Esophageal Reflux (GERD) or Heartburn


Esophageal Reflux refers to the regurgitation of stomach acids into the esophagus. The most common symptom is heartburn. Esophageal reflux is usually a mild condition that can be managed medically or nutritionally. In chronic cases, however, it may lead to esophagitis, ulceration, or hemorrhage.

The esophagus is usually protected from reflux of stomach contents by the contraction of the LES, or lower esophageal sphincter. If the LES becomes stretched and weakened it no longer is able to efficiently protect the patient from reflux (regurgitation of stomach acids).

When the LES muscle loosens, it allows the stomach acids to move back into the esophagus, instead of doing its job and holding the stomach acids in the stomach. The feeling of heartburn comes from those stomach acids being in the wrong place!

Nutritional Changes:

• Achieve and maintain desirable body weight.

• Avoid large meals. If extra calories are needed, have mid-morning and mid-afternoon snacks. Small meals are preferable, since they digest more efficiently and will lessen the chance of reflux.

• Avoid eating meals or snacks for at least two hours before lying down. If you must eat late, prop yourself up with a few pillows before lying down.

• Take chewable digestive or papaya enzymes with each meal to help with your digestion.

Avoid or limit foods and beverages that relax the LES:

• Alcohol

• Peppermint or spearmint

• Garlic or onion

• Chocolate

• High-fat foods: fried foods, meats, cream sauces, gravies, margarine or butter, cream, oil, and high-fat salad dressings

Avoid or limit foods and beverages that can be irritating:

• Carbonated beverages

• Citrus fruit and juices

• Coffee (regular or decaf)

• Spices

• Tomato products

• Very hot or very cold foods

Increase foods that do not affect the LES:

• Low-fat protein foods (low-fat dairy products, lean meat, chicken, fish)

• Carbohydrate foods with a low-fat content (breads, cereals, crackers, fruit, noodles, potatoes, rice and vegetables prepared without added fat)

• Drink liquids between meals instead of with meals

• Wear loose fitting clothes, especially after meals

• Avoid or quit smoking

Addendum to article on GERD:

While making dietary changes to protect yourself from GERD (Gastroesophageal Reflux Disease) it is critical to understand that GERD places the person at higher risk for Esophageal Cancer. The survival rate of esophageal cancer is low: one in five people will survive less than five years.

The good news:

There are diagnostic tests to determine the extent of damage done by this reflux or (commonly known as) “heartburn”. The upper endoscopy is one test that is done under sedation. The other test is a Transnasal esophagoscopy (TNE) that is done with no sedation.

These tests are relatively simple and can determine if GERD has placed the person at risk of developing Esophageal Cancer. With or without symptoms, a scope using either diagnostic methods should be done since there are risks for cancer for those who have had GERD with or without continuing symptoms.

In addition to my dietary recommendations, eat at least 3 or more hours before going to bed and/or use pillows or an object to raise the head to reduce the stomach acid from reaching the esophagus. People may be unaware of the reflux occurring while sleeping so be prepared and safe. Further, symptoms of GERD to be aware of are persistent sore throat, a hoarse voice, chronic coughing or choking upon lying down. Remember, there may be no symptoms and still damage is being done.

For further information please contact ECAN (Esophageal Cancer Action Network) at

About Author: Marci Sloane
Marci Sloane is a registered and licensed dietitian and certified diabetes educator. She is the Food Majesty and author of several books.

2 thoughts on “Esophageal Reflux (GERD) or Heartburn

  • It is important to note that GERD (Gastroesophageal Reflux Disease) can lead to Esophageal Cancer. The type of Esophageal Cancer caused by GERD is one of the fastest increasing cancers in the western world – up more than 600% over the past 35 years. Sadly, it is also one of the deadliest – fewer than one in five people diagnosed with Esophageal Cancer will survive five years. That is why it is important to speak with your health care provider about the possibility that you should be screened for Barrett’s Esophagus, the pre-cancerous condition that can lead to Esophageal Cancer. This is critically important because when the disease is caught at this stage, it can often be successfully treated with outpatient procedures that can prevent progression to cancer.

    While Esophageal Cancer is considered rare (more than 17,000 Americans will be diagnosed with the disease in 2014 – and about 16,000 will die from the disease), it is deadly and usually not detected until late stages when treatment is rarely successful. While more cases of this disease occur in middle aged men, women and young people are also at risk. Today there are no easy ways for health care providers to tell if their patients with reflux are at risk for the disease without doing some type of scope of the esophagus. This is often done under sedation with an upper endoscopy. But it is also possible to undergo an unsedated exam using a nasal scope (TNE – transnasal esophagoscopy). This is a relatively pain-free, quick exam that can rule out the need for further testing or treatment.

    As a mother and widow of a man who left behind two daughters under the age of 13, and the founder of the Esophageal Cancer Action Network (ECAN), I ask that you add to the information you provide to your subscribers so that they can be properly educated about the risks posed by reflux. The elimination of symptoms does not always mean the elimination of the risk of cancer. In fact, one red flag that alerts well-informed health care providers to a patient’s risk is the disappearance of symptoms in patients with persistent heartburn and reflux. This can be a sign that their esophagus has adjusted to the exposure to stomach contents and has already begun the kind of cellular changes that can lead to cancer.

    You might also want to add to your suggestions for addressing reflux itself: refraining from lying down within a few hours of eating – the elevation of the head of their bed. Reflux is often worst and causes more damage while patients sleep, when they may be unaware that it is occurring. This is exactly what happened to my husband. It would also be helpful to list the symptoms that may be caused by reflux disease of which many people may not be aware, like persistent sore throat, hoarse voice, chronic cough or choking upon lying down.

    • Mindy,

      Thank you so much for taking the time to comment on my post with such invaluable information. I am so sorry for the loss of your husband.

      I have added additional information to this post.

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