Gastroesophageal reflux disease (GERD) is a chronic condition in which the liquid contents of the stomach regurgitate back into the oesophagus. Since these contents are highly acidic and may at times contain bile, a typical burning sensation behind the breastbone or the upper abdomen is felt. 

Gravity, swallowing and saliva are important protective mechanisms for the oesophagus but they are effective only when individuals are in the upright position. During sleep, gravity has no effect, swallowing stops and the secretion of saliva is reduced. Therefore, reflux that occurs during the night is more likely to cause greater damage to the oesophageal lining.

The causes of GERD are quite complex and tend to vary in different individuals. However, several contributing factors that may increase the susceptibility of a person to develop this condition include abdominal obesity, multiple pregnancies, hiatus hernia, connective tissue diseases, as well as lower oesophageal sphincter abnormalities or delayed gastric emptying.

The diagnosis of GERD is usually suspected by a doctor when the typical symptoms associated with this condition are present over a prolonged period of time. These may include heartburn, acid or bile regurgitation, increased salivation, as well as nausea and vomiting. However, these symptoms are non-specific. 

Thus, the current gold standard for the definite diagnosis of GERD is 24-hour oesophageal pH monitoring. Endoscopy, gastric emptying and oesophageal motility studies are recommended in those individuals who do not respond well to treatment or present with more alarming symptoms such as difficulty in swallowing, anaemia, blood in the stool, wheezing, weight loss or voice changes.

The primary treatment of GERD typically revolves around simple lifestyle modifications as well as prescribed medications to neutralise the acid reflux as well as preventing the formation of excess acid in the stomach. 

As a general guideline, coffee, caffeinated drinks, citrus, tomato juice, alcohol, spicy and fatty foods should be avoided. Red meat, wholegrains and foods that are rich in fibre should be reserved for the earlier parts of the day as they are more difficult to digest and may remain in the stomach beyond bedtime if they are consumed late.

Moreover, smoking and alcohol intake should be minimised. Mindfulness and breathing techniques may also help in controlling excessive stress which may also be a contributing factor to GERD.

Several changes in eating habits, such as eating smaller portions of food and earlier evening meals are recommended. The consumption of chewing gum, milk, as well as elevation of the head and the upper body while sleeping may also improve the symptoms. 

The modifications that have been described above usually are effective in treating the symptoms of GERD. Nevertheless, sometimes they are not enough. In these cases, the standard surgical treatment for severe GERD is fundoplication. In this procedure, the upper part of the stomach is wrapped around the lower oesophageal sphincter to strengthen it. 

In Western populations, GERD affects approximately 10 to 20 per cent of individuals. The prevalence rate of GERD in developed nations is also tightly linked with age, with adults aged 55 to 65 being the most commonly affected. 

Complications of unresolved GERD may include gastric ulcers, oesophageal strictures, Barrett’s oesophagus as well as iron deficiency and inflammation of the oesophagus. Thus, it is vital to seek medical advice if the symptoms persist.

Recipe

The following light and digestible chicken broth recipe is ideal for dinner time as its ingredients do not take long to be digested. 

Ingredients (makes 2 portions)
2 skinless chicken breasts
1 cup (120g) carrots, peeled and sliced
1 cup (100g) chopped zucchini
½ cup celery, whole or chopped
1 litre water
1 tsp coarse sea salt (optional)
1 cup cooked jasmine or basmati rice
1-2 tbsp of fresh chopped parsley

Method

Bring the water to a boil. Add the carrots, zucchini, celery, chicken and salt. Cover and simmer for 30 minutes or until the chicken is well cooked.

While the soup is simmering, cook the rice in a separate pot. Drain and set aside.

Remove the chicken from the pot and shred by hand or using a fork. Add the shredded chicken back into the soup. Add the cooked rice and the fresh chopped parsley to the soup and enjoy.

Nutritional information

• Chicken breast has a low-fat content when compared to whole chicken or red meat. Cooking it well also separates the muscle fibres and makes them easier to digest. It is thus ideal for avoiding acid reflux. Other stomach- friendly meats include white fish and turkey.

• Peeled, chopped and well-cooked vegetables like carrots, zucchini, potatoes and cauliflower take a short while to digest and add nutrients to our meals. Heavier vegetables like legumes, aubergines, onions, mushrooms and bell peppers are more difficult to digest and are best reserved for lunchtime and are to be eaten in moderation. Moreover, vegetables are rich in fibre and anti-inflammatory nutrients that aid in digestion, improve bowel movements and strengthen gut health. In order to minimise acid reflux, one should avoid tomatoes or tomato concentrates and base any sauces on other vegetables that are less acidic.

• Finer grains like basmati or jasmine rice, couscous or millet are more easily broken down by the stomach acids when compared to wholegrains and glutinous grains such as wheat which is found in bread, pizza or pasta. If one intends to consume grains later during the day, it is recommended to include a smaller portion of these lighter grains rather than having a large plate of pasta or pizza as the latter may result in poor digestion and the production of acid reflux during the night.

Georgiana Farrugia Bonnici is a former diagnostic radiographer and medical doctor. Antonella Grima is a public health specialist and state registered nutritionist. One may follow their blogs on www.facebook.com/be.heart.healthy and www.facebook.com/antonella.grima.nutritionist/.