Heartburn Prevention

“How hot would you like that?” the server at my favorite Thai restaurant asks. My taste buds whisper: fiery. My belly moans, What about me?

I love a hot, spicy meal. But an hour later, like many people, I can end up wishing I’d never lifted my fork. The culprit? Heartburn and acid reflux. Officially known as gastroesophageal reflux disease, or GERD, acid reflux occurs when food and stomach acids escape up into the esophagus through the valve at the top of the stomach. That causes the burning sensation that can sometimes rise up into the throat, known as heartburn.

Surveys of heartburn sufferers suggest spicy foods are among of the worst offenders. Whether spicy foods deserve their reputation is controversial, I’ve discovered. Many different foods can trigger heartburn.But luckily, you don’t have to say no to Chinese kung pao chicken, Mexican salsa, or fiery Thai noodle dishes. A few practical tips can help you put out the fire of heartburn before it starts.

Preventing Heartburn: Recognize Your Own Heartburn Triggers

Researchers have compiled a long list of foods that seem to trigger heartburn. These include alcohol, citrus fruits and juices, carbonated beverages, coffee and caffeine, chocolate, tomato sauce, fatty foods, mint, and, of course, spicy foods.

“But no single food stands out,” says Anish Sheth, MD, assistant professor of medicine at Yale University and co-author of What’s Your Poo Telling You? “For some people, the same food can cause problems after one meal but not after others.”

Dispelling Myths About Heartburn Triggers

In theory, foods most likely to cause acid reflux and symptoms of heartburn are those that cause the valve at the top of the stomach to relax. Mint, alcohol, and caffeinated coffee, among other foods, are believed to have that effect.

Yet when gastroenterologist Lauren B. Gerson, MD, an associate professor of medicine at Stanford University, and colleagues looked at trials designed to test the effects of these and other particular foods on heartburn symptoms, they found very little evidence to support the associations.

Even spicy foods may not deserve their reputation as being the worst culprits. Sure they taste hot, but that doesn’t mean they cause acid reflux. They may simply irritate the stomach.

Continued

“Still,” Gerson says, “it’s commonsense that if a particular food happens to cause you problems, the best advice is to avoid it.”

Since even heartburn sufferers can be misled by popular misconceptions, experts recommend keeping a food diary for several weeks.

“As soon as heartburn strikes, jot down what and how much you ate,” suggests dietitian Elaine Magee, author of Tell Me What to Eat If I Have Acid Reflux. “Also keep track of foods you thought might cause trouble but don’t. That way you won’t have to eliminate foods unnecessarily.”

Heartburn Prevention: Eat Smaller Servings

Not ready to let heartburn force you to say no to salsa caliente? The next best strategy, then, is to limit the amount you eat.

“When you eat a large meal, pressure on the valve increases. So there’s a predisposition to reflux after a big meal,” Sheth says. The problem is worse if the meal causes you to belch, since that requires the valve at the top of the stomach to open. When it does, it allows trapped air to escape, sometimes bringing up acidic stomach contents along with it. For some people, drinking carbonated beverages along with a meal can exacerbate the problem.

Fatty meals can also increase the risk of reflux. “Eating fatty foods delays stomach emptying, since fat takes longer to digest,” explains Gerson. “The longer food remains in the stomach, the more chance there is of reflux.” To help prevent heartburn and GERD, choose roasted, grilled, or baked foods over fried foods, and go easy on butter.

Heartburn Prevention: Eat Early and Often

Some heartburn sufferers find relief by eating smaller meals distributed more frequently throughout the day — a light breakfast, a midmorning snack, a light lunch followed by a midafternoon snack, for example. Scheduling dinner early can also help.

About 50% of heartburn sufferers have nighttime reflux, according to Gerson. This form can be especially unpleasant because when you’re lying down, more stomach contents can flow up into the esophagus. Nighttime reflux can also disturb sleep. Gerson’s tip? Eat dinner at least three hours before bedtime. That’s enough time to allow the stomach to empty before you hit the pillow.

Heartburn Prevention: Rely on Gravity

Another way to relieve nighttime reflux requires nothing more than two wood blocks. Elevating the head of your bed a few inches enlists gravity to help keep stomach contents from rising, Sheth says. You can also use a wedge-shaped pillow to elevate your upper body at night. For daytime heartburn, the best way to employ gravity is to remain upright after a meal. Walking after a big meal can also help. But don’t overdo it. Some research links vigorous exercise to an increase in reflux risk.

Heartburn Prevention: Chew Gum

Saliva helps move food down through the esophagus and can ease the symptoms of heartburn. To increase salivation, try chewing gum after a meal or an attack of heartburn. Avoid mint-flavored gums, however, since these may relax the valve at the top of the stomach.

Heartburn Prevention: Get Healthy

The most reliable ways to avoid GERD may be the hardest to accomplish: quit smoking if you smoke and lose weight if you’re overweight. Studies show that smokers are more prone to heartburn than nonsmokers. And the longer people smoke, the more likely they are to suffer acid reflux.

Being overweight can add to the pressure on the valve between the stomach and the esophagus. One study showed that every increase of 5 on the body mass index increases the risk of GERD by 1.2%. Eating smaller portions and walking after a meal can help you shed pounds at the same time they help prevent heartburn.

Foods to Avoid With GERD & Acid Reflux

If you’re experiencing chronic heartburn symptoms, you may have acid reflux disease or gastroesophageal reflux disease (GERD). While neither GERD nor acid reflux are life-threatening diseases, they are life-changing. In honor of World Health Day this month, let’s talk about how to manage the symptoms that come with GERD and acid reflux disease.

Both diseases can affect eating and sleeping habits. Some people even develop an intolerance for certain foods that cause symptoms to flare up. The good news is you can better manage your symptoms if you are aware of which foods can cause flare-ups.

Acidic Foods Cause GERD Symptoms

Certain foods have high levels of natural acid. In cooking, these acidic foods are used to lighten up otherwise fat-heavy dishes. Acids also work as a natural tenderizer when applied to meats. When cooked, these foods help flavor the entire dish for delicious results.

However, when consumed on an empty stomach, acidic foods tend to irritate the esophagus and lead to heartburn or acid reflux symptoms. Some of these acidic foods include fruits, vegetables and spices like:

Foods that use tomatoes in sauces are another culprit for acid reflux symptoms. Pizza, pasta, stews, and soups tend to include all three of these ingredients.

Citrus fruits are another type of highly acidic food. If you want to avoid triggering GERD or acid reflux, you should avoid the following:

• Grapefruit
• Lemons
• Limes
• Oranges
• Pineapple

Keep in mind that these foods do not directly cause GERD, but they often cause symptoms of acid reflux and heartburn. Many of these foods are good for your general health, but when eaten excessively or on a mostly empty stomach, they can cause problems.

High Fat Foods & GERD Symptoms

When fat enters the stomach, it triggers a release of the hormone cholecystokinin (CCK), which can cause the lower esophageal sphincter (LES) to relax. Chronic relaxing or malfunctioning of the LES is what causes GERD. With the LES left more open, the stomach contents can reflux back up the esophagus and cause discomfort.

The other problem with high-fat foods is they require more time to break down during digestion. In order to help the digestive process, the CCK hormone keeps fatty foods in the stomach for a longer period of time. This is a natural reaction, but when combined with the relaxed LES, the risk of acid reflux symptoms increases.

Below is a list of several types of high-fat foods you should avoid when managing acid reflux or GERD symptoms.

• Fried food
• Whole-fat or 2% milk
• Cream cheese
• Chocolate
• Ice cream
• Potato chips
• Butter
• Cheese
• Full fat sour cream
• Creamy salad dressing (ranch flavored)
• Sauces and dips
• Bacon
• Sirloin
• Prime rib
• Chicken skin
• Creamy soups
• Pudding
• Creamed vegetables
• Bologna
• Sausage
• Fatty meats

Fried foods are especially bad due to their high levels of saturated fat. You should not eliminate all fats from your diet because your body does need fat to work properly. Some healthy sources of fat include avocados, nuts, and olive oil.

While you do not have to eliminate all of these foods from your diet immediately, the more you can limit and monitor fatty foods, the better. Paying attention to your fat intake will also help you avoid future health problems like obesity, heart disease, and cancer.

Spicy Foods

While there is not necessarily a direct medical cause between spicy foods and symptoms of GERD, people who experience acid reflux and heartburn often blame spicy food. What we have yet to mention is the link between acid reflux and the kind of food a person eats depends on the individual.

Some people may experience fewer heartburn symptoms with spicy, acidic, or fatty foods than other people. If spicy food does trigger acid reflux for you, then you should avoid spicy foods such as:

• Black pepper
• Chili
• Curry
• Hot peppers (jalapenos, habaneros)
• Salsa

Other foods/drinks

Alcohol

Just as fatty foods cause the LES to relax, alcohol use can do the same thing. However, some people will do better with alcohol use and heartburn than others. 

Also, certain types of alcohol can create more stomach acid and increase the risk of acid reflux. Occasional alcohol use usually will not increase your symptoms, but frequent or constant use will. If you use alcohol excessively or compulsively, it can damage your esophagus and cause more pain during reflux.

Coffee

While the exact reason why coffee causes acid reflux is in debate, the fact is that some people experience reflux after drinking coffee. Some studies show that drinking coffee relaxes the LES. Other studies say that caffeine causes acid reflux. And other studies still show no correlation.

Carbonated Beverages

Soft drinks not only relax the LES but also increase stomach acid levels. This may be due to the caffeine in popular cola products which can affect the LES and trigger acid reflux.

Tea

Due to the debate of caffeine causing GERD or acid reflux symptoms, it may be worth avoiding certain types of tea. Black, white, and green teas are natural sources of caffeine and may increase your risk of symptoms.

