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Homeopathic Medicines For GERD, Acid Reflux and Heartburn

Gastroesophageal reflux disease (GERD) develops when there is a frequent backwash of the stomach acid into the esophagus. Acid reflux or heartburn refers to the burning sensation felt behind the sternum (retrosternal burning) due to the backflow of stomach acid into the food pipe.  Homeopathic medicine for acid reflux and GERD helps treat the condition and manage the symptoms effectively. The top three homeopathic medicines for treating GERD, acid reflux, heartburn are Robinia, Iris Versicolor, and Natrum Phos.

Gerd if left untreated can lead to a more serious complication called Erosive esophagitis; which in turn can lead to ulceration, bleeding and narrowing of the food pipe.

The Main Cause of Heartburn

To understand GERD, one will have to first understand how our esophagus (food pipe) and stomach handle food and acid. As the food reaches the lower end of the food pipe, a circular muscle (the LES or lower esophageal sphincter) present around the food pipe opens up and allows the food to enter the stomach. Once it enters the stomach, this muscle closes the lower end of the food pipe. This actually behaves like a one-way valve stopping the food and the acid in the stomach from moving back into the esophagus. In Gerd, this valve relaxes abnormally or weakens, so the stomach acid flows back up into your esophagus very frequently, causing repeated attacks of heartburn.

GERD: Symptoms

– Heartburn, which is a burning sensation in the chest behind the breastbone. It gets worse after eating, on lying down and on bending.
– Burning in the throat
– Chest pain
– Sour, bitter belching or waterbrash (sudden flow of saliva due to indigestion) from regurgitation of food or sour liquid
– Sour taste in the mouth
– Difficulty in swallowing
– Sensation of a lump in the throat
– Bad breath
– Feeling of Abdominal bloating
– Cough
– Laryngitis
– Worsening of asthmatic complaint

Homeopathic Remedies for Acid Reflux, Heartburn, and GERD

The conventional treatment for GERD involves the use of antacids, which work by changing the pH of the stomach acid to make it less acidic. This helps decrease the irritation caused by the acid to the stomach, esophagus or the duodenum.
Use of antacids for an extended duration can cause side effects like gas, belching, constipation, diarrhea, and swelling of the hands, feet, and ankles. Antacids also interfere with nutrient absorption. Proton pump inhibitors (PPIs), which are used to reduce the production of stomach acid are known to deplete vitamin B12 in the body. This can further affect the nervous system, cause fatigue, shortness of breath, and loss of vision.
The amount of antacids used, and the duration of their use can affect the electrolyte balance in the body. Any changes in the levels of different electrolytes (like calcium, potassium or sodium) can adversely affect the muscle and nerve function.
Further, aluminum-based antacids can weaken the bones by flushing out salts like phosphate and calcium.

Homeopathy, on the other hand, works gently to minimize the symptoms of GERD and treats the root cause of the problem. Homeopathy can be of great help to those who do not show much improvement even after lifestyle modifications. The top homeopathic medicines that are used to treat GERD are:

Robinia – Top Homeopathic Medicine for Acid Reflux and GERD

Robinia is a top listed homeopathic medicine for treating GERD. Robinia is prepared from a plant named ‘yellow locust.’ The natural order of this plant is Leguminosae. The key indication to use this medicine in GERD is intense heartburn, constant sour belching, and sour vomiting due to regurgitation of acid from the stomach. The symptoms of heartburn and acidity tend to get worse at night time, on lying down and can cause sleeplessness.

Key indications for using Robinia for GERD:

-Intense heartburn
– Sour belching and vomiting
– Heartburn and acidity worse at night

Iris Versicolor – Homeopathic Medicine for Acid Reflux with Sour, Bitter Belching

Iris Versicolor is a natural homeopathic medicine for treating GERD. It is prepared from a plant commonly named ‘blue flag.’ The natural order of this plant is Iridaceae. Sour, bitter belching is the key feature to use this medicine. Vomiting of sour bitter fluid that burns the throat, vomiting with weakness, a smarting, burning sensation in the throat, and heartburn are the key symptoms. There may be burning distress and pains in the epigastric region (the part above the stomach) at frequent intervals. Constant nausea may be present with these symptoms.
There is excessive indigestion, and the food is vomited after an hour or so eating a meal. Iris Versicolor is also a well indicated homeopathic medicine for a headache arising with acidity.

