Acid reflux

Main risk factors for GERD:

• Weak esophageal muscles can impair the ability to push the refluxed content in the esophagus back into the stomach.
• Nerve sensitivity – There are multiple nerve endings in the esophagus, and the sensitivity of these nerve endings differs among individuals. In some people even normal amounts of reflux can stimulate symptoms.
• Hiatus hernia is a condition where part of the upper stomach pushes up through the diaphragm. The barrier between the esophagus and stomach is weakened in the presence of a hiatus hernia, which can allow reflux to occur.
• Increased abdominal pressure such as with obesity or in pregnancy, can reverse the flow gradient from stomach to esophagus.
• Overstimulated gut-brain connection – The gut-brain axis is a communication network that connects your gut and brain through the nervous system. The gut-brain axis can be overstimulated during times of stress and anxiety, leading to increased focus and worry about esophageal health and symptoms.

Lifestyle modifications:

• Stress reduction – Integrate methods to reduce stress in your life to disrupt the overstimulated gut-brain connection. These include
  mindfulness, meditation, and massage therapy.
• Belly breathing or diaphragmatic breathing can help strengthen the diaphragm and reduce esophageal disease and reflux. A video on diaphragmatic breathing can be found here: https://www.youtube.com/watch?v=UB3tSaiEbNY
• Weight management – Losing weight, particularly weight around the abdomen, is a powerful tool to improve GERD symptoms for
  patients that are overweight. Maintaining a healthy weight is important to control GERD in patients with a normal weight.
• Change your eating habits – Including the acidity of food, as well as size and timing of meals, particularly with respect to sleep.
  • Reduce offending food items (alcohol, soda, caffeine, smoking, trigger foods)
  • Eat small meals
  • Avoid eating too close to going bed
• Quit smoking – Saliva helps to neutralize refluxed acid, and smoking reduces the amount of saliva in the mouth and throat. Smoking also lowers the pressure in the lower esophageal sphincter and provokes coughing, causing frequent episodes of acid reflux in the esophagus. Quitting smoking can reduce or eliminate symptoms of mild reflux.
• Chewing gum or using lozenges can increase saliva production, which may help to neutralize and clear stomach acid that has entered the esophagus.
• Avoid tight-fitting clothing as it can increase discomfort, and may also increase pressure in the abdomen, forcing stomach contents into the esophagus.

Lifestyle modification measures including avoidance of refluxogenic foods, food avoidance for at least 2–3 hours before recumbency, positional changes during the sleep period, and weight loss have been proposed for management of GERD. Late evening meals have been shown to contribute to reflux. Head of bed elevation as well as left lateral decubitus position have been shown to improve nocturnal esophageal acid exposure.