Acid Reflux

Acid reflux, or gastroesophageal reflux (GER), is a condition in which your stomach contents come back up into your esophagus, which is the tube that connects your mouth to your stomach.

Acid reflux can happen when the muscle at the end of the esophagus does not close properly. When this happens, stomach acid can travel back into the esophagus and irritate the lining of the esophagus, causing a burning feeling in your chest or throat. Acid reflux may also cause a dry cough, asthma-like symptoms, and trouble swallowing. Experiencing acid reflux occasionally is common, but if you experience these symptoms more than twice a week, you should consult your health care provider, since it may cause serious damage to your esophagus. Gastroesophageal reflux disease (GERD) is a more serious, advanced condition of acid reflux.

Adults and children can experience acid reflux. You are more likely to experience acid reflux if you:

• Are overweight or obese
• A pregnant woman
• Take certain medicines, including calcium channel blockers such as nifedipine (Adalat, Nifedical, Procardia), amlodipine (Novasc), verapamil (Calan, Isoptin, Covera, Verelan), and diltiazem (Cardizem), antihistamines such as diphenhydramine (Benadryl), pain relievers such as aspirin and ibuprofen (Advil, Motrin), sedatives such as diazepam (Valium) and temazepam (Restoril), and antidepressants such as amitriptyline, desipramine (Norpramin), imipramine (Tofranil, Surmontil), doxepin (Silenor), fluoxetine (Prozac, Sarafem, Symbyax), sertraline (Zoloft), and venlafaxine (Effexor XR)
• Smoke or inhale secondhand smoke
• Eat spicy or acidic foods, including citrus fruit, alcohol, and coffee

Most acid reflux can be managed with lifestyle modifications such as avoiding foods that cause acid reflux, stopping smoking, and maintaining a healthy weight. In some cases, surgery or medicines may be required.

The most common symptom of acid reflux is a burning sensation in the chest or throat, which is known as heartburn or indigestion. You may also taste acid in your throat.

Less common symptoms of acid reflux include:

• Stomach pain (pain in the upper abdomen)
• Non-burning chest pain
• Difficulty or painful swallowing or food getting stuck in your throat
• Persistent hoarseness
• Persistent sore throat
• Chronic cough, new onset asthma, or asthma only at night
• Sense of a lump in the throat
• Worsening dental disease
• Recurrent lung infections (called pneumonia)
• Chronic sinus infections
• Waking up with a choking sensation

See your doctor or health care provider if you experience these symptoms, which may indicate a more serious condition.

The esophagus and stomach are separated by a muscle called the lower esophageal sphincter (LES). In acid reflux, the LES relaxes at the wrong time, causing food and acid to travel backwards into the esophagus through the lower esophageal sphincter (LES). It is not clear why the LES sometimes fails to close properly, but when it does not close, it allows acids from the stomach cavity to enter the esophagus and damage its tissue lining.

Conditions like hiatal hernia may contribute to the development of acid reflux. A hiatal hernia happens when the upper part of the stomach and the LES move above the diaphragm, which is the muscle separating the stomach from the chest. Normally, the diaphragm helps the LES keep acid from rising up into the esophagus, but, with a hiatal hernia, acid reflux can happen more easily. This hernia can occur in people of any age, although it is normal in otherwise healthy individuals over the age of 50.

Overweight and obesity, pregnancy, and smoking all contribute to acid reflux. Certain foods also contribute to or worsen acid reflux symptoms. These foods include:

• citrus fruits
• chocolate
• caffeinated drinks
• alcohol
• fatty and fried foods
• garlic
• onions
• mint flavoring
• spicy foods
• tomato-based foods
• coffee

Most cases of acid reflux can be diagnosed on the basis of your symptoms and medical history. Additional testing may be needed if your symptoms do not improve or get worse with lifestyle modifications.

The most common tests used to diagnose acid reflux include the following:

• Upper gastrointestinal (GI) series. An upper GI series is a set of x-rays that are taken to check for damage to the esophagus, stomach, or intestines. You will sit or stand in front of an x-ray machine and drink barium, which coats the inside of your GI tract and makes the images on the x-rays easier to see. The x-ray is used primarily to rule out other problems that could cause similar symptoms to acid reflux.
• Endoscopies and biopsies. For an endoscopy, a small, flexible tube with a very small camera on the end is inserted through the mouth and esophagus into the stomach. The camera allows the doctor to view the lining of the esophagus, stomach, and small intestine by transmitting images from the small camera to a television screen. During this procedure, the doctor can perform a biopsy (removal of a small piece of tissue). Looking at that tissue sample under a microscope can help the doctor determine the level of acid damage to the tissue.
• Esophageal pH probes. An esophageal pH probe is a thin light wire with an acid sensor at its tip that is inserted through the nose and into the lower part of the esophagus. This probe can detect and record the amount of stomach acid that is refluxing into the esophagus.

Acid reflux can be an uncomfortable and painful condition that negatively impacts your quality of life. Avoiding foods that make your symptoms worse can help ease the discomfort of acid reflux and provide relief. If you smoke, quitting may provide substantial relief against acid reflux. Also try eating smaller meals, lose weight if you are overweight, and wear loose-fitting clothing. Try not to lie down for at least three hours following a meal and raise the head of your bed six to eight inches to aid digestion; do not eat close to bedtime.

Speaking with a doctor or health care professional can help in the management of acid reflux. Your doctor can provide medications and advice to help manage your symptoms. Talk to your doctor about all treatment options available and work together to establish a treatment plan tailored to your life.

If lifestyle modifications alone do not improve your symptoms, several over-the-counter and prescription medications are available to prevent the symptoms of acid reflux or relieve them once they begin. These medications include the following:

• Acid-reducing agents called antacids such as Alka-Seltzer, Maalox, Mylanta, Pepto-Bismol, Riopan, Rolaids
• Anti-secretory medications including as H2-blockers such as cimetidine(Tagamet), famotidine(Pepcid AC), nizatidine (Axid), and ranitidine(Zantac), and proton-pump inhibitors such as esomeprazole(Nexium), lansoprazole(Prevacid), omeprazole(Prilosec,Zegerid), pantoprazole(Protonix), and rabeprazole (Aciphex)

If your acid reflux symptoms become severe and the condition progresses to GERD or Barrett’s esophagus, you may need to talk to your doctor about treatment options such as surgical or endoscopic procedures.

Though acid reflux is common, it is not without risks. Persistent acid reflux can cause significant damage to your esophagus without proper treatment and management. Approximately 5 percent of the 20 million Americans with acid reflux have significant episodes 2 to 3 times a day, which may be a sign of a more serious condition called gastroesophageal reflux disease (GERD). If you believe you have GERD, talk to your doctor or a health care professional, as there are medications and surgical treatments available for this more severe condition.

If advanced acid reflux is not treated, it can develop into Barrett’s esophagus, which often requires surgery to correct. Barrett’s also heightens the risk for developing esophageal cancer.

Acid reflux varies from person to person. Fatty, spicy, and acidic foods are the most commonly offenders for episodes of reflux, but other foods may trigger your symptoms. Keep track of what causes or worsens your symptoms and discuss your findings with a doctor.