Antacids help neutralize stomach acid, providing relief from the burning sensation aka heartburn that is often associated with conditions like GERD. Common antacids include Mylanta or Maalox.

This component can reduce muscle spasms in the stomach, helping to relieve symptoms like stomach cramps. Donnatal is a common antispasmodic used as well.

The LES is a ring of muscle that opens to let food into the stomach and closes to keep it there. If it weakens or relaxes abnormally, stomach acid can flow back into the esophagus, causing gastroesophageal reflux disease GERD. Factors like obesity, smoking, and certain medications can contribute to this dysfunction.

Helicobacter pylori – or H. Pylori for short, is a bacteria that is commonly found in the stomach. Over time, it can cause inflammation, ulcers, and even increase the risk of stomach cancer. 

Nonsteroidal anti inflammatory drugs (NSAIDs) like aspirin, ibuprofen, and naproxen, are over the counter medications that are used for pain and inflammation. These can also all reduce prostaglandin which helps protect the stomach’s inner lining. Over time, this can lead to gastritis and other stomach complications.

A hiatal hernia occurs when the upper part of the stomach bulges through the diaphragm into the chest cavity. It can weaken the LES and promote acid reflux, leading to GERD.

Certain foods we consume and how we eat them can contribute to heartburn, GERD, and gastritis.

• Spicy and Acidic Foods
• Fatty Foods
• Caffeinated and Carbonated Beverages
• Eating Large Meals
• Alcohol and Chocolate

Alcohol can irritate and erode the stomach lining, leading to chronic inflammation. Chronic, heavy drinking is a common cause of gastritis.

Stress can also lead to stomach issues. This is usually due to major surgery, injury, burns, or severe infections can lead to acute gastritis. This is from increased stomach acid as your body’s response to the stress. 

Smoking or consuming tobacco products can weaken the LES and irritate the stomach. Both active smoking and exposure to secondhand smoke can be problematic and lead to health problems. 

Often described by patients as a burning sensation in the chest, heartburn and acid indigestion is the hallmark symptom of GERD. This common symptom and burning feeling is felt just behind the breastbone and might also spread up to the neck or throat.

Excessive belching can be a symptom of gastritis. Along with it, bloating or a feeling of fullness in the abdomen is common – especially if the patient has a hiatal hernia.

This symptom is the sensation of stomach contents or acid flowing back into the throat or mouth. It often leaves a sour or bitter taste.

Gastritis can lead to feelings of nausea or even vomiting. Sometimes, the vomit may appear bloody or like coffee grounds in the case of a GI bleed.

Due to consistent irritation of the esophagus in chronic gastroesophageal reflux disease GERD, patients might experience trouble swallowing or painful swallowing. Their esophagus can even develop strictures which need dilated intermittently as time progresses. They may need a barium swallow as the first step in their diagnosis, and eventually an upper endoscopy. 

Patients with gastritis and bad acid reflux might experience reduced interest in eating due to their heartburn and other symptoms above.

Sometimes chronic GERD can cause others ymptoms such as a dry cough that is worse when lying down.

Chronic acid reflux and GERD can lead to dental erosions due to frequent reflux of acid, which eats away at your teeths enamel. 

Lifestyle changes can make a major difference in patients with GERD and gastritis symptoms, helping their heartburn. Lifestyle changes include:

• Consuming more frequent, smaller meals
• Avoiding spicy, acidic, or fatty foods
• Avoiding certain beverages like carbonated drinks can also help

For GERD patients, elevating the head of the bed can prevent acid reflux, especially during sleep. Using wedges or foam inclines can be effective. 

Both alcohol and caffeine can exacerbate symptoms. Reducing or eliminating consumption can aid in symptom relief.

Stopping smoking can help improve LES tone, so healthcare providers should encourage patients to stop smoking (plus help many other health problems that cigarettes can cause).

Being overweight increases the risk of GERD. Achieving and maintaining a healthy weight and making this an important lifestyle change can reduce symptoms.

Antacids are acid neutralizers, and they can treat symptoms from persistent heartburn, acid reflux, and GERD symptoms, as well as pain from gastritis. 

Over the counter medication options for heartburn as well as medications include: 

• TUMS (Calcium Carbonate): 1 – 4 tablets as needed (max dose 8g/day)
• Maalox or Mylanta (Aluminum Hydroxide & Mangesium Hydroxide) 400-800mg up to 4 times daily as needed

H2 blockers work by blocking the action of histamine 2 receptors. H2 produces acid in the stomach. This is often given IV in the ER setting. Common medications in this class ordered in the hospital include Pepcid:

• PO: famotidine 20-40mg, then usually up to 20mg BID (40mg in severe cases)
• IV: 20mg IV BID

Chronic exposure to stomach acid from chronic acid reflux can inflame the tissue lining of the lower esophagus and lead to esophagitis, including the surrounding esophageal muscles. This can lead to ulcers or strictures in the esophagus caused by the above. 

Over time, untreated GERD and esophagitis can lead to the narrowing of the esophagus from scar tissue, known as strictures. This can result in difficulty swallowing and often requires dilation. 

In some people with long-term GERD, the cells lining the lower esophagus can become precancerous (“dysplasia”). This condition, called Barrett’s esophagus, increases the risk of esophageal cancer. Regular monitoring with endoscopy is advised for people diagnosed with this condition.

Chronic inflammation can lead to the formation of ulcers, especially if the patient has H. Pylori infection. These can erode into the stomach and sometimes lead to a upper GI bleed. This usually causes significant discomfort, leading to patients seeking medical attention.

Erosion into blood vessels can lead to GI bleeding of the digestive system. This typically manifests as dark tarry stools, vomiting blood or coffee ground emesis, and anemia. This is a true emergency! Patients with a medical history of GI bleeds with GI symptoms should be made a priority!

GERD can lead to recurrent aspiration of stomach contents into the lungs, leading to asthma symptoms like chronic cough, wheezing, or even pneumonia. 

Causes

Causes of Gastritis and gastroesophageal reflux disease GERD include decreased LES tone, hiatal hernia, NSAID over-use, poor diet, or an H. Pylori infection.

Symptoms

Include of GERD and Gastritis could be as simple as acid reflux, but often include GI upset like nausea, vomiting, epigastric pain, bloating, belching, and decreased appetite.

Physical Assessment

Epigastric tenderness and pretty common with gastritis, and you may find dental erosion or pharyngeal erythema from the reflux.

Treatment

Medical treatment includes medications to decrease the acid in the stomach, decrease stomach acid, and decrease spasms. This is where a GI cocktail can really help! Sometimes antibiotics are needed if an H. Pylori infection is present.