In gastroesophageal reflux disease (GERD), acid from the stomach splashes upward, or “refluxes,” and burns the esophagus (the tube connecting the mouth to the stomach). Normally, a type of sphincter muscle keeps the upper part of the stomach closed, but various factors may loosen it, allowing acid to rise more easily. The result is pain in the chest (heartburn). GERD is generally made worse by lying down because gravity no longer restrains the upward movement of stomach contents. In infants, the major issue with GERD is spitting up of food or milk rather than pain.
Certain foods may worsen GERD, including alcohol, carbonated beverages, caffeine, chocolate, citrus juices, milk, and peppermint. Cigarette smoking may also increase symptoms. Contrary to earlier beliefs, it does not appear that people with GERD need to cut down on fat intake to help control the disease. 1,2
Pregnant women frequently develop GERD due to changes in muscle tone. The connection between obesity and GERD remains unclear.
Treatment for GERD involves elevating the head of the bed and using medications that reduce the acidity of the stomach. In general, more powerful antacid medications are required for GERD than for ulcers or gastritis . Drugs in the proton pump category are most effective. Surgery may be recommended in certain cases.
If left untreated, GERD causes precancerous alterations in the lower part of the esophagus (a condition called Barrett’s esophagus), which can develop into esophageal cancer. For this reason, people with GERD are often given a test to evaluate the condition of the esophagus.
Natural antacids, such as calcium carbonate (Tums) or hydrotalcite, may provide short term relief from GERD. 8
Drugs used to treat GERD may tend to deplete the body of certain nutrients—especially vitamin B 12 , but also folate and various minerals. Use of a multivitamin/multimineral supplement should correct this problem. For more information, see the articles on specific medications in the Drug Interactions section of this database.
Deglycyrrhizinated licorice (DGL), a special form of the herb licorice , has shown some promise for the treatment of ulcers. A drug (carbenoxolone) that is similar to ingredients in licorice has been studied for the treatment of GERD, with good results. 3-5
However, in these studies carbenoxolone was combined with other ingredients, including antacids and alginic acid. It is not clear that carbenoxolone alone will help GERD, and it is even less clear that licorice itself offers any benefit.
A popular over-the-counter drug for GERD, Gaviscon, contains a substance called alginic acid. Alginic acid is thought to form a kind of protective seal at the top of the stomach, reducing reflux. The seaweed bladderwrack is high in alginic acid. However, there is no evidence that whole bladderwrack can reduce heartburn symptoms.
Several other natural supplements are often recommended for the treatment of GERD, including Aloe vera , antioxidants, artemesia, fresh garlic , marshmallow , and slippery elm , but there is no scientific evidence to support their use.
Many naturopathic physicians believe that the supplement betaine hydrochloride can aid GERD by increasing stomach acid. This sounds paradoxical, since conventional treatment involves reducing stomach acid. However, according to one theory, lack of stomach acid leads to incomplete digestion of proteins; these proteins cause allergic reactions and other responses that lead to an increase in reflux. Again, scientific evidence is lacking.
1. Pehl C, Waizenhoefer A, Wendl B, et al. Effect of low- and high-fat meals on lower esophageal sphincter motility and gastroesophageal reflux in healthy subjects. Am J Gastroenterol . 1999;94:1192-1196.
2. Penagini R, Mangano M, Bianchi PA. Effect of increasing the fat content but not the energy load of a meal on gastro-oesophageal reflux and lower oesophageal sphincter motor function. Gut . 1998;42:330-333.
7. Wenzl TG, Schneider S, Scheele F, et al. Effects of thickened feeding on gastroesophageal reflux in infants: a placebo-controlled crossover study using intraluminal impedance. Pediatrics . 2003;111:e355-359.
8. Holtmeier W, Holtmann G, Caspary WF, et al. On-demand treatment of acute heartburn with the antacid hydrotalcite compared with famotidine and placebo: randomized double-blind cross-over study. J Clin Gastroenterol. 2007;41:564-570.
Last reviewed September 2014 by EBSCO CAM Review Board
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