What is Acid Reflux?
Acid reflux, also known as gastroesophageal reflux, occurs when stomach contents (including acid, bile salts, and pepsin) flow back up into the esophagus.
This backwash can irritate the esophageal lining, causing symptoms.
When acid reflux becomes chronic, occurring more than twice a week for several weeks or months, it is classified as gastroesophageal reflux disease, or GERD.
Heartburn is a common symptom of acid reflux and GERD.
What Causes Acid Reflux?
The lower esophageal sphincter (LES), a ring of muscle at the junction of the esophagus and stomach, normally prevents backflow.
If the LES is weakened or doesn't close properly, stomach contents can move up into the esophagus .
Factors that can weaken the LES or increase acid reflux:Pregnancy, obesity, and hiatal hernia.
Delayed stomach emptying or indigestion.
Connective tissue disorders.
Lifestyle factors: alcohol consumption, smoking, large meals, eating late at night, lying down after eating, spicy/fried/fatty foods, excessive caffeine, and certain medications (like aspirin).
Increased pressure on the belly area, including from tight clothing.
What are the symptoms of Acid Reflux?
Common GERD symptoms:Regurgitation of stomach contents.
Heartburn, often after meals and worse at night.
Difficulty swallowing and/or pain when swallowing.
Chest pain.
Nausea.
Difficulty breathing.
Lump-like sensation in the throat.
Chronic cough
Worsening asthma.
Laryngitis and disrupted sleep.
Laryngopharyngeal reflux (LPR) or silent reflux symptoms: These symptoms occur when stomach acid damages the pharynx and larynx.
Symptoms can include frequent throat clearing, hoarseness, a feeling of a lump in the throat, sore throat, and cough.
LPR symptoms often occur during the day, while GERD is usually worse at night.
LPR may not always have classic heartburn symptoms.
Diagnosing Acid Reflux
Diagnosis typically begins with a medical history and physical exam.
Additional tests might include:
Ambulatory acid pH probe testing (to measure acid levels in the esophagus).
Esophageal manometry (to measure muscle contractions in the esophagus).
Upper endoscopy (to examine the esophagus and stomach with a camera).
X-rays (after drinking a chalky liquid).
An endoscopy can identify a hiatal hernia, which can contribute to acid reflux.
How to Treat Acid Reflux (Lifestyle Modifications)
Dietary changes:
Eat smaller, more frequent meals instead of large meals.
Avoid eating late at night
Avoid trigger foods: spicy, fried, fatty, sour, or salty foods.
Limit or avoid caffeine, alcohol, chocolate, carbonated beverages, and mint.
Other Lifestyle changes:Quit smoking.
Maintain a healthy weight.
Elevate the head of your bed by 10-20 centimeters.
Avoid tight-fitting clothes.
Stay hydrated.
Consider stress management and relaxation techniques.
Other home remedies:
Drink cold milk, preferably skim.
Eat cucumber.
Drink herbal tea (some teas are acidic and may worsen reflux).
Medical Treatments for Acid Reflux
Over-the-counter medications:Antacids (like Rolaids and Mylanta) neutralize stomach acid and provide immediate relief.
H2 receptor blockers (like nizatidine and cimetidine) reduce acid production for a longer duration than antacids.
Prescription medications:Proton pump inhibitors (PPIs) (like omeprazole and pantoprazole) block acid production and help in esophageal healing.
PPIs are generally meant for short-term use but may be necessary long-term for some.
Surgery and other procedures (for severe cases or when other treatments fail):
Fundoplication: tightens the LES.
Transoral incisionless fundoplication: an advanced form of fundoplication using endoscopy.
LINX device: a ring of magnetic beads placed around the LES.
Important Considerations
Medication Awareness: Certain medications like NSAIDs (aspirin, ibuprofen), diazepam, theophylline, and calcium channel blockers can worsen acid reflux
Long-term PPI use can lead to dietary deficiencies, changes in the gut microbiome, kidney disease, and increased risk of heart disease.
Mental Health can influence the severity of acid reflux; stress, anxiety, and depression can worsen symptoms.
Untreated LPR can lead to complications such as ulcers, infections, cavities, laryngitis, and chronic cough.
When to see a doctor
If over-the-counter medications and lifestyle changes do not provide relief.
If you have difficulty swallowing, unintentional weight loss, vomiting, or persistent symptoms.
If you notice blood in your stool or vomit blood, seek immediate medical attention.
If symptoms occur regularly (more than twice a week).
To rule out other conditions that can mimic GERD, such as heart problems.
Prevention is Key
Focus on lifestyle changes and self-management strategies.
Address risk factors like obesity, stress, and unhealthy dietary habits
Non-drug treatments can be effective and may prevent the need for medications.
This information should help you understand and manage acid reflux. Always consult with a healthcare provider for personalized medical advice.
