What are the dietary changes to be made in GERD?

Question

Hello doctor,

I am a 33 year old male. I have had chronic constipation since my childhood. The doctors said that my gastric motility is a bit under-par. To rule out any physical damage, I went through colonoscopy three years ago. The reports only mentioned small hemorrhoids. I was on a brief course of antacids and laxatives after that, which gave me temporary relief. Constipation had reduced considerably by the end of last year. However, I have been experiencing acid reflux since early this year. This is the first time that I have had regular episodes of reflux. So, I did my endoscopy four months back. It revealed ulcers in the esophagus near the sphincter (GERD). It also revealed a small sliding hiatus hernia. No metaplasia seen in biopsy. The doctors said that since I am a young patient, surgery is not recommended. They said I have to rely on lifestyle modifications and antacids. Currently, I am taking Nexpro RD 20 mg capsules and Riflux Forte syrup. I have cut down on spicy food, and also have altered my meal times since the past one and a half months.

The acid reflux has reduced by 60 to 70 % since the lifestyle change. However, I still experience some really disturbing symptoms: stinging chest pain at both the breast bones (especially after meals), occasional back-ache, frequent shortness of breath after meals, huge bouts of burping (with the feeling that air is trapped around the diaphragm), and overall fatigue. Regarding chest pain, I have undergone ECG, 2D echo, stress test, and troponin. All tests normal. The cardiologist has ruled out any cardiac problem. However, he has prescribed 2.5 mg of Nebicard SM to control my palpitations. He has already tapered the dose from 5 mg to 2.5 mg, I believe he will take me off the medicine soon. I need help to know what can I do to improve my symptoms.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Your treatment till date is on the right track and I appreciate your adherence to the same. You have a small hiatus hernia, which is not an abnormal finding always. The reflux of acid from the stomach to the esophagus (chest) is causing your current symptoms including the small ulcers. Now you can deal the problem with few dietary and non-medical tips.

Avoid spicy, oily, fried foods which you may be doing now. Restrict the volume and frequency of such foods if it is impossible to stop it altogether.
Consider short frequent feeds rather than three heavy and filling meals.
Stay away from carbonated drinks, excess coffee, etc. which can relax your esophageal sphincter excessively.
Always sit or walk around for 15 minutes after having a meal. Have your dinner at least an hour before going to bed.
Have regular physical exercises. Consider stress-relieving meditation if possible.
Avoid combining eating with other activities like chatting, watching TV, etc.
Chew your food well before swallowing. Avoid drinking a large amount of water with food.
Taper your medications and use it only when you have troublesome symptoms. You can do with Nexpro RD (Esomeprazole and Domperidone) or Pantocid DSR (Pantoprazole and Domperidone).

Please consider the following tests too.

Thyroid function tests (T3, T4, and TSH).
Ultrasound scan of the abdomen to assess liver, gallbladder, and bile duct.

Hope I have cleared you doubts to your satisfaction. You can review with the reports when it is done and revert as needed if any fresh queries.

Thank you.