Key indications for using Iris Versicolor:

– Sour bitter belching
– Sour bitter vomiting
– Heartburn; burning in throat

Natrum Phos – Homeopathic Medicine for Acid Reflux with Heartburn and Difficulty Swallowing

Natrum Phos is another prominently indicated homeopathic medicine for GERD treatment. It is useful when heartburn is attended with difficulty swallowing. Other symptoms include sour belching, waterbrash, and vomiting of sour fluid or cheesy, curdled masses. A lump sensation in the throat may also be present, along with a loss of appetite.

Key indications for using Natrum Phos for GERD:

– Heartburn and difficulty in swallowing
– Vomiting of sour, cheesy or curdled matter

Other Important Homeopathic Medicines for GERD

Arsenic Album – Homeopathic Medicine for Acid Reflux with Burning Pain in Throat

Arsenic Album is a homeopathic medicine for GERD that is accompanied by a burning pain in the throat. The burning gets worse upon swallowing. Swallowing is difficult and painful. Other symptoms include regurgitation of acrid matter, water brash, heartburn, intense nausea, and weakness. Arsenic Album is also a well indicated homeopathic medicine for inflammation of the esophagus (esophagitis).

Calcarea Carb – Homeopathic medicine for Acid Reflux with Sour Taste in Mouth

Calcarea Carb is a well indicated homeopathic medicine for GERD where there is a sour taste in the mouth. There is a regurgitation of sour substances with the flow of sour, watery fluid from the mouth. Foul odor from the mouth may be present with nausea. Sour, bitter belches, vomiting of sour, bitter slime (of food eaten), and heartburn are some other symptoms that may be present. The burning from the food pipe extends to the throat. Along with this, continued loud belching may appear especially after eating; with a cough and nausea.

Carbo Veg – Homeopathic Medicine for Acid Reflux with Bloating and Heartburn

Carbo Veg is an excellent homeopathic medicine for GERD treatment. It is useful when there is bloating along with heartburn. Sour, offensive belching that gets worse after drinking or eating, a burning sensation in the throat and difficulty in swallowing are other symptoms. Even the simplest of food tend to trigger the condition.

Nux Vomica – Homeopathic Medicine for Acid Reflux with Cough

Nux Vomica is a highly effective homeopathic medicine for GERD accompanied with a cough. Nux Vomica is one of the best indicated homeopathic medicines for a gastric cough that gets worse at night time and prevents sleep. Vomiting usually appears from coughing. The throat is sore and raw, and swallowing may be painful. Burning in the throat, especially at night time is present. There is a regurgitation of food with heartburn and sour belching.

Phosphorus – Homeopathic Medicine for Acid Reflux with Laryngitis (Hoarse Voice)

Phosphorus is a homeopathic medicine for GERD where there is hoarseness of voice. The hoarseness may be worse during the evening. A hard, dry, racking cough may appear. Gastric symptoms like heartburn, sour belching, sour taste in the mouth, vomiting of food or sour, acidic liquid may also be present.

Pulsatilla Nigricans – Homeopathic Medicine for Acid Reflux from Fatty Food

Pulsatilla Nigricans is a natural homeopathic medicine prepared from a plant named ‘windflower.’ The natural order of this plant is Ranunculaceae. It is used in cases of GERD where consumption of fatty food worsens the complaint. Greasy, fatty food like creams, pastries, and ice creams trigger the acid reflux. The symptoms include heartburn and water brash. Belching of food, bitter taste in mouth, nausea and a sensation of having a lump in the throat may be present.

Sulphuric Acid – Homeopathic Medicine for Acid Reflux with Sour Belching

Sulphuric Acid is a homeopathic medicine for GERD where intensely sour belching is present. Heartburn, sour vomiting and nausea are other symptoms. The sour vomiting mostly appears after eating.

Risk Factors: GERD

Obesity

Obesity and being overweight are risk factors that contribute to the development of GERD. The reason is that the excess fat in the abdomen compresses the stomach and raises its internal pressure. This increased pressure leads to backing up of stomach acid contents to the food pipe. This is known as acid reflux. Even a small increase in the body weight of a person is likely to increase the risk of GERD. Overweight and obese people are three times more at risk to develop GERD as compared to people who are at a healthy weight. The severity of symptoms of GERD and the risk of developing associated complications is also more pronounced in overweight and obese people.

