GERD - path to cure and prevent gerd from ever coming back

Question

I am trying to wrap my head around the massive amount of information how is GERD caused and treated.

GERD is caused by the lower sphincter of your esophagus relaxing abnormal or weakens, stomach acid goes up your esophagus.

Various risk factors of GERD have been identified such as:

• obesity
• delayed stomach emptying
• connectivity tissue issues/disorders

And various things aggravate acid reflux such as

• smoking
• spicy foods
• fatty foods
• certain medicines

I have read numerous claims throughout the web that to cure GERD all one has to do is eat a low acid diet, or drink alkaline water, or elimination diet, or meds for life.

Does treatment consist of figuring out each individual's personal path to living without any acid reflux (at which point its cured) or is acid reflux considered a normal part of battling GERD and it should slowly go away with time after making substancial changes to diet/lifestyle?

To better explain the question...does healing gerd consist of:

1 - eliminating everything until you finally do not have acid reflux/GERD for a day, living on that diet for awhile, and then figuring out what to add in and work from there

or

2 - making substancial changes to lifestyle/diet and and slowly getting better overtime even with dealing with acid reflux issues throughout the "healing" process?

Answer 1

In summary:

• The first line of treatment of GERD symptoms are lifestyle changes: losing weight (if necessary), avoiding triggering foods and moderate physical activity. Eliminating all suspected foods until symptoms improve and then introducing them back one by one is a reasonable method.
• Even if you can control symptoms of GERD by lifestyle changes, GERD won't likely heal on its own until the underlying causes (obesity, hiatal hernia, delayed gastric emptying) persist.

---

Causes and risk factors of GERD

1) Insufficiency of the lower esophageal sphincter (LES), a muscular valve that normally prevents reflux of food and acid from the stomach into the esophagus due to (Mayo Clinic):

• Obesity, pregnancy
• Fructose malabsorption
• Hiatal hernia - a slip of the upper part of the stomach through an opening (hiatus) in the diaphragm muscle
• Bile reflux due to peptic ulcer or gallbladder removal
• Increased gastric acid secretion can be associated with reflux, but, in most cases, this is not the cause (GI Motility online, 2006)

2) Delayed gastric emptying (gastroparesis), which can result from (WebMD):

• A damage of the nerves due to diabetes mellitus, Parkinson's disease, multiple sclerosis, etc.
• Hypothyroidism
• Drugs, like narcotics and antidepressants
• Abnormal esophageal motility (achalasia, esophageal spasms)
• Connective tissue diseases, such as scleroderma

Triggers of GERD

In a person with established GERD, certain triggers can aggravate reflux:

• Certain foods and large meals
• Lying down shortly after a meal
• Medications: aspirin, antihistamines, narcotics (morphine, codeine, etc.), tricyclic antidepressants (amitriptyline, doxepin...), calcium channel blockers (amlodipine, diltiazem...), clonidine, drugs to treat Parkinson's disease, lithium and progesterone (MedicineNet).
• Smoking (nicotine)

NOTE: Acidic foods may increase the feeling of esophageal irritation, but they don't actually increase the reflux:

...some beverages with high acidity did not induce symptoms (i.e., prune juice) and others with low acidity did (i.e., tomato juice) indicating other factors may play a role (18). Similar incongruencies between physiology and symptoms exist for carbonated beverages. (Journal of Thoracic Disease, 2019)

Diagnosis of GERD

The investigations for diagnosis of GERD may include upper endoscopy, measurement of the acidity and pressure in the esophagus and an abdominal X-ray with barium swallow (Mayo Clinic).

Evidence-based approach to treatment of GERD

1) Lifestyle changes

According to a systematic review of studies: Body weight, lifestyle, dietary habits and gastroesophageal reflux disease (World Journal of Gastroenterology, 2009), weight loss (if overweight) and moderate physical activity can help to improve GERD symptoms, while the evidence about the effect of diet is inconclusive:

There is sufficient evidence to support the relationship between being obese/overweight and GERD, expressed as specific symptoms and endoscopic features. Furthermore, available evidence suggests that controlled weight loss (by diet or surgery) is able to induce a significant improvement in GERD symptoms and/or in GERD clinical-endoscopic manifestations. Definitive data still do not exist regarding the association between dietary behavior, mainly in terms of specific dietary components and GERD manifestations. Moderate physical activity seems beneficial, while vigorous activity may be dangerous in predisposed individuals.

The lack of strong evidence about the effect of diet on GERD symptoms on the population level should not discourage anyone to personally try and see what can help to him/her. The following lifestyle changes have been supported by some studies:

• Avoiding foods that are fatty (fried foods, chocolate), spicy or acidic (citrus fruits), carbonated beverages, sugars, tomato-based products, alcohol, caffeine (coffee, tea, cola), large meals and eating <2 hours before bed (Journal of Neurogastroenterology and Motility, 2019, Journal of Thoracic Disease, 2019)
• Weight loss, tobacco smoking cessation and head of the bed elevation (Clinical Gastroenterology and Hepatology, 2017)

2) Medications and surgery

Medications that reduce the stomach acid (antacids, H2 antagonists or proton pump inhibitors) can prevent symptoms and damage of the esophagus; hiatal hernia and certain other conditions may require surgery (American Family Physician, 2005).

Treatment of eventual H. pylori infection may improve or worsen GERD (GI Motility online, 2006).