Decaffeinated herbal teas may help you manage symptoms of GERD and acid reflux. However, if you do use herbal tea, avoid mint-based teas. Mint, peppermint, spearmint, and other mints can relax the LES and increase your risk for symptoms. 

How can I Prevent my Symptoms of GERD?

As you can see, there are many types of foods to avoid if you have GERD or acid reflux disease. However, you may or may not experience symptoms after eating one of these foods as each case is different. This list of foods is meant to give you general guidelines of foods to avoid.

With that being said, the most reliable way to know which foods you should avoid is to keep a food journal. Pay attention to what you eat, then record whether or not you experience symptoms after. 

You should also pay attention to which situations lead to your symptoms. For instance, do you experience symptoms in the morning before you’ve eaten, or after a large lunch? Or, perhaps you notice symptoms at night after eating a late dinner or dessert.

If you have more questions about preventing GERD or acid reflux symptoms, talk with your doctor. Depending on the severity of your symptoms, your doctor may give you a prescription to help soothe your heartburn.

Prescriptions usually include histamine-2 blockers (h3), proton pump inhibitors (PPI), and promotility agents. These are usually short-term prescriptions for acid reflux treatment while you make dietary adjustments.

Because GERD and acid reflux are not usually serious conditions, it is possible to manage it on your own. However, if these conditions do not improve, they can lead to esophagus cancer. 

If you notice that your symptoms keep getting worse, then it is time to see a doctor. Other warning signs for severe GERD and acid reflux include chest pain, jaw pain, or arm pain. Also, if you experience shortness of breath, you should visit with a doctor or surgeon as soon as possible. Additionally, if your symptoms do not improve after taking medication for two weeks, you may need surgical treatment.

Surgical Treatments for GERD and Acid Reflux

With advances in robotic and laparoscopic surgery, treating GERD is easier than ever. At The Surgical Clinic, we offer several types of surgical procedures to strengthen the weakened LES and other causes of GERD.

One of our providers, Dr. Trudie Goers, is board-certified in general surgery and specializes in minimally invasive gastrointestinal repair. If you need treatment for GERD or acid reflux, Dr. Goers would be happy to meet with you.

To learn more about GERD, acid reflux treatment, GERD surgery, and acid reflux surgery in Nashville, visit the Virtual GERD Center here on our website.

You don’t have to live with acid reflux forever. The providers at The Surgical Clinics of Middle Tennessee are here to help you get the care that you need. Visit one of our many locations across the Greater Nashville Area, including Mt Juliet, Downtown, Franklin, Cool Springs, Hermitage, as well as Columbia, Gallatin, Murfreesboro, and Smyrna.

What to avoid and remedies

Heartburn is a burning feeling that many people experience occasionally. Avoiding certain foods, such as fatty foods and alcohol, can help with the symptoms.

If a person experiences heartburn regularly, they should speak to a doctor, as they may have an underlying condition.

Keep reading to learn more about the foods that cause heartburn, as well as some remedies that may help.

More than 60 million people in the United States experience heartburn symptoms at least once a month. Doctors also refer to heartburn as acid reflux, acid indigestion, or gastroesophageal reflux.

Heartburn occurs when the acid in the stomach flows back up into the esophagus, or food pipe. Some people describe this as a feeling of burning discomfort that starts behind the breastbone and moves up toward the neck and throat. There may also be a bitter taste in the throat or a feeling of pressure.

The symptoms can be present for several hours, and they can feel worse after eating certain foods.

According to a review in Gastroenterology & Hepatology, heartburn is most common among young and middle-aged females. The authors note that other physical and psychological conditions are also commonly present and may contribute to heartburn.

These include:

• depression
• anxiety
• stress
• digestive disorders, such as irritable bowel syndrome (IBS)
• helicobacter pylori infection

Gastroesophageal reflux disease

Many people have occasional heartburn. However, more frequent symptoms may mean that someone has gastroesophageal reflux disease (GERD).

Usually, a muscular valve at the lower end of the esophagus prevents stomach acid from entering it. In people with GERD, this valve — called the lower esophageal sphincter — relaxes too frequently.

Prolonged exposure to stomach acid can cause complications if a person does not receive medical treatment. For instance, in the long term, untreated GERD can lead to Barrett’s esophagus and esophageal cancer. Doctors often prescribe medications called proton pump inhibitors (PPIs) for GERD.

Anyone with frequent or prolonged heartburn symptoms should see a doctor. GERD symptoms may be similar to those of heartburn, but people can also experience hoarseness, vomiting, or weight loss.

Learn more about GERD here.

Some foods and drinks can trigger heartburn symptoms or irritate the esophagus.

As everyone may react differently to foods, a person should try monitoring their symptoms after eating different foods to determine which may be causing heartburn.

The following foods and drinks are those that commonly cause heartburn.

Spicy foods

Spicy foods can irritate the stomach and may cause heartburn. Chili peppers contain capsaicin, which research suggests causes delayed gastric emptying and may promote reflux.

Spicy foods from takeaways or restaurants often also contain onions and fats that can cause heartburn.

It may be preferable to prepare curries and chili dishes at home from scratch and use milder spices or fresh herbs instead. People can also try adding coconut milk to curry to make it less spicy.

Fatty and fried foods

Experts advise that fatty and fried foods take longer to digest, increasing the pressure on the esophageal sphincter. The sphincter then opens, and acid flows into the throat.

Foods to consider excluding from the diet include:

• fries
• burgers, takeouts, and fast foods
• heavy or creamy dressings, such as mayonnaise
• fried bacon, chicken, and sausages
• potato chips
• donuts
• pastries
• full fat dairy foods

Acidic foods

According to the American College of Gastroenterology (ACG), acidic foods such as tomatoes and citrus fruits can irritate the lining of a damaged esophagus.

People can try avoiding lemons, oranges, and grapefruits, opting for other fruits, such as berries, melons, and strawberries, instead. People should also limit their consumption of orange juice and other citrus juices.

Either a pesto sauce or olive oil and fresh herbs can replace a tomato-based sauce to make a pasta dish less acidic. Alternatively, adding a little baking soda to tomato-based sauces can help neutralize some of the acids.

Carbonated drinks

Sodas contain gas that can force open the lower esophageal sphincter and cause a person to burp. The sugar in sodas can ferment in the stomach and cause more gas and bloating.

People should avoid carbonated and sugary drinks and drink water or dilutables instead.

Meat

In a 2018 pilot study, participants who ate vegetable protein had less acid reflux an hour after the meal than those who ate meat. According to the study, saturated fats and animal protein may negatively affect digestive acid and hormones, as well as the constriction of the esophageal sphincter.

People may experience more symptoms when eating fatty meat or meat fried in fats. However, they may be able to eat lean meats, such as turkey and chicken, as part of their diet.

Alcohol

Research in 2009 indicated that alcoholic beverages relax the lower esophageal sphincter and stimulate gastric acid secretion. In the study, beer, red wine, and white wine all caused reflux.

Some people may experience symptoms after one alcoholic drink, but others may tolerate moderate amounts. A person will need to work out their own limits.

Peppermint

Peppermint oil relaxes the lower esophageal sphincter and can cause reflux and heartburn. When doctors give people peppermint oil for symptoms of IBS, it is enteric coated, which allows it to bypass the esophagus and enter the stomach where the body breaks it down.

However, people should watch out for peppermint in teas, candies, and mouthwash.

Chocolate and coffee

According to the ACG, chocolate can be a trigger for heartburn. If this is the case, a person may wish to avoid:

• chocolate bars
• chocolate candy
• chocolate-based drinks, such as hot chocolate, mocha, and cocoa

Research on the effects of coffee on reflux has produced conflicting results. The authors of a 2015 review suggested that certain factors, such as the type of coffee a person drinks and whether they have an empty stomach, may influence coffee’s effects. People should monitor their symptoms to decide whether they can tolerate caffeine.

Alongside making dietary changes, some people may need treatment to reduce their symptoms.

Medical treatment

People can buy antacids such as Gaviscon or Rennies for the symptomatic relief of heartburn.

Doctors may sometimes prescribe PPIs such as omeprazole (Prilosec). However, the long-term use of these drugs carries risks.

PPIs reduce acid and can lead to a condition called hypochlorhydria. People with hypochlorhydria do not have enough stomach acid to perform essential bodily processes.

The hydrochloric acid that the stomach produces helps absorb essential vitamins and minerals, as well as preventing the overgrowth of bacteria in the small intestine.

According to some research, the long-term use of PPIs may cause small intestinal bacterial overgrowth (SIBO). In this condition, someone may experience symptoms of bloating, steatorrhea (fatty stool), and vitamin deficiency.

Natural remedies

Some people with heartburn may prefer to try using natural remedies.

A 2016 study on heartburn tested the efficacy of a natural remedy containing olive leaf and prickly pear extract against a placebo. The formulation, called Mucosave, almost abolished symptoms in participants who used the product for 2 months. However, further research is necessary to confirm these effects.

Mucosave is an ingredient in some products available for purchase online.

According to a 2018 review, natural remedies such as ginger, aloe vera, and turmeric may also be useful for digestive issues, but they are not well-studied for heartburn.

People with heartburn can also take steps at home to improve their symptoms. The ACG and the International Foundation for Gastrointestinal Disorders advise:

• reaching or maintaining a moderate weight
• stopping smoking, if a smoker
• eating in stress-free surroundings
• avoiding eating for 2–3 hours before sleep
• staying seated for a time after eating
• avoiding physical exertion after a meal
• seeing a doctor if self-medicating for heartburn two or more times a week

Learn more about remedies for heartburn here.

As some foods and drinks can trigger heartburn symptoms, eliminating them from the diet may help people prevent heartburn.

People respond differently to foods, but spicy and greasy foods, alcohol, and caffeine often contribute to symptoms.

A person can also try eating earlier and avoiding stress while eating. Changing other habits, such as by resting for a short time after eating and quitting smoking, is often also beneficial.