Hiatus hernia

People having hiatus hernia are at risk of developing GERD. Hiatus hernia is the bulging of the upper part of the stomach through the hiatus opening in the diaphragm (muscle partition between chest and abdomen). Hiatus hernia leads to weakening of the LES that allows easy reflux of stomach contents into the esophagus.

Smoking

Smokers are at high risk to develop GERD. This is because nicotine present in tobacco tends to relax the lower esophageal sphincter. This allows reflux of acid contents to rise into the food pipe.

Pregnancy

The risk of GERD and heartburn is high in pregnant women. There are two reasons for this. One is that the hormonal changes that occur during pregnancy tend to cause relaxation of esophageal muscles and LES. Second is that the growing fetus tends to put pressure on the stomach. Both these factors cause pushing of the stomach acid into the esophagus. The heartburn usually develops in the second and third trimester of pregnancy.

Type of Exercise

Strenuous exercise right after eating a meal is not advised. Those who indulge in heavy exercise with a focus on the core muscles of the abdomen are at an increased risk of developing GERD. Certain activities can decrease the blood flow to the gastrointestinal area, causing the gastric fluids to get collected. (1) This can further lead to irritation and inflammation.
Exercises that involve hanging upside down or bending are some examples that can worsen GERD symptoms. People also tend to gulp air during high-impact workouts. This can relax the lower esophageal sphincter, forcing the stomach acid into the esophagus. Eating immediately before a workout also increases the risk of acid reflux.

Some high-impact exercises that can cause heartburn are:

– weightlifting
– cycling
– sprinting
– gymnastics
– running
– skipping

Factors that can Trigger or Worsen GERD Symptoms

Food: Fatty foods, fried food, chocolates, spicy food, tomatoes, garlic, onions, and citrus fruits are known to worsen GERD symptoms.

Medications such as NSAID’s, antibiotics (such as tetracycline), pain relievers (such as ibuprofen and aspirin), birth control pills, hormone replacement therapy steroids, antidepressants like amitriptyline, asthma medication like beta-adrenergic agonists or bronchodilators, iron supplements, and quinidine (a heart medication) are some medications that tend to worsen the symptoms of GERD and cause acid reflux.

Stress

Carbonated drinks, caffeinated drinks: These are often sweetened and contain excessive air which can cause gas, contributing to GERD.

Late night eating

– Eating food in large quantity

– Immediately lying down after eating food

Smoking

Alcohol

Coffee

Classification of GERD

GERD is classified into two types. Erosive reflux disease (ERD) and non-erosive reflux disease (NERD). This classification is not based on the symptoms, but rather on the findings derived from an endoscopy.
In case of erosive reflux disease, the stomach acid damages the esophageal mucosa.
In non-erosive reflux disease, the esophageal mucosa is not damaged by acid reflux.

The Link between Acid Reflux and Heartburn

Acid reflux causes heartburn because of underlying irritation and inflammation in the food pipe from stomach acid. Several layers of tissue line the stomach. These are mucosa (inner lining), submucosa (it covers the mucosa), muscularis propria (next layer to submucosa and serosa). Stomach stores food temporarily for approximately 2 hours; the acid and enzymes help break down the food and digest it. There are specialized cells in the mucosa layer that produce hydrochloric acid (HCl) and digestive enzymes to enable the digestion of food.
The stomach can hold this acid without being damaged since the goblet cells in the mucosa secrete large quantities of protective mucus. This helps protect the stomach lining from being corroded by the stomach acid.
However, the lining of the esophagus does not share this protective feature, and the throat is not designed to handle such acidic contents. Therefore, when reflux of stomach acid goes into the esophagus, it damages, irritates, and inflames the food pipe. This is the reason for the burning sensation felt behind the sternum, known as heartburn.

Complications / Long-term Effects of GERD

Long-standing uncontrolled or untreated GERD carries a risk of developing certain complications. These include inflammation of the esophagus (esophagitis), Barret’s esophagus, Ulcers/erosions in the esophagus, stricture of the esophagus from a scar.

