturopathic doctor can help identify the underlying causes of your problems and recommend alternative methods for controlling GERD symptoms.
Medical Treatment
Once again, it is important to note that medication does not cure GERD but rather aims to alleviate the symptom of heartburn. This is achieved through the use of over-the-counter medications such as antacids. In severe cases, prescription medications may be required to prevent damage to the esophagus (H2 blockers and PPIs).What medications are used to treat GERD and how do they work?
Which medications are used to treat GERD and how do they work?
- Antacids are medications that counteract (neutralize) stomach acid, providing relief from stomach upset and heartburn. Ingredients include aluminum hydroxide, magnesium carbonate, and magnesium trisilicate.
- H2 blockers compete with histamine for H2 receptors on the parietal cells of the stomach, thereby suppressing the production of gastric acid. They are rapidly absorbed, reaching peak concentration in the blood within 1-3 hours. These medications should not be discontinued without consulting a doctor if you have been taking them for an extended period.
- Proton pump inhibitors (PPIs) block the gastric H+/K+-ATPase, inhibiting the secretion of gastric acid. It is strongly recommended not to discontinue these medications without consulting a doctor, as you may experience a sudden exacerbation of your symptoms.
Side effects of this treatment are:
The side effects of such treatment include:
- Food cannot be properly digested and absorbed if you are constantly combating high stomach acidity.
- Prolonged reduction of stomach acid levels leads to chronic atrophic gastritis and is associated with side effects, including vitamin B12 deficiency, autoimmune conditions, asthma, diabetes, chronic fatigue, and various other disorders.
- Infections that our stomach is meant to eliminate through the action of stomach acid can enter the body as a result of reduced stomach acid levels. Researchers found a twofold increase in the risk of Clostridioides difficile infection among those taking H2 blockers and nearly a threefold increase among those taking PPIs.
- Other side effects include headaches, muscle spasms, rapid heartbeat, and more.
But that’s not all…
Popular medications for treating GERD increase the risk of cancer.
In April 2020, the FDA requested an immediate recall of ranitidine because the drug contains a cancer-causing chemical called NDMA (N-nitrosodimethylamine). The FDA has found that NDMA levels increase in ranitidine even under normal storage conditions. FDA testing has also shown that the older the drug, the higher the NDMA levels. Because the NDMA level in it exceeded the allowable daily intake limit, ranitidine was recalled by the manufacturers last year.
Two other popular heartburn drugs, omeprazole and esomeprazole, are also currently under investigation. Both drugs belong to the same class of acid-lowering drugs called proton pump inhibitors (PPIs). They do not contain high amounts of NDMA, although a 2017 study published in the journal Gut found that long-term use of PPIs may increase the risk of stomach cancer.
The Canadian side has already agreed with the decision of the American side regarding ranitidine, but 2 years later (in March 2022), no decision has yet been made on omeprazole and esomeprazole. And for some reason, it seems this is only the beginning.
Conclusion
If you have already tried all the alternative remedies mentioned above and are still experiencing problems, it is best to consult a doctor. Each case is unique, and it is far more important to identify the cause of heartburn than to try to avoid its consequences with medication, exposing yourself to other risks.
Argyrou A, Legaki E, Koutserimpas C, Gazouli M, Papaconstantinou I, Gkiokas G, Karamanolis G. Risk factors for gastroesophageal reflux disease and analysis of genetic contributors. World J Clin Cases. 2018 Aug 16;6(8):176-182. doi: 10.12998/wjcc.v6.i8.176. PMID: 30148145PMCID: 6107529
Eguaras N, Rodríguez-lópez ES, Lopez-dicastillo O, Franco-sierra MÁ, Ricard F, Oliva-pascual-vaca Á. Effects of Osteopathic Visceral Treatment in Patients with Gastroesophageal Reflux: A Randomized Controlled Trial. J Clin Med. 2019 Oct 19;8(10):1738. doi: 10.3390/jcm8101738. PMID: 31635110PMCID: 6832476
Dial S, Delaney JA, Barkun AN, Suissa S. Use of gastric acid-suppressive agents and the risk of community-acquired Clostridium difficile-associated disease. JAMA. 2005 Dec 21;294(23):2989-95. doi: 10.1001/jama.294.23.2989. PMID: 16414946
Canadian Digestive Health Foundation. GERD
FDA Requests Removal of All Ranitidine Products (Zantac) from the Market
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