If someone has heartburn symptoms two or more times a week, they should see their doctor, as they may have GERD or another underlying medical condition.

Spicy Foods You Should Avoid If You Get Heartburn

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If you find that shortly after eating something spicy you start to experience the discomfort of heartburn, it’s no coincidence. While the connection between diet and heartburn has been poorly understood in the past, according to research published in Current Opinion in Gastroenterology, there’s increasing scientific evidence that suggests certain trigger foods can cause heartburn in people.

The tricky part is that everyone’s heartburn triggers are different, explains Dr. Marvin Singh, MD, an integrative gastroenterologist and voluntary assistant clinical professor at the University of California San Diego’s Department of Family Medicine and Public Health. “Some people may experience heartburn from nuts and others have no problem,” Dr. Singh says. “Some people can drink a pot of coffee and be fine, and others drink half a cup and may have heartburn.”

Here, Dr. Singh shares some of the most common spicy foods to avoid if you’re prone to getting heartburn.

Why You Should Avoid Spicy Food If You Get Heartburn

Spicy foods can often be a trigger because, according to Dr. Singh, they contain a compound called capsaicin, which is known to slow down the rate of digestion and increase the risk that food in the stomach will reflux upwards. “Spicy foods can act directly as an irritant to the esophagus, which may already be inflamed, and that can also aggravate symptoms,” Dr. Singh adds.

If you’re prone to heartburn,

avoid spicy foods like:

• Salsa
• Spicy Asian or Indian meals, like pork vindaloo, curry, and Sichuan cuisine
• Anything marinated or with hot sauce
• Foods that contain red chili paste
• Foods that contain sriracha
• Wasabi
• Foods that contain horseradish
• Jalapeño

“Capsaicin can activate the release of a compound called substance P, and this transmits pain and burning sensations,” says Dr. Singh. This explains why spicy foods can have such a kick to them, and along with irritating the esophagus and increasing the risk of reflux, can make it easy for heartburn to occur.

If you’ve eaten spicy food or another trigger food that causes heartburn, try TUMS Chewy Bites for fast heartburn relief you can count on.

8 Foods To Eat & Avoid

Acid reflux, that irritating backflow of stomach acid up into your esophagus, is often triggered by what you eat and drink. Eat the wrong food and you’re sure to feel the burn. Some foods are known to cause reflux more than others.

Quick reminder: If you have heartburn more than twice per week, you may have a more serious condition called GERD – schedule an appointment today.

Here are 8 foods to avoid if you have acid reflux, and 8 foods that keep you free from the burn and keep you healthier overall. A win-win!

8 Foods that make acid reflux worse

1. Chocolate — Everyone’s favorite treat comes with a dark side; chocolate contains caffeine, cocoa, and plant chemicals that can all trigger heartburn. Also, a chemical in cocoa relaxes the LES, making it easier for stomach contents to leak into your esophagus.
2. Peppermint — Known for soothing an irritable bowel, peppermint has the opposite effect on acid reflux. Peppermint relaxes the muscles used for digestion, and a relaxed LES is a leaky LES.
3. Fatty foods — If you feel like fatty foods make you sluggish, you’re right. They relax your LES and are slower to digest than other foods. When food sits in your stomach longer, your body responds by making more acid. Fried foods like onion rings are obvious culprits, but meats like prime rib or bacon, and whole milk dairy products also cause symptoms.
4. Spicy foods — Spicy foods make acid reflux worse in two ways. First, the capsaicin in many spicy foods can slow digestion. But before it even gets that far, it can irritate an already irritated esophagus on its way down.
5. Acidic foods and drinks — Acidic foods are common triggers of acid reflux. Foods like citrus fruits and juices, tomatoes and tomato products, pineapple, and vinaigrette salad dressings all have a high acid content, contributing to an already acidic environment.
6. Garlic — Garlic, especially raw, is known to cause heartburn and upset stomach in healthy people. That makes it even more likely to cause issues for those who suffer from acid reflux.
7. Onions — Raw onions don’t just make you cry; they stimulate acid production. That extra acid puts you at risk for heartburn.
8. Drinks containing alcohol, caffeine, or carbonation — Alcohol and caffeine both relax the LES, allowing acid to leak up your esophagus. The bubbles in carbonation expand your stomach, pushing stomach contents up against the LES. That makes soda, coffee and tea, and alcoholic beverages all triggers. Be especially careful with mixed drinks, which could combine triggers.

8 Foods that help acid reflux

1. Vegetables and non-citrus fruits — Aside from the “bad” foods listed above, nearly all fruits and vegetables help reduce stomach acid. They’re also low fat, low sugar, and provide fiber and important nutrients.
2. Whole grains — High fiber, whole-grains like brown rice, oatmeal, and whole grain breads help stop symptoms of acid reflux. They are a good source of fiber and may help absorb stomach acid.
3. Lean protein — Low-fat, lean sources of protein also reduce symptoms. Good choices are chicken, seafood, tofu, and egg whites. The best ways to prepare them are baked, broiled, poached, or grilled.
4. Beans, peas, and lentils — Along with being good sources of fiber, beans, peas, and lentils also provide protein, vitamins and minerals.
5. Nuts and seeds — Many nuts and seeds provide fiber and nutrients and may help absorb stomach acid. Almonds, peanuts, chia, pomegranate, and flaxseeds are all healthy choices.
6. Yogurt — Not only is yogurt soothing to an irritated esophagus, but it provides probiotics that support your digestive tract. It’s also good source of protein.
7. Healthy fats — Fat is a necessary nutrient but eating too many fatty foods can trigger acid reflux. Replacing unhealthy fats with unsaturated fats can help. Avocados, olive oil, walnuts, and soy products are good choices for healthy fats.
8. Ginger — Ginger has anti-inflammatory properties and has been used throughout history for gastrointestinal problems. Ginger can be added to smoothies, soups, stir fry, or other dishes, or steeped as a tea.

If acid reflux is impacting your quality of life, or if you have acid reflux more than twice a week, schedule an appointment with one of the experts at Gastroenterology Consultants of San Antonio.

How do I fix heartburn?

Nothing kills the buzz of devouring a delicious meal quicker than a bout of heartburn.

It’s that feeling of pain or discomfort, escalating from your chest to your mouth that can vary from mild to severe.

According to the Trust Me, I’m A Doctor team, the sensation of heartburn, which was first written about 2,000 years ago, now affects one in five of us on a regular basis.

“Some sufferers blame it on an excess of stomach acid but that’s actually pretty rare,” says medical expert Dr Giles Yeo on episode three of Trust Me, I’m A Doctor – the last show in the current series airing on SBS on Monday 18 March at 8.30pm.

“Others claim just the opposite, that too little acid [in your stomach] is the problem.

“Some even think you can top up your levels by drinking vinegar. Let me save you that particular taste sensation: very few of us have low stomach acid, and drinking vinegar is not going to help.” 

Heartburn is actually a symptom of GORD (gastro-oesophageal reflux disease) and is caused by acid that reverts back into the oesophagus via a faulty valve at the top of the stomach.

Spicy food causes heartburn: fact or myth?

Heartburn is typically blamed on the consumption of spicy foods. But is this fact or fiction? 

Researchers from Korea University Guro Hospital, Seoul attempted to answer this question by studying 126 Korean patients with GORD to determine the food items that caused heartburn and other symptoms. The study’s results, published in 2017, revealed that hot spicy stews, rice cakes, ramen noodles, fried foods, and topokki induced GORD symptoms like heartburn. 

Yet, even though the consumption of spicy and acidic foods has been proven to aggravate heartburn and other GORD symptoms, they’re generally not the cause.

Heartburn is actually a symptom of GORD (gastro-oesophageal reflux disease) and is caused by acid refluxing back into the oesophagus via a faulty valve at the top of the stomach.

Dr Yeo speaks to the director of The Functional Gut Clinic, Dr Anthony Hobson, about GORD on the show. He also gets a tiny probe placed down his oesophagus for the purposes of science, to show viewers what’s really going on inside of us.

As we see, Dr Yeo’s food pipe is considered healthy and ‘normal’. That means there’s a barrier at the bottom of the food pipe that makes sure all the contents within the stomach stay there, preventing heartburn.

However, we also learn that when there is no oesophagus barrier, pressure from the stomach pushes upwards. Contents of the stomach will come up and result in heartburn.

What can you do to prevent heartburn?

Dr Hobson stresses that avoiding trigger foods is important in preventing heartburn. 

The biggest culprits are fatty foods because they sit in your stomach for longer, increasing your chance of an attack. A study published in the BMJ in 2004 confirms that high dietary fat intake was associated with an increased risk of GORD symptoms. Meanwhile, a high fibre intake correlated with a reduced risk of GORD symptoms.

Other trigger items include coffee, alcohol, soft drinks and overly processed meals.

Dr Hobson adds that changing the way you eat your food could also help relieve heartburn. 

“Anything you can do to take pressure off the stomach and off the valve is great, so eat slowly, chew your food well, that gets digestion going, sooner,” says Dr Hobson.

“Eat smaller meals, all of those things just give your body a helping hand to reduce the amount of pressure on the barrier that protects your from acid reflux.”

According to Health Direct online, walking regularly can also help with digestion. It suggests avoiding eating large meals, eating late at night or lying down straight after eating.

How about antacids?

The Trust Me, I’m A Doctor team confirm that antacids are a great quick fix for heartburn. However, they’re so fast acting and highly effective that the concern is people will become too reliant on them.

“I think the problem is that it suddenly becomes some kind of lifestyle drug so it allows you to eat and drink what you want and you mask the symptoms,” says Dr Hobson.

“But if you had a headache and you took painkillers continuously then you would probably want to go to the doctors and it’s the same thing with antacids.”

