Acid Reflux

Acid Reflux

What Is Acid Reflux?

Acid reflux, or gastroesophageal reflux disease (GERD), occurs in the gastrointestinal tract between your stomach and esophagus. The lower esophageal sphincter (LES) is a muscle that allows food to pass from the esophagus and into the stomach. It the LES doesn’t close completely after allowing food to pass through, or if it opens frequently, the acid in your stomach may move into your esophagus. If you experience acid reflux symptoms more than twice weekly, you have acid reflux disease, also called GERD.

What Causes Acid Reflux?

Acid reflux occurs when the lower esophageal sphincter (the muscle between the stomach and esophagus that allows food to pass through) does not close all the way or opens too frequently, allowing stomach acid to flow into the esophagus. There are several potential causes for acid reflux disease, including:

  • Lying down after eating a snack or meal
  • Eating certain food triggers, like mint, onions, fried foods, or spicy foods
  • Smoking
  • Certain medications
  • Eating large meals
  • Hiatal hernias

A hiatal hernia occurs when the lower esophageal sphincter and part of the stomach move above the diaphragm. The diaphragm helps to keep acid in the stomach, but it cannot perform this function you have a hiatal hernia, so you may be more likely to suffer from acid reflux.

Acid Reflux Trigger Foods

  • Acidic beverages
  • Citrus fruits
  • Tomatoes
  • Garlic and onions
  • Spicy foods
  • Fried foods
  • Alcohol, carbonated, or caffeinated beverages
  • Fatty foods
  • Chocolate

Who is at risk for Acid Reflux?

Acid reflux is very common; 60% of adults experience some type of acid reflux each year, and 20% to 30% will have weekly symptoms. Approximately seven million Americans suffer from the symptoms of acid reflux disease. Certain risk factors may make you more prone to developing acid reflux. People who are overweight or obese are more likely to have acid reflux; scientists aren’t sure why this is, but they speculate that surplus fat around the belly increases pressure in the stomach, causing the fluid to rise up into the esophagus. Losing just a few pounds can significantly relieve your acid reflux symptoms, including heartburn.

More than half of all pregnant women report symptoms of acid reflux, as well. Hormone changes cause muscles to relax more frequently, including the lower esophageal sphincter. In addition, the uterus expands as the fetus grows, putting pressure on your stomach so that food and acid are pushed upward toward the esophagus.

Women and the elderly are more frequently diagnosed with acid reflux.

Acid Reflux Risk Factors:

  • Obesity/overweight
  • Pregnancy
  • Smoking
  • Diabetes
  • Hiatal hernia
  • Scleroderma

Signs and Symptoms of Acid Reflux

The primary symptom of acid reflux is a burning sensation in the chest or upper abdomen, commonly known as heartburn. Heartburn pain is often worse at night, and can be exacerbated by bending, stooping, lying down, or eating. You may also experience a sour or bitter taste in your mouth or the back of your throat.

Other symptoms of acid reflux include:

  • Coughing or wheezing
  • Bloating
  • Difficulty swallowing
  • Dysphagia – a narrowing of the esophagus, so it feels like something is stuck in your throat
  • Chest pain
  • Hiccups
  • Sore throat

Diagnosis

If your discomfort is relieved by acid reducers or antacids, this can be a good indication that the symptoms were caused by acid reflux. If you don’t find lasting relief, your doctor may order tests to diagnose acid reflux. These tests may include:

  • Esophagram or Barium Swallow – The patient drinks barium, which will highlight certain parts of the esophagus on an X-ray. This study can identify hiatal hernias, GERD, and other structural or functional abnormalities in the esophagus. However, these changes are only visible in 1/3 of patients with acid reflux.
  • Esophageal Manometry – This test measures the strength and muscle coordination of your esophagus. It also allows the doctor to examine the lower esophageal sphincter to ensure it is working properly.
  • Esophageal pH Test – This test measures the amount of acid that flows upward from the stomach to the esophagus over the course of 24 hours.

Occasionally, an endoscopy and/or biopsy may be performed in order to determine if a patient is suffering from any complications from acid reflux.

Treatment

Luckily, acid reflux can usually be eliminated or significantly reduced by making a few changes to your diet and lifestyle. Avoid foods and beverages that typically give you heartburn; common culprits include coffee, alcohol, citrus fruits, tomatoes, and anything fatty or spicy. Eat smaller meals more frequently, rather than having a couple of big meals during the day. Stop eating a few hours before bedtime, and don’t lie down after you’ve eaten. If you need to take a nap, sleep in a chair.

If you’re carrying a few extra pounds, try some simple exercises to lose weight. Avoid medications that may trigger acid reflux, including NSAIDs like aspirin, ibuprofen, and naproxen, as well as certain muscle relaxants and blood pressure medications.

If you’re experiencing frequent heartburn and other symptoms of acid reflux, you may want to try over-the-counter medication. There are two main types of medication to alleviate acid reflux: antacids and acid reducers, including histamine antagonists (H2 antagonists or H2 blockers) and proton pump inhibiters.

Antacids – These drugs, which include Alka-Seltzer, Milk of Magnesia, Mylanta, and Pepto-Bismol, help to neutralize your stomach acid. If you’re also feeling gassy, look for an antacid that includes simethicone. Take antacids as directed, and don’t overuse or you may experience constipation or diarrhea.

Acid Reducers – These types of drugs reduce the production of stomach acid, so stomach juices are less acidic. This soothes the esophagus and relieves symptoms of acid reflux. H2 blockers include Pepcid AC, Tagamet HB, and Zantac 75. Proton pump inhibitors, like Prilosec OTC and Prevacid 24HR block the enzymes in the wall of the stomach that produce stomach acid.

You can take both an antacid and an acid reducer, but take the acid reducer first and wait an hour before consuming an antacid, as the antacid can slow the effects of the acid reducer. These drugs have been found to be similarly effective, so find one that has few side effects for you. If you find yourself frequently turning to antacids or acid reducers, talk to your doctor about your symptoms, as he or she may perform further tests or recommend prescription medication.