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GERD/Acidity treatments.
The best and simplest treatment of Acidity/GERD is to live an organized healthy life. Unhurried well chewed meals, an
early dinner(with respect to the time to bed), a long walk after dinner(dress warmly to avoid cooling of stomach-
cooling reduces Peristalsis and causes motility), non-smoking, avoidance of acidic foods and alcohol, shedding of
excessive pounds around the waste, relaxed fitting cloths all go a long way in reducing heartburns and acidity. The
elimination of H. pylori, if present in the stomach reduces chances of HB.
Keeping the head and shoulder in slightly elevated position ( 6 inches or so) will help in preventing acid wash back in
to Esophagus.

Occassional acidity is most commonly treated by Antacids. These are cheap(in terms of cost) alkaline substances
(Solid, liquid, foam, gel etc…) of Sodium, Calcium or Aluminum. These are recommended only for occasional
heartburn. They efficiently neutralizes and washes down any acids in the easophagus (thus providing an immediate
relief from heartburn – pain of flesh being burned by the acid.). They enter the stomach and neutralize some more
acid inside the stomach. However they do not provide any long-term relief since they are pretty much neutralized with
in 10 minutes of ingestion. People with high blood pressure problems or on sodium restricted diet should not take
Sodium bicarbonate containing antacids. Those with kidney stone troubles should avoid Calcium carbonate antacids.
Aluminum is suspected to induce Alzheimer’s disease and hence Aluminum containing antacids for long-term use is
not recommended. Antacids are found to be effective in about 33% of GERD cases. Also certain drugs like Tetra
cycline, Aspirin, Iron supplements, corticosteroids can cause problems when taken along with antacids. Check with a
qualified pharmacist for medicinal interactions.
Prokinetic drugs (like cisapride) helps to tone LES and clearing of Esophagus and gastric emptying.
When life style changes and antacids do not help mild to moderate GERD, it is treated with H2 blockers ( Histamine2
receptor antagonists) like Cimetidine (Tagamet), ranitidine (Zantac), Famotidine (Pepsid) or nizatidine(Axid), each of
which reduce the acid production. The stomach cells produce acids when a type of Histamine(H2) fits in to their
receptors. The H2 blockers, very much like Allegra for allergies, blocks these docking ports by taking H2`s place.
Thus the amount of acid produced is reduced but not completely shut down.
For more severe cases of GERD, the solution generally used is to shut down the stomach acid production altogether
using a class of medicines called Proton Pump Inhibitors(PPI) like Omeprazole (Prilosec), Lansoprazole (Prevacid-) or
Esomeprazole Magnesium (Nexium). However since these shut down the acid production altogether may reduce one’
s resistance to food born bacterium. In some cases it also results in poor digestion or gastric emptying.

Surgical treatments of GERD.
When medical therapy has failed or results in undesirable side effects, a surgical solution is sought. It is also used on
patients with BE, Esophageal bleeding or hiatal hernia, Esophageal ulcers, Esophageal stricture.
Surgeons rebuild the upper end of stomach in to a high pressure zone, strong enough to prevent acid backwash but
lets the food through. The surgery is generally carried out laparoscopically (through very small incisions). This
restoration of LES competence by wrapping of the gastric fundus is called fundoplication. This results in immediate
relief in 92 to 97% of the cases. However with in a period of 5 yrs(20%) to 10 years(60%) of the patients return to
medication for relief.
Other newer endoscopic therapies approved by FDA are Stretta ( Radiofrequency energy delivery system) and
endoscopic suturing. In stretta the region of LES made narrower by precise microwave burning(!!!) of the region. This
is a short procedure with no hospital stay involved. As the burn cures a thickening of the walls at LES happens, thus
reducing the acid reflux. In Endoscopic suturing the region around LES is folded ( Like you stitching the bottom of
your jeans) and stitched by using a device like a tiny sewing machine. These strategically placed 3 or 4 sutures helps
to tighten the LES and prevent acid reflux. The long-term efficacy of these procedures is yet not well proven.

Symptoms.
People with gerd often experiences sour tasting (sour due to acidic nature) stomach acid wash back in their mouth at
the time of burping. The acid wash back resulting in HB, often 30 to 60 minutes after meals is common among GERD
patients. The acid burn of Esophagus results enormous discomfort and loss of sleep in many GERD patients.

Related illnesses.
In some people with heartburn chronic ear infection is observed. It is suspected that some wash back of stomach
acids and pepsin might be the root –cause of this condition. It has been observed that a treatment of acidity in such
patients mostly cures their ear infections.
In many cases chronic sore throat, chronic bronchitis, chronic cough, morning hoarseness, bloating, belching etc may
also be observed. In some people with heartburn chronic asthma has been observed. At least in some cases
treatment for acidity improves the Asthma condition too.
In any case, it has been observed that irritability, depression are not rare among GERD patients. GERD patients
generally consider their Health Related Quality Of Life (HRQOL) as very low, indicating immense psychological
suffering.

Effect of food and other factors affecting Acidity/GERD.
As we have discussed in “How stomach works”, fatty food tends to slow down the transit of food through the
stomach. Thus resulting in greater amount of stomach acids to be left-over, causing more frequent heartburns.
Certain types of food are best avoided by acidity/GERD patients. Nicotine from smoking , Chocolate, Mints, caffeine
from coffee or presence of H.pylori bacterium in stomach (See the discussion on Stomach ulcers) all tend to increase
the production of more stomach acids, thus more likely to cause acidity and GERD.
Lying down (the gravitational help to keep acid inside the stomach is lost) with in two hours after a heavy meal or a
hurried meal (see “How stomach works”) or extra quantity of meal all tend to worsen the situation.
Why acidic foods like tomato tend to worsen the situation for people with heartburn problems? Lemonade has a pH
factor of 2.2 to 3.0. The pH value of tomato is 2.9 to 3.3 ( The commercial sweeter variety is more like 4.2 ) . Both of
these are highly acidic. These acidic foods neutralize the alkaline saliva and the bi-carbonate secretions in the
Esophagus. This makes Esophagus more vulnerable to any stomach acid wash back.
Spices by themselves do not promote acidity; however certain spices or types of foods or gas producing beans or
pulses may cause excessive acid production in some people. Mild foods (in quality and quantity) are healthy choices
to make to reduce HB.
Any factor, which exerts pressure on the stomach after a meal, can result in acid being pushed up from the stomach
in to Esophagus. This may be due to excessive fat around the waist (obesity) or tight fitting cloths (especially for
people who work sitting on a chair -the dresses tend to press down the stomach in a seated position) or exercises
like bending over or abdominal crunches during a period of two hours after a heavy meal all should be avoided. (That
is why old wise Indian mothers ask their children not to stand upside down or do heavy physical exercises for an hour
after meals)