Essentially, GORD is a digestive problem. So to manage the symptoms of GORD, it is best to implement diet and lifestyle changes to nourish your gut.

“Long-term, heartburn could be your gut’s way of telling you there’s something else wrong,” says Dr Yeo. “So it’s best to get checked out.”

The new three-part series of Trust Me, I’m A Doctor will air on Mondays on SBS from Monday 4 March at 8.30pm, and stream on SBS On Demand after broadcast.

Watch episode one of the new series on SBS On Demand below.

More from Dr Michael Mosley

Minimally Invasive & Robotic Surgery

Surgery can be necessary in severe cases of GERD, but you can avoid the need for invasive procedures by controlling your gastroesophageal reflux disease with conservative treatments. One of the best ways to keep symptoms of GERD under control is to avoid dietary triggers. This, however, assumes you know what your triggers are.

While everyone is different, most people with GERD find specific categories of food troublesome. The team at the Center for Minimally Invasive and Robotic Surgery can help you identify and avoid the foods that cause your GERD and help keep your symptoms at bay.

If you find you still experience chest pain, unpleasant regurgitation of food, and heartburn after cutting these foods out, consult with the doctors to learn about other treatment options.

Why care about easing GERD?

Of course you want relief from GERD, because it affects your day-to-day quality of life. Experiencing the discomfort caused by the frequent backflow of stomach acid into your esophagus can make mealtime stressful. You may also experience disturbed sleep, regular coughing, and a sore throat.

GERD can also cause long-term damage to your body. You may have scar tissue form in the esophagus. You may also develop a condition known as Barrett’s esophagus, which is characterized by cancerous changes to the lining of the esophagus.

Specific foods to avoid with GERD

Relieving GERD symptoms can be as simple as making some smart meal choices. Spicy foods, including curry, salsa, chili, and hot sauce aggravate GERD symptoms. The spices make stomach acid stir up and become more likely to kick back up into your throat.

Garlic and onions are also aggravating foods. Beware as these are ingredients in many recipes, including holiday stuffing, stews, and some salads.

Fatty meals from fast-food restaurants or barbecue joints can slow digestion, so food sits and stomach acid releases over a longer period of time. Greasy cuts of meat, French fries, and burgers are best kept off your plate. Opt for grilled chicken, baked potatoes, and flatbread instead.

Pizza is a double whammy as it’s often fatty and covered in acidic tomato sauce, which exacerbates GERD. Classic or spicy marinara sauces over pasta can be triggers for GERD symptoms, too.

Citrus fruits and chocolate are highly acidic, meaning you should also avoid these if you’ve been diagnosed with GERD. Coffee, alcohol, carbonated drinks, and alcohol also irritate your digestive tract.

Sometimes, the simple after-dinner mint — which seems entirely harmless — can also set off a surge of GERD symptoms.

How you eat your food matters

It’s not just the foods you choose. How you eat and where you eat makes a difference in your GERD symptoms. Avoid overstuffing yourself at meals. Large meals take longer to digest, meaning more time to regurgitate acid and food into your esophagus.

Plan ahead for meals. Eating a meal within an hour or two of bedtime can also be triggering for GERD symptoms. Much of the food remains undigested and can cause reflux symptoms just as you try to get some shuteye. The same is true for late-night snacking.

Smart eating habits go a long way in minimizing the effects of GERD. Know if you’re struggling with chronic heartburn and acid reflux, the team at the Center for Minimally Invasive and Robotic Surgery can help. Call the office in Peoria, Arizona or schedule online to learn your full array of treatment options. 

In medical language, this is called reflux / Health / Nezavisimaya gazeta

Heartburn as an indicator of acid-dependent esophageal status

The main symptom of the world’s most common esophageal disease is heartburn.
Photo by Pixabay

In medical practice, there are often cases when the true ailment is masked. For example, a person is worried about pain in the heart, and as a result of an examination, it turns out that he has a disease of the esophagus.Doctors sometimes encounter a similar situation when diagnosing gastroesophageal reflux disease (GERD). The fact is that the patient’s pain in this disease, which is very common at the present time, resembles heart pain in nature.

According to statistics from the World Health Organization, about half of the population of developed countries suffers from GERD. Most often, this chronic disease develops against the background of increased acidity of gastric juice and therefore belongs to the group of so-called acid-dependent states.However, sometimes GERD occurs in patients with low or normal acidity. The cause of its occurrence is the systematic throwing of the acidic contents of the stomach up into the esophagus. In medical parlance, this is called reflux. Its consequence is irritation of the esophageal mucosa.

The impetus for the development of GERD is a dysfunction of the lower sphincter (circular muscle) of the esophagus, which is usually preceded by the reflux of acidic contents from the stomach.Disorder of the sphincter is primarily due to poor nutrition, in particular, a person’s addiction to fatty and spicy foods, as well as alcohol and smoking abuse. In addition, GERD often develops against the background of diaphragmatic hernia, gastritis, and gastric ulcer. Another negative factor contributing to the onset of the disease is stress.

Under the influence of the disease, pathological changes occur in the esophagus. Over time, this leads to a violation of the permeability of food, the formation of ulcers, and sometimes to cancer.

The main symptom of the disease is heartburn. A person with GERD usually experiences it after eating or exercising. However, it can also appear with a change in body position. Sometimes heartburn is accompanied by increased salivation and belching. Another symptom of the disease is chest pain that occurs after eating. In the event that reflux reaches the larynx and vocal cords, causing their inflammation, GERD is disguised as laryngitis: the patient has a hoarse voice.

In the presence of heartburn and other symptoms of GERD, it is necessary to consult a doctor, who first of all will refer the patient to gastroscopy – a study that allows to identify diseases of the esophagus and stomach in the early stages.

If a patient is diagnosed with gastroesophageal reflux disease, the first step is to follow a diet. First of all, spicy, fatty, fried foods, seasonings and, of course, alcohol should be excluded from the diet.Legumes, cabbage, citrus fruits, coffee, chocolate, carbonated drinks contribute to an increase in the acidity of gastric juice, so you will definitely have to say goodbye to them at least for a while. Preference should be given to boiled meat and fish, as well as milk, cottage cheese, various cereals, boiled vegetables and fruits.

Speaking about the diet, it should be emphasized that only medical nutrition and medications prescribed by the doctor will help the patient to truly overcome the ailment. But soda or alkali-containing mineral water, which patients often resort to to relieve heartburn attacks, is only a one-time measure.

As for medications, so-called proton pump inhibitors are used to treat GERD, which are used to treat stomach ulcers. The action of these drugs is aimed at reducing the acidity of gastric juice. And this, in turn, helps to reduce damage to the mucous membrane of the esophagus. In addition, the patient is prescribed medications that improve the motor activity of the digestive tract, as well as relieve symptoms such as heartburn and belching.

It should be emphasized that the choice of a particular drug, its dose and duration of administration is determined by the attending physician. In combination with official drugs, traditional medicine is also used. So, to increase the stability of the mucous membrane of the esophagus, the patient is recommended to drink a decoction of flaxseed.

To prevent exacerbation of gastroesophogeal reflux disease, it is imperative to follow the diet and diet (food should be taken 4-6 times a day, in small portions, warm).In addition, you should avoid heavy physical exertion, prolonged work in an inclined state. Failure to comply with these requirements is fraught with disruption of the passage of food, as well as serious diseases of the esophagus and stomach.

Reflux (GERD). The use of Donat Mg healing mineral water reduces hyperemia and edema of the mucous membrane of the esophagus, stomach and duodenum, reduces the acidity of gastric juice, reduces the number of gastroesophageal and duodenogastric reflux

The use of the medicinal mineral water DONAT MG reduces hyperemia and edema of the mucous membrane of the esophagus, stomach and duodenum, reduces the acidity of gastric juice, reduces the number of gastroesophageal and duodengastric reflux.

The lifestyle of a modern person is far from ideal: constant stress, sedentary work at the computer, food, far from healthy. All this contributes to the development of unpleasant diseases of the digestive system, among which reflux – esophagitis is quite common.

What is reflux?

Gastroesophageal reflux, or GERD for short, is a chronic condition caused by stomach contents entering the esophagus.With reflux, these attacks are repeated regularly and cause irritation and serious damage to the lining of the esophagus.

Today, reflux (GEBR) is the leader in severe consequences among diseases of the digestive system. Certain reflux symptoms (GERD) are observed in almost 50% of adults. Reflux (GERD) is characterized by frequent relapses, which recur every six months in 80% of cases. Moreover, for 5-20% of patients suffering from reflux (GERD), the disease ends with surgery.

Reflux (GERD) can be caused by a decreased tone of the cardiac sphincter between the stomach and the esophagus, impairments in the process of self-cleaning of the esophagus, disturbances in the processes of gastric emptying, and other causes.

The appearance and development of reflux (GERD) is promoted by a sedentary lifestyle, excess weight, smoking, constant stress. Reflux (GERD) can also be caused by unhealthy eating habits with an abundance of fatty and spicy foods, sweets and alcohol.

Reflux (GERD) is hard not to notice, because it gives a person a lot of unpleasant sensations.Among the most common manifestations of reflux are heartburn and belching after meals and at night. In addition, people with reflux disease (GERD) often experience chest pain that spreads to the area between the shoulder blades and the lower jaw. With reflux (GERD), a person is faster with food, suffers from bloating, as well as nausea and vomiting.

Reflux (GERD) also causes symptoms that are not related to the digestive system. Reflux (GERD) can be accompanied by coughing and shortness of breath, and wheezing in the throat.

How is reflux (GERD) treated?

Reflux treatment (GERD) begins with a healthier lifestyle. Patients suffering from reflux are advised to lose weight, give up cigarettes and alcoholic beverages. A balanced diet with a minimum intake of fatty foods, coffee and drinks based on it, and sugary carbonated drinks is also important for GERD. In addition to improving the diet, to get rid of reflux, it is advisable to revise the food intake.For GERD, it is recommended to eat in small portions, but often enough. If you have reflux, it’s best to plan your last meal at least a couple of hours before bedtime.