Inflammation of the Esophagus (Esophagitis)

The esophagus is a tube that connects the mouth to the stomach. Frequent back up of acid into the throat leads to its inflammation. If inflammation is left untreated, it carries a chance of forming ulcers in the esophagus and scarring that leads to the formation of a stricture. Its symptoms are difficulty in swallowing, painful swallowing, burning behind the sternum (heartburn), nausea and vomiting.

Stricture of Esophagus

Stricture of esophagus means narrowing of the esophagus. A stricture forms as a result of the damage to the lining of the esophagus (from the acid contents of the stomach). As a result, there is inflammation and the development of scar tissue, which leads to narrowing and obstruction of the esophagus. The symptoms arising in esophageal stricture include:

– difficulty in swallowing
– chest pain
– regurgitation of food or liquids
– heartburn
– a sensation of having something stuck in the chest after eating
– unintended weight loss

Complications of esophageal stricture: Choking or difficulty in breathing due to the lodging of solid food in the esophagus, dehydration, malnutrition, pulmonary aspiration causing aspiration pneumonia.

Ulcers/Erosions in Esophagus

Long-term backing up of stomach acid can damage the lining of the esophagus causing ulcers. These can lead to difficult/painful swallowing, heartburn, pain behind the sternum, and there may be bleeding.

Barret’s Esophagus

Barret’s esophagus is a serious complication of GERD. In this condition, the squamous type of cells present in the lining of the esophagus change from squamous type to columnar epithelial type. Back up of acidic stomach contents into the esophagus lead to damage of esophageal tissue. During the process of healing this damage, the original kind of cells naturally present can change form. People with Barret’s esophagus are at risk to develop esophageal cancer. The symptoms of Barret’s esophagus include heartburn, dysphagia (difficulty swallowing) and chest pain (although rare).

Investigations in GERD

GERD is primarily diagnosed with the help of an upper endoscopy. An endoscopy helps rule out a hiatus hernia and the complications of GERD, like inflammation, ulcers in the esophagus.
A biopsy of the tissue from the esophagus may be conducted in case of suspected Barrett’s esophagus.

Acid reflux and GERD in Infants

Acid reflux is very common among infants. Spitting up of milk is a part of their daily activities and can occur several times in a day. It is usually not a reason for concern as long as the baby has a healthy weight and has no respiratory difficulty. It usually resolves on its own at around 18 months of age. Rarely is acid reflux indicative of GERD in the case of infants. Frequent vomiting, feeding refusal, weight loss, difficulty feeding, high irritability, and long-term wheezing are few indications of GERD in infants. An evaluation by a pediatrician is essential to rule out whether it is normal reflux or GERD.

Managing Acid Reflux and GERD

Some tips that can help minimize acid reflux and manage GERD include:

Drink More Water

Increasing the consumption of water helps reduce the symptoms of GERD and also improves overall digestion. This is because in most cases, water replaces other drinks that may include alcohol, sweetened beverages or caffeine.

Avoid Smoking and Alcohol

Smokers have a drastically higher risk of developing GERD and other inflammatory conditions as compared to non-smokers.
Alcohol can also trigger GERD, and lead to the development of symptoms like increasing inflammation and stress, weight gain, and dehydration. It is also known to worsen symptoms like nausea, bloating, gas and sleep issues.

Eat Small, Regular Meals

Instead of the usual 3-large meals a day, it is preferable to eat 4-6 smaller meals throughout the day to facilitate better digestion. Also, food must be eaten slowly and chewed thoroughly before swallowing. Eating mindfully also helps prevent overeating (which can cause an increased release of stomach acid). While drinking a beverage, one must take small sips instead of gulping down large amounts of fluid, since that can trap gas in the stomach.

Exercise

GERD tends to be more common in people who lead a sedentary lifestyle with little or no exercise. Those who have a poor nutritional diet or are overweight are more susceptible to developing GERD. Exercise helps improve physiological functions like digestion, circulation, and maintain body weight. It also helps reduce inflammation and enhance the quality of sleep.

Medications

Certain medications like NSAIDs (non-steroidal anti-inflammatory drugs) and hormone replacement drugs can contribute towards the development of GERD. Their use should be minimized and discontinued (after consulting a physician) if they contribute towards the symptoms of GERD.

Early Dinner

Exercising before bedtime or lying down soon after dinner can worsen the symptoms of GERD. The last meal of the day should ideally be consumed 2-3 hours before bedtime, and the system should be relaxed before it is time to sleep. Doing so helps ease digestion.

