We’ve all heard the term “acid reflux”, but how many of us really know what it means? When does it become a problem and what steps should be taken to treat acid reflux, or even prevent it from occurring in the first place? Learning the basics will help you determine if acid reflux is affecting you and if it’s time to seek professional help.
What is Acid Reflux?
Acid reflux is the reverse passage of gastric contents into the oesophagus (‘food pipe’) which can cause heartburn. The terms are often used interchangeably, but acid reflux is the actual action of part of the stomach contents traveling back up the oesophagus (sometimes into the throat and even into the mouth), while heartburn is the uncomfortable feeling as a result of that action.
At the entrance to your stomach is a valve, which is a ring of muscle called the lower esophageal sphincter (LES). Normally, the LES closes as soon as food passes through it. If the LES doesn’t close all the way or if it opens too often, acid produced by your stomach can move up into your esophagus. This can cause symptoms such as a burning chest discomfort called heartburn. If acid reflux symptoms happen more than twice a week, you may have acid reflux disease, also known as gastroesophageal reflux disease (GERD).
If you have frequent acid reflux, you may have GORD – Gastro Oesophageal Reflux Disease. It might sound scary, but in most cases GORD is not a serious condition and is experienced by one in ten people every day. However persistent episodes can damage the lining of the oesophagus, so have a chat with your GP or pharmacist if you’re at all concerned
Symptoms Of Acid Reflux?
The lower esophageal sphincter (LES) is a ring of muscle which functions as a valve at the entrance to your stomach. The LES should close as soon as food passes through it, but if it doesn’t close completely or simply opens too often, stomach acid can travel up into your esophagus. This backflow of acid is called gastroesophageal reflux, or acid reflux as it is commonly referred to.
Acid reflux can irritate the lining of your esophagus, resulting in a burning sensation in your chest that most of us know as heartburn. During an episode of reflux, you may also taste regurgitated food or sour liquid at the back of your mouth. According to Firelands Physician Group Gastroenterologist Martin Beerman, MD, patients may also experience less common symptoms such as hoarseness, chronic cough, or trouble swallowing.
Common symptoms of acid reflux are:
- Heartburn: a burning pain or discomfort that may move from your stomach to your abdomen or chest, or even up into your throat
- Regurgitation: a sour or bitter-tasting acid backing up into your throat or mouth
Other symptoms of acid reflux disease include:
- Bloody or black stools or bloody vomiting
- Dysphagia — the sensation of food being stuck in your throat
- Hiccups that don’t let up
- Weight loss for no known reason
- Wheezing, dry cough, hoarseness, or chronic sore throat
What Causes Acid Reflux Disease?
One common cause of acid reflux disease is a stomach abnormality called a hiatal hernia. This occurs when the upper part of the stomach and LES move above the diaphragm, a muscle that separates your stomach from your chest. Normally, the diaphragm helps keep acid in our stomach. But if you have a hiatal hernia, acid can move up into your esophagus and cause symptoms of acid reflux disease.
Acid reflux is when some of the acid content of the stomach flows up into the esophagus, into the gullet, which moves food down from the mouth. Despite the name, heartburn has nothing to do with the heart.
The stomach contains hydrochloric acid, a strong acid that helps break down food and protect against pathogens such as bacteria.
The lining of the stomach is specially adapted to protect it from the powerful acid, but the esophagus is not protected.
A ring of muscle, the gastroesophageal sphincter, normally acts as a valve that lets food into the stomach but not back up into the esophagus. When this valve fails, and stomach contents are regurgitated into the esophagus, the symptoms of acid reflux are felt, such as heartburn.
These are other common risk factors for acid reflux disease:
- Eating large meals or lying down right after a meal
- Being overweight or obese
- Eating a heavy meal and lying on your back or bending over at the waist
- Snacking close to bedtime
- Eating certain foods, such as citrus, tomato, chocolate, mint, garlic, onions, or spicy or fatty foods
- Drinking certain beverages, such as alcohol, carbonated drinks, coffee, or tea
- Being pregnant
- Taking aspirin, ibuprofen, certain muscle relaxers, or blood pressure medications
How Is Acid Reflux Disease Diagnosed?
It’s time to see your doctor if you have acid reflux symptoms two or more times a week or if medications don’t bring lasting relief. Symptoms such as heartburn are the key to the diagnosis of acid reflux disease, especially if lifestyle changes, antacids, or acid-blocking medications help reduce these symptoms.
If these steps don’t help or if you have frequent or severe symptoms, your doctor may order tests to confirm a diagnosis and check for other problems. You may need one or more tests such as these:
- Barium swallow (esophagram) can check for ulcers or a narrowing of the esophagus. You first swallow a solution to help structures show up on an X-ray.
- Esophageal manometry can check the function and movement of the esophagus and lower esophageal sphincter.
- pH monitoring can check for acid in your esophagus. The doctor inserts a device into your esophagus and leaves it in place for 1 to 2 days to measure the amount of acid in your esophagus.