Patients suffering from reflux (GERD) should avoid any tension that causes a surge in intra-abdominal pressure. First of all, it is worth refusing to wear tight-fitting belts, which can aggravate the condition of the patient with reflux.

People with reflux disease (GERD) are advised to sleep in an elevated position 15-20 cm.

Reflux (GERD) is also treated with medications that are designed to normalize acidity and increase motor skills.

Reflux treatment (GERD) with Donat Mg mineral water

Donat Mg healing mineral water helps to reduce hyperemia and edema of the mucous membranes of the digestive system, and also reduces the acidity of gastric juice. All this contributes to the reduction of reflux (GERD).

Donat Mg not only eliminates the unpleasant symptoms of reflux (GERD), but also acts on the main cause of its occurrence – poor motility of the esophagus and stomach.This effect is confirmed by clinical studies conducted in patients suffering from reflux. They have decreased such manifestations of reflux as heartburn and belching, heavy sensations after eating, and bowel function returned to normal.

Reflux (GERD) is treated with Donat Mg mineral water for a month and a half. Donat Mg for reflux is consumed three times a day on an empty stomach 15-20 minutes before eating. For the treatment of reflux (GERD), it is recommended to drink 100-150 ml of warm mineral water without gas before each meal.

Reflux Donat Mg Drinking (GERD)

When treating reflux (GERD) with Donat Mg mineral water, it should be borne in mind that at the initial stage, there may be some loosening of the stool.This is a normal phenomenon, which is accompanied by the cleaning of the body from harmful toxins.

For patients suffering from reflux disease (GERD), Donat Mg treatment duration is no more than one and a half months. The break before starting the next course of treatment for reflux (GERD) is 2-3 months.Similar course of patients who are worried about reflux (GERD) should be repeated at least 2-3 times annually.

After the end of the course of taking Donat Mg mineral water for the treatment of reflux (GERD), it is recommended to use Sulinka mineral water before meals (15-20 minutes), and after meals (after 2-3 hours) – Stelmas artesian water.

If, in addition to reflux, you suffer from chronic diseases of the kidneys and digestive organs, it is advisable to get the advice of your doctor before starting treatment.

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Otolaryngological manifestations of gastroesophageal reflux disease | Soldatskiy Yu.L.

Gastroesophageal reflux disease (GERD) has attracted close attention of researchers over the past several decades. This is due to the clinical significance and widespread prevalence of the disease throughout the world: on average, 40–45% of residents of industrialized countries note the leading symptom of GERD – recurrent heartburn.In particular, in the United States, about 45% of the population experience heartburn at least 1 time per month, and 7% – daily. Among residents of various regions of Russia, the prevalence of GERD is up to 40-60% [1].

GERD is a chronic recurrent disease with characteristic esophageal and extraesophageal manifestations and various morphological changes in the esophageal mucosa caused by retrograde reflux of gastric or gastrointestinal contents [2]. The immediate cause of GERD is gastroesophageal reflux (GER).Gastroesophageal reflux is the involuntary discharge of gastric or gastrointestinal contents into the esophagus. There are two forms of reflux: physiological GER, which does not cause the development of esophagitis; and pathological GER, which leads to damage to the esophageal mucosa with the development of reflux esophagitis. Physiological GER occurs in healthy people of any age, more often after meals, is characterized by a low frequency (no more than 20-30 episodes per day), short duration (no more than 20 s), and no clinical symptoms.Pathological GER occurs at any time of the day, is characterized by a high frequency (more than 50 episodes per day, the total duration of which exceeds 1 hour per day), leads to damage to the surrounding tissues with the formation of esophageal and extraesophageal manifestations, i.e. to the development of GERD.
Currently, GERD is considered as a disease associated with impaired motility of the esophagus and stomach. The leading role in the pathogenesis of GERD belongs to the weakening of the function of the antireflux barrier of the lower esophageal sphincter due to a decrease in its tone or an increase in episodes of its spontaneous relaxation.Other factors in the development of the disease are a violation of the chemical and volumetric clearance of the esophagus, i.e. the ability of his “self-cleaning” from the acidic contents of the stomach; as well as the damaging effect on the mucous membrane of the esophagus of the gastric refluctate itself (hydrochloric acid, pepsin, bile acids). The development of GERD is facilitated by obesity, stress, increased intra-abdominal pressure due to pregnancy or prolonged forced position of the body, dietary habits (consumption of fatty foods, alcohol, chocolate, drinks containing caffeine, etc.)), the use of drugs that reduce the tone of smooth muscles (nitrates, calcium channel blockers, b-adrenergic drugs, theophylline), etc. [3,4].
The clinical manifestations of GERD are very diverse and numerous. It is customary to distinguish esophageal and extraesophageal symptoms [3,4]. Esophageal symptoms include: heartburn, belching, regurgitation, pain in the epigastric region or behind the sternum, dysphagia, odinophagia (painful passage of food through the esophagus). Heartburn is the most common symptom that occurs in 83% of patients and arises from prolonged contact of acidic (pH <4) gastric contents with the esophageal mucosa [4].A feature of heartburn in GERD is the dependence on body position: when the body is tilted forward or in the supine position, it increases. Less common symptoms of GERD are a feeling of heaviness, stomach fullness, early satiety, and bloating that occurs during or after a meal.
Extraesophageal (atypical) symptoms are mainly represented by complaints indicating the involvement of the bronchopulmonary, cardiovascular systems and ENT organs in the process.
Bronchopulmonary manifestations include chronic cough, especially at night, obstructive pulmonary disease, pneumonia, paroxysmal sleep apnea [5].Numerous foreign and domestic studies have shown an increase in the risk of bronchial asthma morbidity, as well as the severity of its course in patients with GERD [4,6]. In this case, pathological GER is considered as a trigger for asthma attacks, mainly at night, because the frequency of swallowing movements decreases and, therefore, the effect of acid on the esophageal mucosa increases, which causes the development of bronchospasm due to microaspiration and neuroreflex mechanism.
Cardiovascular manifestations of GERD include chest pain, similar to angina pectoris, arising from hypermotor dyskinesia of the esophagus (secondary esophagospasm) [4].
Otolaryngological symptoms of GERD are the most numerous and varied. These include a feeling of pain, coma, foreign body in the throat, perspiration, the desire to “clear the throat”, hoarseness, paroxysmal cough. In addition, GERD can cause recurrent sinusitis, otitis media, pharyngitis, laryngitis, which are not amenable to standard therapy [7].
At the same time, in many patients, GERD is not typical, which causes both difficulties in making a diagnosis and errors in therapy. Most of these patients turn to otorhinolaryngologists or therapists with complaints characteristic of chronic otorhinolaryngological, cardiac or bronchopulmonary pathology; at the same time, they do not have complaints of heartburn, regurgitation, pain in the heart, and others, allowing to suspect GERD. This is due to the presence of another form of the disease, called pharyngolaryngeal reflux (FLR), which is caused by GER, which penetrates proximally through the upper esophageal sphincter [8].
The epithelium of the pharynx and larynx is more sensitive to the damaging action of gastric secretions and is less protected than the epithelium of the esophagus. There are 4 physiological barriers that protect the upper respiratory tract from the damaging effects of reflux: lower esophageal sphincter, esophageal clearance, tissue resistance of the esophagus, upper esophageal sphincter. In addition, one of the most important protective mechanisms of the esophageal mucosa from the damaging effect of hydrochloric acid is the enzyme carbonic anhydrase, which catalyzes the hydration of carbon dioxide, leading to the formation of bicarbonate [9].An active pump pumps bicarbonate into the extracellular space, where it neutralizes reflux hydrochloric acid. In the mucous membrane of the larynx, a low level of carbonic anhydrase is determined; moreover, this enzyme is absent in 64% of tissue samples taken from patients with FLR [10]. As a result, the acidic contents of the stomach and pepsin, being in the pharynx and larynx, are inactivated much longer. In this regard, GER that penetrates the upper esophageal sphincter will never be considered physiological, therefore, even one episode of a decrease in pH <4 in the laryngopharynx is diagnosed as FLR.
Differences in the clinical symptoms of GERD and FLR are presented in Table 1.
The most common symptoms of FLR are hoarseness, which is found in 71% of patients, cough – in 51%, lump in the throat – in 47%, desire to “clear the throat” – in 42% [8]. All of the above symptoms are not specific, as they can occur with acute respiratory viral infections, increased voice load, allergies, smoking and alcohol abuse, etc., which complicates the diagnosis.It is believed that FLR can play an important role in the pathogenesis of such diseases of the larynx as: nodules of the vocal folds, functional disorders of the vocal apparatus, contact ulcers and granulomas, Reinke’s edema [11]. The direct effect of refluctate on the mucous membrane is especially great in the posterior parts of the larynx, therefore contact granulomas and ulcers are usually localized in the region of the vocal processes of the arytenoid cartilage. The influence of FLR on the development and course of such diseases as recurrent respiratory papillomatosis, cicatricial stenosis, and malignant tumors of the larynx remains controversial [12-14], however, as well as the question of the participation of reflux in the pathogenesis of chronic diseases of the nose and paranasal sinuses.It is believed that a possible mechanism explaining the association between FLR and sinusitis includes chronic irritation of the nasal mucosa and chronic adhesion of bacterial agents to the mucosa. However, there is no significant difference in the frequency of detection of acidic stomach contents in the oropharynx in patients with vasomotor rhinitis and in healthy volunteers [15]. And although there is information about the high frequency of detection of refluctate in the nasopharynx in patients with chronic rhinosinusitis [16], other researchers [17] believe that reflux does not play a significant role in the pathogenesis of this disease.The physiological basis of the possible effect of FLR on chronic inflammation of the auditory tube, leading to otitis media, is also not completely determined and is being discussed. A possible mechanism could be inflammation of the nasopharyngeal mucosa, which leads to obstruction of the Eustachian tube, although it may also be associated with a vagal reflex transmitted from the distal esophagus via the glossopharyngeal nerve.
The “gold standard” for diagnosing GERD is daily esophageal pH-metry, which allows to determine the type of reflux (acid or alkaline), the total number of reflux episodes during the day and their duration (normal esophageal pH is 5.5-7.0; in the case of reflux – pH less than 4 or more than 7), relationship with food intake, body position.Unlike the diagnosis of GERD, there is currently no clearly established “gold standard” for the diagnosis of FLR. Most clinicians rely on a combination of patient complaints, laryngeal changes on laryngoscopy, additional testing to confirm reflux, and clinical changes in response to empirical treatment. Of the instrumental methods for the diagnosis of FLR, the most informative are daily pH-metry with the simultaneous use of two probes (pharyngeal and esophageal) and intraesophageal impedance measurement [18].However, until now, not a single study has been carried out in the world covering a sufficient number of healthy volunteers, which would make it possible to determine the normative indicators for reliable diagnosis of FLR with pH-metry of the pharynx and esophagus, which extremely complicates both the instrumental diagnosis of the disease and the possibility of carrying out any or controlled medical research.
Despite the difference in clinical symptoms, the basic principles of treatment of GERD and FLR are similar and are carried out in several directions: lifestyle changes, drug therapy, and surgical correction.
Lifestyle changes include: normalizing body weight; decrease in physical activity, especially associated with forward bending of the trunk; dietary recommendations – frequent fractional meals, the last meal no later than a few hours before bedtime, cessation or sharp restriction of the use of chocolate, coffee, tea, carbonated and other drinks containing caffeine, as well as foods that increase gas production, hot and spicy foods and etc.; quitting smoking, taking alcoholic beverages; if possible – restriction or withdrawal of drugs that increase the acidity of the stomach or reduce the tone of smooth muscles (nitrates, theophyllines, calcium antagonists, etc.)).
Drug therapy for GERD includes the use of antacids and alginate drugs, drugs that affect gastrointestinal motility (prokinetics), and antisecretory drugs.
However, drug treatment of both GERD and FLR must be carried out taking into account the fact that the key etiological factor of the pathology is the lack of the antireflux barrier. In this case, the acidity of the gastric contents can be normal or even reduced, i.e. the development of the disease is mainly associated with the ingress of gastric contents into a non-physiological place for it.In this regard, it is advisable to use alginates, which temporarily reduce the acidity of the stomach contents. The only drug in this group that has recently appeared in Russia is Gaviscon (Reckitt Benckiser Healthcare, Great Britain).
The active substances of Gaviscon are sodium alginate, sodium bicarbonate and calcium carbonate. The mechanism of action of the drug has a physical nature, it is not absorbed into the systemic circulation. When taken orally, Gaviscon quickly reacts with the acidic contents of the stomach, forming a strong viscous gel of alginate or alginate “raft”, which has an almost neutral pH value, which is located on the surface of the contents of the stomach and prevents the reflux of acid, pepsin and bile into the esophagus.Compared to simple antacids and other alginate products, the “raft” remains in the upper part of the stomach much longer. This is due to the fact that sodium bicarbonate interacts with hydrochloric acid, forming bubbles of carbon dioxide, “soaking” the alginate “raft”, giving it buoyancy. As a result, Gaviscon effectively prevents the reflux of stomach contents into the esophagus, does not alter the acidity of the contents of the stomach and does not interfere with digestion processes. In addition, the gel itself can enter the esophagus, and thus protecting the inflamed mucous membrane, promotes its healing [19].The drug is approved for over-the-counter dispensing from the pharmacy for patients over 6 years old. Due to the lack of systemic action, Gaviscon is also approved for use in pregnant and lactating mothers and has shown high efficiency in the treatment of GERD in pregnant women [20]. Gaviscon is used in children from 6 to 12 years old, 5-10 ml, children over 12 years old and adults are prescribed 10-20 ml after meals and before bedtime. The duration of therapy is 2 weeks or more.
In case of insufficient effectiveness of treatment or in severe cases of the disease, in addition to alginates or antacids, prokinetics, H2-antihistamines (H2-blockers), proton pump inhibitors are prescribed.Prokinetics lead to the restoration of the physiological state of the esophagus, promote increased motility, which leads to an accelerated evacuation of gastric contents and an increase in the tone of the lower esophageal sphincter. H2-blockers and proton pump inhibitors inhibit the production of hydrochloric acid by parietal cells, as well as pepsin; however, H2-blockers have been used much less frequently in recent years due to their systemic action and lower efficiency compared to proton pump inhibitors.
Drug therapy for FLR should be more aggressive and prolonged than treatment for GERD, due to the fact that the larynx is more sensitive to the damaging effects of refluctate than the esophagus.
Indications for surgical treatment of GERD and FLR are the lack of results from conservative treatment within 6 months and life-threatening conditions such as: laryngospasm, cicatricial stenosis of the larynx, asthma, precancerous conditions and laryngeal cancer. For surgical treatment, Nissen fundoplication is mainly used, the purpose of which is to restore the lower esophageal sphincter [21].

