Caring for People With Gastroesophageal Reflux Disease (GERD)

Gastroesophageal reflux disease (GERD) is becoming an increasing problem for people of all ages in the United States. This is probably due in part to an increase in the consumption of fast food, which tends to be greasy and fatty, as well as the escalating rate of obesity. If you suspect that a loved one is suffering from acid reflux, it's important that he or she sees a doctor who will be able to determine if a diagnosis of GERD is appropriate and exclude all other disorders with similar symptoms. The severity of his or her GERD symptoms will determine the best treatment options. In the meantime, here are ways you can help lessen the severity of heartburn symptoms at home.

Food Choices

The lower esophageal sphincter (LES), the valve between the esophagus and stomach, normally closes tightly to keep food and stomach acid where it belongs. If it relaxes when it shouldn't, food and stomach acid come back up into the esophagus and cause heartburn.

Heartburn is often triggered by certain foods. Help your loved one become familiar with these triggers and try to keep trigger foods out of the house so he won't be tempted and end up in pain.

Foods that can relax the LES include:

  • Fried (greasy) foods
  • High-fat meats
  • Butter and margarine
  • Mayonnaise
  • Creamy sauces
  • Salad dressings
  • Whole-milk dairy products
  • Chocolate
  • Peppermint
  • Caffeinated beverages (e.g., soft drinks, coffee, tea, cocoa)

Heartburn may also occur when the stomach produces too much acid, and this backs up into the esophagus. Foods that may stimulate acid production and increase heartburn include:

  • Caffeinated beverages
  • Carbonated beverages
  • Alcohol
  • Spicy foods
  • Black pepper
  • Citrus fruit and juices (e.g., orange, grapefruit)
  • Tomato juice

When you eat out, inquire as to how different dishes are prepared, if your loved one doesn't. You can ask that meat is grilled rather than fried, for example. Many dishes include high-fat gravies and sauces that you can ask to have switched to a low-fat substitute or served on the side. While adults will undoubtedly want to make their own choices when it comes to food, starting the conversation may help lead the way to better choices.

Mealtime

Encourage your loved one to cut down the size of her meals, as they expand the stomach and can increase upward pressure against the lower esophageal sphincter (LES), which causes heartburn. Eating less, but more frequently may help (think snacks, rather than full courses).

Using smaller dishes at home, preparing less food, and serving meals from the stove—rather than the table, where it's easy to reach for seconds—may be helpful strategies.

Late night snacking may be your loved one's bedtime ritual, but if she suffers from GERD, it can make for a painful, uncomfortable night's sleep. Try to dissuade her from eating during the two- to three-hour window before she goes to bed, perhaps by avoiding snacking yourself.

Gravity helps keep the stomach juices from backing up into the esophagus and assists the flow of food and digestive juices from the stomach to the intestines. So, while after dinner snacking isn't advised, staying up for a while after the meal can help give the body time to take advantage of gravity's forces while food is being digested.

Bedtime

Nighttime heartburn can be the most dangerous. If frequent nighttime heartburn occurs, the risk of complications increases. There are several reasons for this. For example, refluxed acid tends to remain in the esophagus for longer periods, allowing it to cause more damage to the esophagus. There are, however, a few ways to prevent nighttime heartburn.

Lying down flat presses the stomach's contents against the lower esophageal sphincter (LES). With the head higher than the stomach, gravity helps reduce this pressure. Ask your loved one's doctor how high to elevate the head of the bed. Elevating the entire head of the bed by placing bricks or wooden blocks under the feet on that side, so that the bed is at a slight slant, works well. Your doctor may also suggest using an acid reflux bed or a wedge pillow to elevate your loved one's head while sleeping.

Clothing Choices

Clothing that's tight around the abdomen squeezes the stomach, forcing food up against the LES, causing food to shoot back up into the esophagus. Options that can especially tend to cause problems include tight-fitting belts, tight-waisted jeans, and slenderizing garments.

Symptom Tracking

Buy your loved one a journal and, if he's able and willing, have him record when he experiences heartburn symptoms, what foods were consumed, and/or what activity he was doing before the heartburn occurred. The severity of each heartburn episode and what gave him relief should also be noted. He can rank his discomfort on a scale of 1 to 10 with 10 being the most discomfort he can imagine and 1 being pain that is barely there.

He can bring this information to his doctor, who can then help him make modifications to his diet, activity, or medications, if needed.

Exercise

If your loved one is overweight or obese, even losing 5 or 10 pounds can help alleviate heartburn symptoms and exercise, in general, is beneficial for a host of reasons. Encourage her to go on walks, ride her bike, or jump on the treadmill while she's watching TV. Try fun family activities like bowling, hiking, gardening, or swimming. Getting active with your loved one may help her feel more motivated.

Medications

Antacids like Tums, Rolaids, and Mylanta neutralize stomach acid. It's helpful to keep them handy, especially if your loved one often forgets them. However, if he or she needs to use antacids for more than a week or so, or if an antacid doesn't quickly resolve symptoms, a visit to the doctor is recommended. Using an antacid for more than one to two weeks should only be done with the guidance of a physician.

If your loved one has made dietary and lifestyle changes that reduce heartburn without success, it may be time to use one of the stronger medications. Beyond antacids, there are two primary categories of heartburn medications:

  • Acid blockers (H2 blockers), such as Tagamet (cimetidine), Pepcid (famotidine), Zantac (ranitidine), and Axid (nizatidine)
  • Acid suppressors (proton pump inhibitors, PPIs), such as Prilosec (omeprazole), Prevacid (lansoprazole), Nexium (esomeprazole), Aciphex (rabeprazole), and Protonix (pantoprazole)

However, long-term use of these drugs has been associated with kidney disease, heart attack, and bone fractures. Potential side effects should be discussed with a physician. Long-term acid reflux can also result in complications, so your loved one's doctor can help you weigh the risks and benefits of treatment.

If your loved one often forgets to take his or her medication, you may find medication reminder smartphone apps helpful.

Support

The best treatment for acid reflux is prevention, and making changes to your loved one's diet, sleeping position, and activity is the best way to begin. These changes, however, can sometimes be hard to make. Do what you can to encourage and set your loved one up for success, and try to have patience as they find their way.

Involving your loved one's doctor can be helpful, not only in learning more about how to help control symptoms, but because it involves someone else who can support and back you in the suggestions you have made.

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