- Endoscopycan check for problems in your esophagus or stomach. This test involves inserting a long, flexible, lighted tube with a camera down your throat. First, the doctor will spray the back of your throat with anesthetic and give you a sedative to make you more comfortable.
- A biopsymay be taken during endoscopy to check samples of tissue under a microscope for infection or abnormalities.
What Are Some Common Treatments?
Can Acid Reflux Disease Be Treated With Diet and Lifestyle Changes?
For individuals experiencing typical symptoms of acid reflux, Dr. Beerman usually recommends non-medical lifestyle changes as a first line of treatment. He advises patients to not smoke, to refrain from eating soon before going to bed, and to maintain a healthy weight.
Other natural, proven ways to help alleviate symptoms include eating smaller portions at mealtime, adhering to a low-fat heart healthy diet, avoiding alcoholic beverages and excessive amounts of caffeine, and exercising regularly while minimizing time spent in sedentary states like sitting or reclining.
If necessary, the symptoms of acid reflux can be treated with several different types of medication, including over-the-counter antacids, H-2 receptor blockers (cimetidine, famotidine, ranitidine), and proton pump inhibitors (omeprazole, lansoprazole, pantoprazole). In the most severe cases, if lifestyle changes and typical medical treatments are not adequately controlling the effects of chronic acid reflux, doctors may recommend a surgical procedure as a last resort.
One of the most effective ways to treat acid reflux disease is to avoid the foods and beverages that trigger symptoms. Here are other steps you can take:
- Eat smaller meals more frequently throughout the day and modify the types of foods you are eating..
- Quit smoking.
- Put blocks under the head of your bed to raise it at least 4 inches to 6 inches.
- Eat at least 2 to 3 hours before lying down.
- Try sleeping in a chair for daytime naps.
- Don’t wear tight clothes or tight belts.
- If you’re overweight or obese, take steps to lose weight with exercise and diet changes.
- Also, ask your doctor whether any medication could be triggering your heartburn or other symptoms of acid reflux disease.
Can Acid Reflux Disease Be Treated With Medications?
- PPIs, including omeprazole, rabeprazole, and esomeprazole
- H2 blockers, including cimetidine and famotidine
- Over-the-counter treatments, such as antacids, which are available to buy online
- Alginate drugs, including Gaviscon
- The main treatment options for people who repeatedly experience acid reflux in GERD are either PPIs or H2 blockers, both of which are medications.
PPIs and H2 blockers decrease acid production and reduce the potential for damage caused by acid reflux.
These medications are generally safe and effective, but like any prescription drug, they are not appropriate for all people with reflux disease and can cause side effects.
For instance, they can cause problems absorbing nutrients. This can lead to malnutrition.
OTC Remedies for Acid Reflux
For people who experience heartburn or indigestion infrequently, perhaps in association with occasional food and drink triggers, OTC treatments to reduce the acidity of the stomach contents are available.
These liquid and tablet formulations are called antacids, and there are dozens of brands available, all with similar effectiveness. They may not work for everyone, and any need for regular use should be discussed with a doctor.
Antacids provide rapid but short-term relief by reducing the acidity of the stomach contents.
They contain chemical compounds such as calcium carbonate, sodium bicarbonate, aluminum, and magnesium hydroxide. They can also inhibit nutrient absorption, leading to deficiencies over time.
Alginate Drugs Such as Gaviscon
Gaviscon is probably the best-known heartburn therapy. It has a different mode of action than antacid drugs. Alginate drugs such as Gaviscon vary slightly in composition, but they usually contain an antacid.
The alginic acid works by creating a mechanical barrier against the stomach acid, forming a foamy gel that sits at the top of the gastric pool itself.
Any reflux is then relatively harmless as it consists of alginic acid and not damaging stomach acid.
The active ingredient—alginate—is found naturally in brown algae.
Is Acid Reflux Disease Ever Treated With Surgery?
If medications don’t completely resolve your symptoms of acid reflux disease and the symptoms are severely interfering with your life, your doctor could recommend surgery. There are two types of surgical treatment used to relieve symptoms of GERD if daily use of medication isn’t effective.
The most recently approved procedure involves surgically placing a ring known as a LINX device around the outside of the lower end of the esophagus, the tube that connects the mouth to the stomach. The ring consists of magnetic titanium beads held together by titanium wires. The device helps reflux by preventing stomach contents from backing up into the esophagus. In one study, patients were able to stop taking medicine or cut down the amount they took. You shouldn’t get the LINX device if you’re allergic to certain metals, and once you have a LINX device you shouldn’t get any type of MRI test.
Another surgical procedure called a fundoplication can help prevent further acid reflux. It creates an artificial valve using the top of your stomach. The procedure involves wrapping the upper part of the stomach around the LES to strengthen it, prevent acid reflux, and repair a hiatal hernia. Surgeons perform this procedure through either an open incision in the abdomen or chest or with a lighted tube inserted through a tiny incision in the abdomen.
These procedures are done only as a last resort for treating acid reflux disease after medical treatment has proven to be inadequate.