Literature
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2. Belmer S.V., Khavkin A.I. Pediatric gastroenterology. M .: Medpraktika-M, 2003. – 360 p.
3. Privorotsky V.F., Luppova N.Ye. Draft working protocol for diagnostics and treatment of gastroesophageal reflux disease. – Manual for physicians.- M., 2005. – 15 p.
4. Ivashkin V.T., Sheptulin A.A. Diagnosis and treatment of gastroesophageal reflux disease. – A guide for doctors. –M., 2005.– 30 p.
5. Chang A.B., Lasserson T.J., Kiljander T.O. et al. Systematic review and meta – analysis of randomized controlled trials of gastro – oesophageal reflux interventions for chronic cough associated with gastro – oesophageal reflux.// BMJ.– 2006. – Vol. 330, No. 1. – P. 11-17.
6. Sontag S.J. Gastroesophageal reflux and asthma.// Am J Med.-1997.-Vol. 103, no. 5A.–P. 84 -90.
7. Barbero G.J. Gastroesophageal reflux and upper airway disease. Otolaryngol Clin North Am 1996 Vol. 29, No. 1. – P. 27–38.
8. Koufman J.A The otolaryngologic manifestations of gastroesophageal reflux disease (GERD) // Laryngoscope. 1991 Vol. 101, no. 4 Pt2 (Suppl. 53) – 78 p.
9. Axford S.E. Sharp N., Ross P. E., et al. Cell biology of laryngeal epithelial defenses in health and disease: preliminary studies. // Ann Otol Rhinol Laryngol.–2001. – Vol –110, No. 12. – P. 1099–1108.
10. Johnston N., Bulmer D., Gill G. A., et al. Cell biology of laryngeal epithelial defenses in health and disease: further studies // Ann Otol Rhinol Laryngol. – 2003. – Vol. 112, No. 6. – P. 481 – 491.
11. Ylitalo R., Ramel S. Extraesophageal reflux in patients with contact granuloma: a prospective controlled study.// Ann Otol Rhinol Laryngol. – 2002. – Vol. 111, No. 5. – P. 441–446.
12. Halstead L.A. Gastroesophageal reflux: A critical factor in pediatric subglottic stenosis.// Otolaryngol Head Neck Surg. – 1999. – Vol.120, No. 7.– P. 683–688.
13. Qadeer M.A., Colabianchi N., Vaesi M.F. Is GERD a risk factor for laryngeal cancer? // Laryngoscope.– 2005.– Vol. 115, No. 3. – P. 486 – 491.
14. Geterud A., Bove M., Ruth M. Hypopharyngeal acid exposure: an independent risk factor for laryngeal cancer? // Laryngoscope.– 2003.– Vol. 113, No. 12. – P. 2201 – 2205.
15. Shaker R., Bardan E., Gu C., et al. Intrapharyngeal distribution of gastric acid refluxate.// Laryngoscope.– 2003.– Vol. 113, No. 7. – P. 1182 – 1191.
16. DelGaudio J.M. Direct nasopharyngeal reflux of gastric acid is a contributing factor in refractory chronic rhinosinusitis.// Laryngoscope.– 2005.– Vol. 115, No. 6. – P. 946 – 957.
17. Wong I. W. Y., Omari T. I., Myers J. C., et al. Nasopharyngeal pH monitoring in chronic sinusitis patients using a novel four channel probe.// Laryngoscope.– 2004.– Vol. 114, No. 9. – P. 1582 – 1586.
18. Kawamura O., Aslam M., Rittmann T., et al. Physical and pH properties of gastroesophagopharyngeal refluxate: a 24– hour simultaneous ambulatory impedance and pH – monitoring study.// Am J Gastroenterol. –2004. –Vol. 99, No. 6. – P. 1000–1010.
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treatment and diagnosis of causes and symptoms in Moscow

General Description

Gastroesophageal reflux is a condition in which gastric contents enter the esophagus when the cardiac opening is abnormally dilated.

Today, about ¼ of the world’s population have gastroesophageal reflux. According to WHO European statistics, about 30-35% of the total number seek medical help from specialists. 3-4% receive full treatment.

The ratio of men and women among the population suffering from GERD is 2: 1.

Causes of occurrence

Anatomical features:

• Disorders of muscle tone of the lower esophageal sphincter
• Congenital and acquired destructive pathologies of the esophagus
• Hernia of the diaphragm
• Connective tissue failure

Conditions in which the anti-reflux barrier is violated:

• Excessive activity of the sympathetic nervous system
• When eating foods with a high fat content, spices
• For abuse of beverages – alcohol and caffeine
• The use of high dosages of medications such as barbiturates, morphine, NSAIDs, hormonal drugs
• Increased intra-abdominal pressure

Gastroesophageal reflux symptoms

Symptoms of GERD are divided into esophageal (typical) and extraesophageal.