Avoid Overeating

It is important to eat small, easily digestible meals and not burden the digestive system with a large amount of food in a single sitting. This helps prevent acid reflux as well as gastrointestinal disorders.

Maintain a Healthy Weight

It is essential to maintain a healthy body weight to reduce the chances of developing GERD.

Clothes

Wearing restrictive clothing that put pressure on the stomach should be avoided. Loose, comfortable clothing that does not restrict movement helps keep the digestive system functioning properly.

Raised Head Position

Keeping the head slightly elevated while sleeping helps reduce acid reflux. The head should ideally be 6 to 8 inches higher than the feet while sleeping. The upper body needs to be uniformly raised.

Stress Management

Stress can disturb digestion due to the production of stress hormones. Stress can further cause a person to turn to alcohol, smoking, bad eating habits and more.
It is important to manage stress and find time for relaxation. Light exercise, indulging in hobbies and getting adequate rest are important factors that help reduce the chances of developing GERD.

GERD: Foods to Eat

Whole foods that are prepared fresh and do not have too many added preservatives or chemicals are generally good for health, and more so for those dealing with GERD. A plant-based diet that is rich in antioxidants, nutrients, water content, and fiber can help manage the problem, and also treat it. Some examples of foods that help address GERD include:

Fresh vegetables of different colors like green leafy vegetables, sweet potatoes, peas, cucumber, carrots, etc.

Fermented products like apple-cider vinegar can help balance the stomach acid and reduce the tendency of acid reflux.

Foods that have a high amount of fiber, like whole grains, nuts, seeds, vegetables, and fruits.

Foods that contain healthy fats, like coconut milk, olive oil, coconut oil, almonds, flaxseeds and chia seeds.

Low-fat, lean proteins like wild fish and soaked beans.

Probiotics like yogurt or fermented vegetables also increase the healthy gut bacteria in the system, thereby aiding digestion.

GERD: Foods to Avoid 

Animal products and dairy products, in general, are difficult to digest and should be limited or avoided by people dealing with GERD.

Caffeinated drinks like energy drinks and coffee or tea.

Carbonated drinks

Allergy-causing foods or foods that lead to a sensitivity in the body, like gluten, certain nuts, or synthetic ingredients.

Fatty foods like processed meat, cereals, cheese and fast food.

Alcoholic drinks like wine, beer, or liquor are difficult to digest and can worsen the symptoms of GERD, especially if consumed too close to bedtime.

Overly spicy foods.

Foods that are high in sodium, like chips, salted products, etc.

Tomatoes and tomato-based products are also known to worsen the symptoms of GERD in some people.

Chocolates contain a substance called methylxanthine, which is known to relax the smooth muscles in the lower esophageal sphincter, thereby increasing the chances of acid reflux.

 

Call Dr. Sharma's Clinic - From United States and Canada call 703-659-0873.Patients From rest of the world and India call+91-9815299965

Homeopathic Remedies for Heartburn

Homeopathic Remedies for Heartburn

Homeopathic Remedies for Heartburn

Homeopathic Remedies for Heartburn

A burning sensation in the chest or middle area of the upper abdomen is referred to as Heartburn. It may be triggered by the intake of alcohol, smoking, coffee, fatty food, spicy food or even chocolates. Heartburn is mainly  due to Gastro esophageal Reflux Disease or GERD. It’s a medical condition in which the acid contents of the stomach rise above in oesophagus (food pipe), leading to burning. The main reason behind the acid rising back in the food pipe is weakness or relaxation of the ring at the junction of stomach and lower end of oesophagus. The Homeopathic mode of treatment is of great help in providing relief from Heartburn. The Homeopathic remedies for heartburn are made of natural substances and go to the core of the problem to ensure that Heartburn does not recur. The Homeopathic treatment for heartburn is totally safe and has zero side effects.

Homeopathic Treatment for Heartburn

Heartburn can be very effectively treated with natural Homeopathic medicines. The natural remedies act as wonderful agents to bring about relief in the most distressing cases of Heartburn, including sour, burning or acid risings. The Homeopathic medicines for providing relief in acute episodes of Heartburn are selected mainly based upon the trigger factors.  Associated symptoms like vomiting, belching and headache are also given importance. To remove the tendency to have Heartburn, more deep acting constitutional Homeopathic remedies are prescribed. For this purpose, the peculiar characteristics experienced by each patient are taken into account.