Frequently Asked Questions About Acid Reflux & GERD
What is the difference between acid reflux and GERD? Acid reflux, or gastroesophageal reflux, is the occasional backwash of stomach acid into the esophagus, often causing a burning sensation. This is a normal, albeit uncomfortable, experience that most people will experience from time to time. GERD, or Gastroesophageal Reflux Disease, is a chronic condition characterized by frequent acid reflux episodes (more than twice a week for several weeks or months), which can cause persistent irritation, inflammation of the esophageal lining and is usually a sign of an underlying issue with the lower esophageal sphincter. Heartburn is a common symptom of both, but is a defining characteristic of GERD.
What causes acid reflux and GERD? The primary cause of acid reflux and GERD is the dysfunction of the lower esophageal sphincter (LES), the muscle that separates the esophagus and stomach. When the LES is weakened or relaxes inappropriately, stomach contents, including acid, can flow back up into the esophagus. Factors that contribute to this dysfunction include pregnancy, obesity, hiatal hernias, delayed stomach emptying, connective tissue disorders, and certain lifestyle factors, such as smoking, excessive alcohol or caffeine intake, eating large or late-night meals, and consuming spicy, fried, or fatty foods, and certain medications like aspirin, NSAIDs, calcium channel blockers and other medications.
What are the common symptoms of acid reflux and GERD? Common symptoms of acid reflux and GERD include heartburn (a burning sensation in the chest), regurgitation of stomach contents (sometimes reaching the mouth), difficulty swallowing, chest pain, nausea, difficulty breathing, a sensation of a lump in the throat, chronic cough, worsening asthma, laryngitis, and disrupted sleep. Notably, symptoms often worsen after meals, at night, and when lying down. However, some people may experience atypical symptoms, such as those associated with laryngopharyngeal reflux (LPR), which include a persistent sore throat, hoarseness, frequent throat clearing, and the feeling of a lump in the throat. LPR symptoms are often felt more during the day than at night.
How is acid reflux and GERD diagnosed? Diagnosis typically begins with a medical history and physical examination by a general practitioner. If further clarification is needed, tests like an ambulatory acid pH probe test (measures acid levels in the esophagus), esophageal manometry (measures muscle contractions in the esophagus), an upper endoscopy (visualizes the esophagus and stomach using a thin tube with a camera), and X-rays (often taken after drinking a chalky liquid) may be performed. It's also important to rule out other conditions with similar symptoms such as heart problems.
What lifestyle modifications can help manage acid reflux and GERD? Several lifestyle modifications can significantly improve acid reflux and GERD. These include: losing weight if overweight or obese, avoiding late-night meals (allow 2-3 hours between eating and lying down), eating smaller, more frequent meals, raising the head of the bed by 4-8 inches to use gravity to aid digestion, sleeping on the left side, avoiding trigger foods (e.g., spicy, acidic, fatty foods, chocolate, mint, tomatoes, carbonated drinks, and caffeine), avoiding tight-fitting clothing, quitting smoking, reducing alcohol consumption, reducing stress, and mind-body relaxation therapies.
What are the treatment options for acid reflux and GERD besides lifestyle changes? When lifestyle changes alone are insufficient, medical treatments may be necessary. Over-the-counter medications include antacids (like Rolaids and Mylanta) which neutralize stomach acid, H2 receptor blockers (like nizatidine and cimetidine) which reduce stomach acid production, and proton pump inhibitors (PPIs, like omeprazole and pantoprazole) which block acid production in the stomach cells. For severe cases unresponsive to medication and lifestyle changes, surgical options may be considered, including fundoplication (tightening the LES), transoral incisionless fundoplication (a less invasive form), and the LINX device (a magnetic ring placed around the LES to keep it closed). However, it's recommended that these medications are started only after exhausting lifestyle changes and used sparingly due to potential side-effects
What are the risks of long-term reliance on medications to treat GERD and what steps can people take to safely discontinue them? Long-term use of medications, particularly PPIs, can lead to various side effects such as dietary deficiencies (iron, calcium, zinc, B12), changes to gut microbiome, increased risk of c. difficile infections, kidney disease, increased risk of gastric cancer, and increased risk of heart disease. It is important to rely on medications sparingly and only as a last resort. To safely discontinue PPIs, focus on non-drug lifestyle strategies, taper the PPI dose slowly while adding an H2 blocker, and focus on diet coaching. Note that acid secreting cells can increase while on medication which can result in exacerbated rebound symptoms when medication is discontinued.
Why is it important to address acid reflux and GERD even when the symptoms are mild? While mild symptoms can be managed with lifestyle changes, untreated acid reflux and GERD can lead to serious complications. Chronic irritation and inflammation of the esophageal lining can progress to Barrett’s esophagus (a precancerous condition), and potentially esophageal cancer. The disease can also reduce a person’s quality of life from the pain and sleep disturbances that are common with this disease. It is also important to address acid reflux and GERD in order to prevent complications that may arise from it such as ulcers, infections, cavities, laryngitis, and chronic cough. Therefore, it is important to see your doctor for regular check ups if you're experiencing these symptoms.
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