Esophageal:

• Heartburn, especially at night and in the morning
• Profuse drooling
• Belching air, sour or bitter taste
• Nausea and vomiting
• Sore throat when swallowing
• Aching pain in the epigastric region

Extraesophageal:

• Pain in the throat, neck
• Cardiac arrhythmias (interruptions in the work of the heart)
• Inflammatory diseases of the oral cavity (stomatitis, gingivitis)
• Damage to tooth enamel (caries)
• Dry, unproductive cough
• Hoarseness

Diagnostics

• General clinical analysis of blood, urine
• Analysis of feces for coprogram
• Biochemical blood test (liver function tests, cholesterol, alkaline phosphatase)
• ECG
• X-ray of the chest organs in 2 projections
• X-ray of the esophagus, stomach with barium mixture
• Ultrasound of the hepatobiliary system
• Daily pH monitoring in the lower esophagus and stomach
• EGDS
• Helicobacter pylori non-invasive tests (respiratory)

Treatment of gastroesophageal reflux

The main treatment for uncomplicated course of GERD consists of a healthy lifestyle and proper balanced nutrition.

In case of inflammatory processes in the esophagus in the form of reflux esophagitis, Barrett’s esophagus, it is necessary to use medication, and in other cases, surgical treatment.

Components of a healthy lifestyle and healthy diet:

• Refusal to consume alcoholic, strongly carbonated drinks
• Weight loss in obesity
• Smoking cessation
• Avoid eating in large quantities and in late hours
• Adequate drinking regime
• Exclusion of excessive physical exertion, especially with frequent bending of the body
• Elimination of the horizontal position after a direct meal

If such non-drug treatments do not bring relief, drugs are used.

Therapy is aimed not only at eliminating symptoms, but also at complications of GERD.

It is recommended to start treatment already at the first signs of inflammation of the esophagus and stomach.

The following preparations are used:

• Prokenetics (help accelerate the movement of the food bolus from the esophagus into the stomach, then into the duodenum, increase the tone of the lower esophageal sphincter) – Domperidone (Motilak, Motilium), Itoprid (Ganaton)
• Antisecretory drugs (help suppress the secretion of hydrochloric acid) – proton pump inhibitors (Omeprazole, Pantoprazole, Esomeprazole, Rabeprazole)
• Antacids (Phospholugel, Almagel, Gaviscon)

The treatment regimen is selected individually in accordance with the patient’s condition and taking into account concomitant diseases.

90,000 What happens to the stomach when you eat too spicy food

• We just like to turn up the heat when we eat
• It can mess up your system, especially your stomach
• Spicy foods have several beneficial effects on our body

The Indians have a tendency to flock to masaledar khan, which uses a lot of spices and, of course, a lot of red chili powder. We just love to heat up when we eat, but did you know that spicy foods can do more than just enhance the flavor of your dish? While eating spicy foods can have serious health benefits, it can also ruin your system, especially your stomach.So, if you’ve indulged in hot and spicy foods excessively, then perhaps you should think again. Here are some reasons to stop it now.
_{Eating spicy foods can worsen stomach ulcers}
Much has been said and written about the fact that spicy food has several beneficial effects on our body. You already know that it can work wonders for your waistline. But eating spicy foods can aggravate stomach ulcers and gastritis. According to Dr. Kapil Agrawal, Senior Consultant, Laproscopic & Bariatric Surgeon, Habilite & Apollo Spectra Hospital, “While spicy foods do not cause ulcers or reflux, they may worsen symptoms in patients who already have these conditions.In addition, excessive consumption of spicy foods can cause diarrhea in some patients, causing intestinal irritation. It also reduces the sensitivity of your taste buds, so if you plan on enjoying your favorite spicy foods for years, less is more. ”

Eating spicy foods may cause the gastrointestinal tract to feel the most warmth. It feels like your inner body is on fire, but the capsaicin compound in chili activates the release of substance P, a compound that conveys pain and burning sensation.

Excessive consumption of spicy food can cause the following stomach diseases that you should be aware of.

1. Acid reflux

Spices are a combination of acids, and when too much of these acids are injected into the stomach, which also has its own acidic content, it begins to damage the walls of the stomach.

_{Acid reflux}

2. Stomach ulcer

Eating excessively spicy food can aggravate ulcers in the sensitive mucous membrane or in the small intestine called the duodenum, and sometimes even in the esophagus, making it worse.These ulcers are excruciatingly painful, causing more stomach pain, nausea, vomiting, and weight loss.

3. Loss of appetite

GKB №31 – Gastritis | City Clinical Hospital No. 31 of the city of Moscow

World renown

– According to the World Health Organization, 50% of the world’s population suffers from chronic gastritis.
– In the structure of diseases of the digestive system, gastritis occupies about 35%, and among diseases of the stomach – 80-85%.
– In 75% of cases, chronic gastritis is combined with chronic cholecystitis, colitis and other diseases of the digestive system.
– In 1983, Australian scientists Barry Marshall and Robin Warren discovered a spiral-shaped bacterium and gave it the name Helicobacter pylori (Helicobacter pylori) for its shape – “Helico” – spiral and habitat – “pylori” – pyloric stomach (outlet, adjacent to the duodenum).
– In 2005, B. Marshall and R. Warren were awarded the Nobel Prize. Scientists have proved by self-infection that it is Helicobacter pylori that enters the stomach with food or saliva that causes its inflammation – gastritis, and in more severe cases – ulcers and even stomach cancer.
– The Russian group for the study of helicobacteria in the territory of the Russian Federation and in the CIS countries has established that the level of infection with it reaches 80%.

Agree, each of us from time to time experiences discomfort in the abdomen: heartburn, a feeling of heaviness and even pain. The trouble is that we react to these signals in different ways. Only a few take action right away, but most of them wave their hand at the problem: they say, he will hurt and stop … Do you know what threatens such an indifferent attitude to your own body?

Do you know each other?

Gastritis is the most common stomach disease in the world that occurs at any age.It is an inflammation of the lining of the stomach, which lines the inside of the stomach to protect it from the hydrochloric acid and digestive enzymes it produces. Gastritis has many varieties, depending on the cause of the inflammation and two forms – acute and chronic.

Acute gastritis is an acute inflammation of the mucous membrane that occurs as a result of a strong irritant entering the stomach. It manifests itself suddenly or within 1-2 days with the following symptoms: a feeling of heaviness and pain in the epigastric region, nausea, vomiting (sometimes with bile), intestinal upset, weakness, sweating, dizziness, pallor, and sometimes fever.

Chronic gastritis is a long-term, progressive inflammatory process that causes structural changes in the inner lining of the stomach with subsequent disruption of its functions. In the mucosa, connective tissue gradually grows, replacing secretory cells that produce gastric juice. The insidiousness of this disease is that the gastric mucosa does not have pain receptors, therefore, when a small amount of irritant gets on it (for example, spicy food, alcohol, etc.) discomfort often does not arise. However, the constant intake of a traumatic substance contributes to the recurrence of inflammation, which gradually turns into a chronic form of gastritis. And only when the functions of the stomach are already impaired, the symptoms of the disease begin to appear: a feeling of oversaturation with food, heartburn, belching, stool disturbances, pain.

The chronic form, in turn, differs in the activity of the secretory function, that is, in the level of acidity production. It can be increased and decreased.With increased secretion, sensations of heaviness and burning in the stomach after eating, hungry pains prevail. When low, appetite disappears, morning sickness and an unpleasant taste in the mouth disturb. During the course of the disease, as a rule, there is a tendency to a decrease in acidity, since the production of gastric juice is disturbed.

Prime suspect

The causes of gastritis are different. Acute gastritis occurs due to excessive irritation of the stomach by indigestible, fatty, spicy, too hot or too cold food.It is also a consequence of poisoning with spoiled food, alcohol, drugs, poisonous substances, sometimes accompanied by an acute infection.

Important factors provoking the emergence of chronic gastritis – the systematic use of irritating food (spicy / salty), alcohol, drugs. Improper nutrition – dry food, prolonged abstinence from food followed by oversaturation, insufficient chewing. By the way, the chewing process is the most important in digestion.The fact is that by chewing food, we not only prepare it for passage through the esophagus, but thereby inform the stomach about its composition. Having received this information, the stomach begins to produce exactly those enzymes that are necessary for the digestion of this food.

Chronic gastritis can develop both independently and be a complication of other diseases, for example, cholecystitis, colitis, be the result of frequent stress or metabolic disorders. In some cases, with poor-quality treatment, gastritis turns into a chronic form from an acute one.

However, almost all of the above factors, according to modern scientists, are only contributing to the disease. The main culprit of chronic gastritis and its severe consequences is the gram-negative bacillus Helicobacter pylori. Scientists have found that it is she who plays a leading role in the inflammatory process, the development of peptic ulcer and stomach cancer. The peculiarity of Helicobacter is its ability to withstand the acidic gastric environment. With the help of special flagella, it clings to the walls of the organ, moves, penetrates into the mucous membrane, hiding from aggressive juice and incoming food.But most importantly, it increases the secretion of ammonia, which neutralizes the acidic environment, allowing it to inhabit the stomach and thereby disrupting its normal functioning. Reproducing, Helicobacter pylori secretes harmful substances that affect the mucous membrane, and then the deeper, muscular layer. In addition, the destruction of the protective membrane clears the way for the aggressive effect of hydrochloric acid on the unprotected layers of the stomach.

Accurate diagnosis

Diagnosis of acute gastritis is generally not particularly difficult and is confirmed according to the collected anamnestic data (set of information) and examination of the patient.Since gastritis is inherently poisoning, it is necessary to find out its cause as soon as possible in order to take adequate measures. After all, for example, treating food poisoning is different from treating chemical poisoning.