Top natural Homeopathic Remedies for Heartburn

Nux Vomica: Best Homeopathic medicine for Heartburn due to alcohol, coffee or spices

Nux Vomica is the top natural Homeopathic medicine for treating Heartburn triggered by the intake of alcohol, coffee or spices. The foremost complaint for which Homeopathic medicine Nux Vomica is the ideal remedy is burning in the mid upper abdomen and chest with acid risings. The mouth also fills with bitter and acid fluid along with burning. In some persons,there is a complaint of nausea and vomiting of sour material. Pressure and heaviness in abdomen also forms a part of symptom picture for using Nux Vomica. Although not a part of Heartburn, a history of long-standing constipation may be found to select Nux Vomica.

Pulsatilla: Top Homeopathic remedy for Heartburn excited by fatty and fried food

Pulsatilla is a natural Homeopathic medicine that is the best remedy when fatty or fried food has excited Heartburn. Along with Heartburn,the person also experiences nausea and vomiting to a high degree. Vomiting contains acidic, bitter matter, at times greenish in colour. Belching acid or bitter taste are also noticed for using Pulsatilla. In addition to these symptoms, pain and tightness in stomach may also appear. One characteristic feature that calls for using this remedy is a total absence of thirst along with the other symptoms.

Natrum Phos and Iris Versicolor: Homeopathic remedies for Heartburn with sour belching and vomiting

The top natural Homeopathic medicines for treating Heartburn with sour belching or sour vomiting are Natrum Phos and Iris Versicolor. Natrum Phos is very beneficial in all cases of Heartburn where the patient experiences sour belching or sour vomiting along with burning in chest or mid upper abdomen. In such cases, Homeopathic medicine Natrum Phos is the best prompt relieving agent. A specific coating of tongue with yellow pasty matter is a redline symptom along with sour belching and vomiting. Acidic symptoms due to intake of excess of sugar can also be best treated with Natrum Phos. Natural Homeopathic medicine Iris Versicolor, on the other hand,is the best remedy when the major symptom is burning throughout the gastrointestinal tract, right from the mouth to anus with sour vomiting.

Robinia: Homeopathic medicine for Heartburn that gets worse on lying down at night

Natural Homeopathic medicine Robinia is of great help in providing relief to Heartburn patients when the burning symptoms get worse on lying down at night. Acrid burning, bitter or worsesour belching appear along with burning in the chest and stomach. The symptoms may even prevent the person from sleeping. Another sphere for using Robinia is when headache accompanies heartburn. Robinia is the most apt natural Homeopathic remedy for persons who have pain in head with Heartburn.

Arsenic Album and Phosphorus: Homeopathic remedies for Heartburn which gets better by warm or cold drinks

Both Arsenic Album and Phosphorus are top natural Homeopathic medicines for Heartburn cases. Both these medicines have their own group of symptoms that guide in selecting the remedy, but the major differentiating symptom is regarding Heartburn getting better by warm or cold drinks. If the Heartburn is relieved by warm drinks, then Arsenic Album is the best remedy. The other symptoms for using Arsenic Album are burning in upper abdomen with acid, bitter risings in the throat. Nausea and vomiting may also appear. The vomiting occurs soon after eating or drinking. Thirst for a small quantity of water at short intervals is also a prominent symptom for using Arsenic Album. Homeopathic medicine Phosphorus is the ideal natural remedy when cold drinks or cold water seems to provide temporary relief from burning in chest and abdomen. The accompanying symptoms are sour belching after eating. Vomiting also appears, but not immediately after drinking. Vomiting occurs a few hours after taking water when the water gets warm in abdomen. A desire for ice creams, juices and cold drinks is another useful symptom for selecting Phosphorus for the successful treatment of Heartburn cases.

Call Dr. Sharma's Clinic - From United States and Canada call 703-659-0873.Patients From rest of the world and India call+91-9815299965

Gerd

Homeopathic treatment of Acidity

459534827_9e36307cd3_m If it is very common (more than twice a week) for you to suffer from the symptoms of hyperacidity. (heartburn or feeling of pain and/or burning in the chest or throat) it is possible that it could be more than just the so-called acidity. You could be suffering from GERD (Gastro esophageal reflux disease).

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