Common Myths In Gastroesophageal Reflux Disease (Gerd)
MYTH 1: WRONG FOOD IS THE SOLE CAUSE OF GERD
The origin of this belief lies in the myth that lifestyle habits, certain foods, beverages can actually increase the heartburn symptoms. Although appealing to the common sense, that the more spicy or hard to digest foods you eat, you are more likely to produce more acid in the digestive tract; heartburn is actually a medical condition which is caused by other biological causes. Even with a lifestyle and diet change, the condition will remain the same. A bland diet may appear to be good initially, but it alone will not cure heartburn caused by GERD.
Some acidic foods like orange juice and carbonated beverages do indeed trigger heartburn in GERD sufferers. The reason behind this is not the acid content or amount of acid. Even, the non acidic orange juice can cause problems. So, it is recommended to undergo treatment and alongside follow a bland diet initially followed by resumption of normal food later. Clubbing these two things together helps to cure GERD faster
MYTH 2: GERD PATIENTS SHOULD KEEP THE BED RAISED
A partially correct old myth suggests that GERD patients must keep the bed raised or sleep sitting up or sleep with extra pillows under the head. Few patients who get nocturnal regurgitation may find this useful, however not all may find it to be beneficial. Few recent studies have indicated that sleeping on the left side is a better way to avoid nighttime heartburn. This happens because sleeping on the right side makes the acid take longer to clear out of your esophagus which increases heartburn symptoms. The acid can regurgitate back into your esophagus more often if you lay on your back. But sleeping with your head elevated using a wedge pillow will keep the acid in your stomach. Another useful process is by using a wedge pillow on the right side
MYTH 3: BODY WEIGHT DOES NOT MAKE A DIFFERENCE
It was considered a myth because until recently there was not enough evidence to prove this to be a fact. Earlier it was considered that weight does not make a difference in GERD. But recent researches have proven that losing weight actually helps relieve GERD.
Clinical evidence has emerged that acid reflux increases when you gain weight. This is true for all overweight or obese patients, normal weight patients and even underweight patients. This happens because with the increase of body mass index, you start to show an increased prevalence of symptoms of reflux disease. While in the converse, losing weight decreases the likelihood of reflux symptoms. Weight reduction alone will not cure your GERD, but it'll certainly help a lot in symptom alleviation.
MYTH 4: EXCESS ACID PRODUCTION CAUSES GERD
Another old misconception. The problem in GERD is not only the amount of acid. The amount of acid produced in a GERD sufferer's stomach is usually normal but the problem is of the acid being in the wrong location. Instead of staying in the stomach, the acid moves into the esophagus. Now the probable doubt would be about the significance of medications, which the clinician’s prescribe to reduce stomach acid if excess acid is not the actual problem. The reason being that there is no medication to keep the acid in the right place or effectively stop the acid from dropping back in the esophagus. So, medicines are given to reduce the acid, because lack of acid in the stomach will decrease the acid volume and chances of reflux decrease.
MYTH 5: GERD CAUSES ONLY COMPLICATIONS IN ESOPHAGUS
This is an absolutely wrong myth. Even though heartburn is the most well known symptom in GERD patients, it is not the only symptom/ complication. Recent studies suggest that GERD causes or exacerbates asthma. This is a unique problem where by the fact, that asthma and asthma medications also cause or aggravate GERD in return. Non cardiac chest pain is another significant complaint.
Other complications include hoarseness in the throat or around the vocal cords caused by irritation from acid reflux. Patients may also experience chronic cough , sinusitis, sleep disturbance and sore throat.
MYTH 6: TOO MUCH STRESS CAUSES GERD
As use of sugar would worsen the condition of a diabetes patient. Similarly, stress is not the cause of heartburn but it can worsen heartburn. The stress can both be physical and/or mental. Extreme physical stress while undergoing severe illness or injury, can cause immense heartburn and even develop ulcer with time/without treatment. Conceptually it is the same with mental stress. Extreme mental stress and anxiety can increase the symptoms of acid reflux as evidenced by symptoms of heartburn seen in students just before examination. So the right thing to say would be that too much stress worsens GERD.
MYTH 7 :GERD IS BEYOND TREATMENT
This is the biggest myth perpetrated on our generation. You can definitely help your GERD and heartburn. General treatment includes prescription medications and over the counter remedies along with subtle changes in diet and lifestyle. You can keep a Heartburn record to find out what might be triggering your heartburn( food, activity, exercise, smoking, alcohol etc.)
The current generation has far better investigative, treatment (both medical and surgical therapies) and management strategies to counter GERD.
MYTH 8: ACID SUPPRESSING MEDICATIONS WILL IN RETURN CAUSE INDIGESTION
As we know that there is no direct medication available for the acid present in esophagus, medicines are prescribed to lower the production of acid in the stomach. Hence patients tend to think that acid suppressing medicines may cause indigestion. Digestion happens to be a multi step, multi tasked process using acid, enzymes and hormones. Medications like Histamine H1 blockers, proton pump inhibitors, would work significantly in reducing the production of acid but enough acid would still be present in the stomach for digestion
MYTH 9: GERD IS NOT A SERIOUS DISEASE
Statistics from USA indicate that about 60 million Americans suffer from GERD experience an induced heartburn at an average of once or twice a month. Hence, people tend to think that GERD is a common disease like flu and is not really serious. No such detailed study is available from India.
This is a serious mistake. GERD should not be taken lightly. Chronic heartburn can cause many complications and can also make a serious impact on an individual's life. It is important to treat it properly; investigated with endoscopy, Barium studies, pH manometry and motility studies or else it can lead to Barrett's esophagus, esophageal strictures, erosive esophagitis and even esophageal cancer
MYTH 10 : IF MEDICATIONS FAIL, NOTHING CAN BE DONE
Not in the current times. If medications and other strategies fail, effective surgical treatment in form of surgeries like fundoplication is available and expertise is constantly growing.
P.S. The above descriptions are in general to dispel the common myths about GERD. Individual cases would require the attention of your treating physician to exclude disease states like ulcers, hiatus hernia and malignancy.
Figure 1. GERD is a common problem
Figure 2: Heartburn is interpreted in variety of ways due to its location