Sometimes it can be difficult to make a correct diagnosis due to the similarity of symptoms with other diseases. These include appendicitis, acute cholecystitis, acute pancreatitis, ulcers, hepatic and renal colic, infectious diseases, and even myocardial infarction.However, with gastritis, it is not painful, but dyspeptic manifestations that predominate – stool disturbance, vomiting, etc.

For the diagnosis of chronic gastritis and complex cases of acute, a wide arsenal of various studies is provided. In addition to carefully collected anamnestic data and a careful study of the clinical picture of the disease, studies of the secretory function of the stomach, gastroscopy, various types of biopsies, scanning of the stomach cavity to study its motor-evacuation function, X-rays are carried out, laboratory tests are prescribed.The most important diagnostic method is the study of gastric juice. It is obtained using a thin probe (2-3 mm) fractionally: on an empty stomach and after the so-called test breakfast – taking special drugs that stimulate gastric secretion. The composition of the portions of the obtained juice makes it possible to assess the acid-forming and enzymatic functions of the stomach, to detect pathological impurities (bile, blood, etc.). Gastroscopy is also one of the most informative methods for examining the stomach. In modern conditions, the gastroscopy procedure has become much more comfortable – the diameter of the tube has halved (up to 5 mm), and if desired, it is carried out during the patient’s drug-induced sleep.This method has become no less convenient for specialists – the equipment is equipped with a special eyepiece, through which the image is transmitted to the screen of the device. Thus, the video recording of the study can be placed on electronic media, re-viewed and discussed with other specialists.

As the most common cause of chronic gastritis, the diagnosis of Helicobacter pylori infection is especially relevant. It can be detected during gastroscopy, by blood analysis, as well as using special breathing tests, for example, the Helik test.This diagnosis takes no more than 15 minutes and immediately gives the result. The patient takes a certain dose of urea, exhales into a special tube and an indicator or digital system (depending on the modification of the apparatus) instantly reports on the presence of bacteria in the body by its urease activity (ability to break down urea). The procedure is absolutely safe and is indicated even for young children and pregnant women.

There is an output

Acute gastritis, as a rule, is not complete without appropriate measures.Since the pronounced, acute symptoms simply do not allow the disease to take its course. Treatment of chronic gastritis, on the other hand, is often delayed, which significantly complicates the situation.

In the acute form of the disease, adsorbent drugs that improve digestion and replace lost moisture are usually prescribed. With infectious gastritis, antibiotic therapy is performed. In cases of severe poisoning, urgent help from a toxicologist is required: determining the type of poison, neutralizing it and urgently removing it from the digestive tract, as well as measures to maintain the vital functions of the body.

If ordinary acute gastritis is cured on average in a week, then the treatment of chronic gastritis takes months and even years. Inflammation caused by infection with Helicobacter, first of all, requires antibacterial therapy, and depending on the level of acidity production, antacids, adsorbents, enveloping agents or drugs that enhance the secretory and motor functions of the stomach are prescribed. In the case of pain, antispasmodics and prokinetics are indicated. In addition, patients with chronic gastritis should be under dispensary observation and visit a doctor at least twice a year.

It is believed that Helicobacter pylori can peacefully exist in the stomach, without causing disease, until provoking factors appear: weakening of the immune system, ingestion of irritating substances into the stomach, etc.

An inflammatory reaction in the stomach is a consequence of not only the ingress of any irritant into it, but also the response of the body. In this case, special cells of the immune system are activated. They are trying to remove the intruder and restore the integrity of the mucous membrane. This work of immune cells outwardly looks like inflammation.

Main types of chronic gastritis:

– Type A gastritis – autoimmune gastritis. The consequence of a violation of the immune system, which begins to produce antibodies that destroy its own cells of the gastric mucosa.
– Type B gastritis – chronic gastritis caused by Helicobacter pylori.
– Type C gastritis – reactive gastritis (reflux gastritis). It appears as a result of food being thrown back into the stomach from the duodenum. The alkaline contents of the intestine damage the pyloric mucosa and reduce acidity.

Laryngopharyngeal reflux: treatment of the disease | Clinic Rassvet

Fast passage

Laryngopharyngeal reflux (LFR) is the reflux of gastric contents (acid and enzymes such as pepsin) into the larynx, resulting in hoarseness, a lump in the throat, difficulty swallowing, coughing, and a feeling of mucus in the larynx.

Reflux as the cause of the above symptoms without gastroesophageal reflux disease (GERD) is constantly being questioned.The guidelines issued by the specialized societies for laryngology and gastroenterology represent different points of view. Both groups acknowledge that the interpretation of existing studies is difficult due to ambiguous diagnostic criteria for LFR, varying rates of response to treatment, and the significant placebo effect on treatment.

There are relatively limited data on the prevalence of LFR: about 30% of healthy people may have episodes of reflux on a daily pH-meter or detect characteristic changes in the larynx.

LFR can directly or indirectly cause laryngeal symptoms. The direct mechanism includes irritation of the laryngeal mucosa with caustic substances – refluxates (acid, pepsin). An indirect mechanism involves irritation of the esophagus, which leads to laryngeal reflexes and symptoms.

Helicobacter pylori infection may also contribute. The prevalence of H. pylori among patients with LFR is about 44%.

Laryngophangeal reflux and GERD

Although gastric acid is common to both LFR and GERD, there are many differences that make LFR a distinct clinical entity.

• A prerequisite for GERD is heartburn, which is reliably observed in only 40% of patients with LFR.
• Most patients with GERD show signs of esophagitis on biopsy, while patients with LFR only show signs of esophagitis in 25% of cases.
• GERD is thought to be a problem of the lower esophageal sphincter and occurs primarily in the supine position. In contrast, LFR is viewed primarily as a problem of the upper esophageal sphincter, and occurs mainly in an upright position during exercise.
• The formation of LFR requires much less acid exposure than GERD.

There are significant differences between the lining of the esophagus and the larynx.

• The upper limit of normal for acid reflux into the esophagus is considered to be up to 50 episodes per day, while 4 episodes of reflux into the larynx is no longer a normal option.
• In the larynx, in contrast to the esophagus, which removes acid during peristalsis, refluxate lasts much longer, causing additional irritation.
• The epithelium of the larynx is thin and poorly adapted to deal with caustic chemical damage from the same pepsin and acid.

Laryngopharyngeal reflux symptoms

• Dysphonia or hoarseness;
• cough;
• sensation of a lump in the throat;
• discomfort and sensation of mucus in the throat;
• dysphagia (swallowing disorder).

Some researchers believe that chronic laryngeal irritation can lead to the development of carcinoma in non-alcoholic or non-smoking patients, although there is no evidence to support this.

Symptoms specific to LFR can also be caused by the following conditions:

• postnasal syndrome;
• allergic rhinitis;
• vasomotor rhinitis;
• upper respiratory tract infections;
• habitual coughing;
• use of tobacco or alcohol;
• excessive use of voice;
• change in temperature or climate;
• emotional problems;
• environmental irritants;
• vagus neuropathy.

Diagnostics

There is considerable disagreement about the appropriate method for diagnosing LFR.

Most patients are diagnosed clinically based on symptoms associated with LFR.

With laryngoscopy (examination of the larynx), there is swelling and hyperemia (redness) of varying degrees. However, the relatively weak correlation between symptoms and endoscopic findings is an argument against the use of endoscopic diagnostic methods.

The Reflux Sign Scale and Reflux Symptom Index are well suited for both diagnosis and monitoring of response to therapy.

Daily ph-metry with a dual probe probe, despite its excellent sensitivity and specificity, is questioned, since the results of this diagnostic method often do not correlate with the severity of symptoms.

Another diagnostic option may be the empirical prescription of PPI therapy.

Treatment of laryngopharyngeal reflux

Lifestyle changes and diet are the main approaches in the treatment of LFR and GERD.The role of drug therapy is more controversial. It is not known whether asymptomatic patients with incidental signs of LFR need treatment. There are theoretical concerns that LFR may increase the risk of malignant neoplasms, but this has not yet been proven. In any case, dietary adherence is recommended for patients with asymptomatic LFR.

Patients are advised to give up smoking, alcohol, exclude foods and drinks containing caffeine, chocolate, mint. Prohibited foods also include most fruits (especially citrus fruits), tomatoes, jams and jellies, barbecue sauces and most salad dressings, and spicy foods.Fractional meals are recommended.

Avoid exercise for at least two hours after eating, and refrain from eating and drinking three hours before bedtime.

Drug therapy usually includes proton pump inhibitors (PPIs), h3 blockers, and antacids. PPIs are recommended for six months for most patients with LFR. This figure is based on the results of endoscopic examinations (this is the time required to reduce laryngeal edema), as well as the high relapse rate in the case of a three-month course of therapy.Discontinuation of therapy should be carried out gradually.

If PPI therapy and H2 blockers have been unsuccessful, treatment with tricyclic antidepressants, gabapentin and pregabalin should be considered, as one of the possible mechanisms for the development of reflux is an increased sensitivity of the larynx.

How is laryngopharyngeal reflux treated at the Rassvet clinic?

All patients with complaints of hoarseness, a feeling of a lump in the throat, difficulty swallowing, cough, a feeling of mucus in the laryngopharynx are examined by an otorhinolaryngologist and a gastroenterologist.

An endoscopic examination of the nasal cavity, nasopharynx and larynx is performed to exclude other diseases that, in addition to LFR, can provoke these symptoms. The gastroenterologist also prescribes the entire necessary range of examinations, including the exclusion of H. Pylori infection.

The key to successful therapy is the joint management of the patient by an otorhinolaryngologist, a gastroenterologist, in some cases a psychiatrist and a psychotherapist.

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