Functional Medicine for Acid Reflux (GERD) and Indigestion

What are acid reflux (GERD) and indigestion?

The esophagus, or food pipe, is the tube that carries food from your mouth to your stomach. Acid reflux, called gastroesophageal reflux (GER), happens when the muscle at the end of the esophagus doesn't close properly. Stomach contents can then move back up and irritate the esophagus. Having reflux once in a while is common.¹

If you have symptoms two or more times a week, or if reflux damages the lining of your esophagus, you may have gastroesophageal reflux disease (GERD). GERD is a chronic (long-lasting) condition that can lead to other health problems over time. It can happen when the muscle at the bottom of the esophagus becomes weak or relaxes at the wrong time.¹

Anyone can have GERD. You are more likely to have it if you are overweight or have obesity, are pregnant, or smoke or are around secondhand smoke. A hiatal hernia, when part of the stomach pushes up into the chest, also raises the chance. Certain foods, drinks or medicines can also make GERD worse.¹

Indigestion (dyspepsia) is a group of symptoms in the upper belly. They include pain or burning, feeling full after a meal, and feeling full too soon while eating. Heartburn and indigestion are two separate conditions, though you can have both. Most long-lasting (chronic) indigestion is diagnosed as functional dyspepsia, a disorder of how the gut and brain interact. Disorders of gut-brain interaction are not diseases. They are groups of symptoms that occur together.^{2, 7}

Sometimes a health problem causes indigestion. The most common are peptic ulcers and infections such as Helicobacter pylori (H. pylori). A peptic ulcer is a sore in the lining of your stomach or your duodenum, the first part of your small intestine. The most common cause of peptic ulcers is infection with H. pylori, a type of bacteria. Another cause is long-term use of nonsteroidal anti-inflammatory medicines (NSAIDs), such as aspirin and ibuprofen. Some other medicines can also cause indigestion. Examples include certain antibiotics, iron supplements, steroids, and GLP-1 medicines for diabetes or obesity.^{2, 5}

Risk factors for functional dyspepsia include anxiety and other mental health problems, a recent gut infection, being female, smoking, NSAID use and H. pylori infection. The causes are not fully understood. They are probably linked to how the gut and brain communicate. This can lead to changes in how the gut moves, how sensitive it is, and the mix of bacteria in the gut. Specific foods are not thought to cause indigestion. But certain foods or drinks may bring on symptoms in some people with functional dyspepsia.^{2, 7}

Common symptoms of GERD and indigestion

The most common symptom of GERD is heartburn, a burning feeling in your chest or throat. You can also have GERD without having heartburn. Peptic ulcers most often cause a burning stomach pain that may start between meals or during the night and briefly stop if you eat or take antacids. Other common symptoms of GERD and indigestion include:^{1, 2, 5}

• Tasting acid or food in the back of your mouth¹
• A dry cough or hoarse voice¹
• Asthma-like symptoms¹
• Trouble swallowing¹
• Pain, a burning feeling or discomfort in your upper belly²
• Feeling full too soon while eating a meal²
• Feeling uncomfortably full after a small amount of food²
• Bloating, nausea or belching²

How GERD and indigestion are diagnosed and treated

For GERD, your health care provider will ask about your symptoms and medical history. They may suggest an upper GI endoscopy. This test uses a tiny camera to look at the lining of your esophagus and stomach. Other tests include a biopsy (a small tissue sample) and x-rays. An esophageal pH test measures how often acid backs up into the esophagus and how long it stays there.¹

Most people can manage GERD with lifestyle changes and medicine. Lifestyle changes can include eating smaller meals, not lying down for at least 2-3 hours after eating, and avoiding foods that trigger symptoms, such as spicy foods, chocolate, caffeine or fatty foods. Other changes can include losing weight if needed, raising the head of your bed and quitting smoking. Medicines include over-the-counter antacids and prescription medicines. In rare cases, surgery is needed. Without treatment, GERD can cause problems such as inflammation of the esophagus, scarring, or changes in its lining called Barrett's esophagus.¹

To find the cause of indigestion, doctors use your symptoms, your medical and family history, a physical exam and sometimes tests. Your doctor may check for H. pylori with a stool test, a breath test, a blood test, or a small tissue sample taken during an upper GI endoscopy. A stool test can also show whether H. pylori treatment has worked.³

The American College of Gastroenterology and the Canadian Association of Gastroenterology wrote a joint guideline on indigestion. It recommends that people under 60 have a non-invasive test for H. pylori, such as a breath or stool test, and treatment if the test is positive. For people 60 and older, it suggests an upper endoscopy to rule out other problems.^{3, 6}

Treatment depends on the cause. It may include antibiotics for an H. pylori infection or changes to what you eat and drink. Some medicines lower the amount of acid your stomach makes, such as proton pump inhibitors (PPIs) and H2 blockers. If a medicine is causing your indigestion, your doctor may suggest changes to the medicines you take. Anxiety and depression may play a role in functional dyspepsia. Your doctor may suggest ways to lower stress, such as relaxation exercises or counseling.⁴

How our care fits alongside your gastroenterologist

Avicenna Functional Medicine does not replace your gastroenterologist or the treatment they prescribe. Our role is to add to your care, not to take its place.

In a functional medicine visit, we look at factors that may contribute, such as H. pylori infection, foods and drinks that trigger symptoms, eating habits, medicines, smoking, body weight, stress and gut health, alongside the care you already receive. Our aim is to understand the whole picture of your health and to support your overall wellbeing.^{1, 2, 4, 7}

Please do not stop or change any prescribed medication, including acid-reducing medicine, without talking to the doctor who prescribed it. For safety reasons, talk with your doctor before using dietary supplements or other alternative products.⁴

What to expect at Avicenna

All visits are by telehealth, for patients located in Florida and Texas. We are a cash-pay practice, and we accept HSA and FSA. Care usually follows these steps:

• A free, 30-minute discovery call to talk about your health and whether our approach is a good fit for you
• A full intake visit with our health coach, under clinician supervision, covering your history, symptoms, current treatment and goals
• Testing chosen for you, where it is likely to be useful
• A personalized plan, with follow-up visits to review how you are doing and adjust the plan as needed

When to get urgent care

Get medical help right away if you have chest pain with shortness of breath, or pain in your jaw or arm. These can be signs of a heart problem.¹

If you have indigestion, see a doctor right away if you also have trouble or pain when swallowing, frequent vomiting, bloody vomit, or severe and constant belly pain. The same goes for long-lasting bloating or swelling in your belly, weight loss without trying, loss of appetite, yellowing of your eyes or skin, or black, tar-like stools. Also see a doctor if your indigestion doesn't get better.²

Telehealth visits with our team are not for emergencies. Call 911 right away if you have warning signs of a medical emergency, such as:

• Chest pain or pressure that lasts two minutes or more⁸
• Trouble breathing or shortness of breath⁸
• Sudden confusion, unusual behavior or trouble waking up⁸
• Fainting or passing out⁸
• Sudden dizziness, weakness or changes in vision⁸
• Being unable to speak⁸
• Severe belly pain, or sudden severe pain anywhere in the body⁸
• Coughing up or vomiting blood⁸
• Thoughts of suicide or of harming someone else (you can also call or text 988)⁸