Do you have a burning sensation in your chest (heartburn)? Is your voice hoarse, or do you have a sore throat? You may have acid reflux, a common digestive condition marked by a backward flow of stomach acid into your esophagus (food pipe).
If acid reflux, which is also known as acid regurgitation or gastroesophageal reflux (GER), occurs more than twice a week, you likely have gastroesophageal reflux disease (GERD). If left untreated, GERD can lead to serious health complications, so if you suspect you have the condition, it is recommended that you visit your doctor.
Causes of Acid Reflux
The lower esophageal sphincter is a ring of muscle connecting your esophagus with your stomach. It acts as a valve, preventing stomach contents from traveling back up in the esophagus from the stomach. But if the sphincter weakness or relaxes abnormally, the backwash of stomach contents and acid may occur, causing the symptoms of acid reflux such as heartburn.
The lower esophageal sphincter may become weak or fail to function normally due to various reasons. These risk factors include:
- Hiatus hernia: a condition in which the upper part of your stomach pushes up into your chest cavity through your diaphragm, i.e., the muscle that separates them.
- Being obese/overweight or pregnant: causes increased pressure on your abdomen.
- Taking certain medications: these may include painkillers (e.g., ibuprofen and aspirin), sedatives, asthma medication, antidepressants, and calcium channel blockers (used to treat high blood pressure).
- Eating certain foods: for example, fatty, fried, or spicy foods.
- Drinking certain beverages: these include alcohol, coffee, and acidic juices.
- Dietary habits: for instance, eating large meals, lying down after a meal, or eating close to bedtime.
- Smoking or breathing secondhand smoke.
Symptoms of Acid Reflux
The two most common signs and symptoms of acid reflux are:
- Regurgitation. The backing up of food or stomach acid into your esophagus, which may leave a bitter or sour taste in your mouth.
- Heartburn. A burning pain or discomfort in your mid-chest that may move up to your neck or chest. Heartburn tends to get worse when lying down.
Other signs and symptoms of GER include:
- Respiratory problems such as a dry cough, wheezing, chest pain, and new or worsening asthma
- Throat problems, including, burning throat, hoarseness, sore throat, laryngitis (inflammation of the voice box), and difficulty swallowing or pain when swallowing,
- Nausea, vomiting or bloating
- Hiccups that come and go
- Bad breath
- Dental erosion, i.e., the wearing away of teeth enamel
- Burping
- Back pain
- Shortness of breath
Diagnosis
If your acid reflux symptoms are persistent and neither over-the-counter medications nor lifestyle changes are helping, it’s time to see your doctor. In most cases, a GER diagnosis will be achieved through a physical exam and reviewing your symptoms and medical history. However, further testing may be required to confirm the diagnosis or check for other problems. These may include:
Upper endoscopy: Your doctor uses a thin tube with a light and camera at the tip (endoscope) to examine your upper gastrointestinal tract, i.e., your esophagus, stomach, and duodenum (the first part of your small intestine). In most cases, it will only detect moderate to severe cases of GERD. The doctor may also use an endoscope to perform a biopsy by collecting a small piece of tissue to test for complications such as Barrett’s esophagus.
Upper gastrointestinal series (UGI): An X-ray technician takes several X-rays of your upper digestive system after you ingest a chalk liquid called barium that makes it more visible. A radiologist then reads the X-rays and reports the findings to your doctor. The procedure helps find problems related to GERD, such as a hiatus hernia.
Esophageal pH and impedance monitoring: A gastroenterologist inserts a thin, flexible tube (catheter) into your esophagus through your nose to measure the amount of stomach acid that refluxes to your esophagus. The end of the catheter outside your body connects to a monitor worn around your waist with a strap over your shoulder. The monitor records the measurements for 24 hours, which helps assess whether acid reflux is causing your symptoms.
Esophageal manometry: A test used to measure muscle contractions as well as the pressure of muscle contractions in different parts of your esophagus.
Treatment of Acid Reflux
Depending on the severity of your symptoms, your doctor may recommend the following acid reflux medication and lifestyle changes as option to get rid of acid reflux. You will also need to make dietary modification to help reduce or cure the discomfort of GERD:
Lifestyle changes
Lifestyle changes you can make to help stop or reduce heartburn include:
- Losing weight if you’re obese or overweight
- Avoiding clothes that fit tightly around your waist
- Doing away with smoking
- Sleeping on a slight angle by raising or elevating the head end of your bed to 6 to 9 inches by placing wood or cement block under the bedposts
- Not lying down within 3 hours of eating
- Eating smaller but more frequent meals
- Avoiding foods and drinks that could trigger GER, this includes; spicy foods, fatty foods, garlic, onions, coffee, alcohol, carbonated drinks
Acid reflux medicine
There are different acid reflux medicines that can be used to relieve, treat, and cure your acid reflux symptoms. You can either use over the counter medicine, home remedies or prescription medications as instructed by your doctor. Below are some of the acid reflux medicines recommended and used to treat acid reflux
Over-the-counter medications(OTC)
- Antacids. Antacids, such as Maalox, Mylanta, Riopan, Rolaids, and Tums, may provide quick relief by neutralizing stomach acid. Side effects may include diarrhea, constipation, or even kidney problems.
- H2 blockers. These medications work by decreasing acid production for a period of up to 12 hours. H2 blockers include cimetidine (Tagamet HB), famotidine (Pepcid AC), and nizatidine (Axid AR).
- Proton pump inhibitors. PPIs are stronger acid blockers that can also help heal esophageal tissue. Those sold over the counter include omeprazole (Zegerid OTC, Prilosec OTC) and lansoprazole (Prevacid 24 HR).
Prescription medications
Prescription H2 blockers. For example, famotidine (Pepcid AC) and nizatidine (Axid AR). If used for a long time, there’s a likelihood of bone fractures and vitamin B-12 deficiency.
Prescription proton pump inhibitors (PPIs). These include esomeprazole (Nexium), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (AcipHex), omeprazole (Prilosec, Zegerid), and dexlansoprazole (Dexilant).
Prokinetics. These medications help control acid reflux by strengthening your lower esophageal sphincter (LES) and helping your stomach empty faster. Examples include bethanechol (Urecholine) and metoclopramide (Reglan). Both medications may cause nausea, diarrhea, fatigue, depression, anxiety, and reduced or slow movements.
Surgery
Your doctor may recommend surgery if your acid reflux or GERD is unresponsive to medications. Your surgeon may perform either of these procedures to help relieve your symptoms:
Fundoplication. Your surgeon partially or completely wraps the upper part of your stomach around the lower esophageal sphincter (LES) to tighten it hence prevent reflux. It’s a minimally invasive procedure that employs a laparoscope, a thin tube with a tiny small video camera inserted through a small incision in the abdomen.
LINX procedure. With this also minimally invasive procedure, your surgeon places a ring consisting of magnetic beads held together by titanium wires around the junction of your stomach and esophagus. The device keeps the lower esophageal sphincter closed to backing up of stomach acid but allows for it to open for food to pass through.
Risk and Complications of Acid Reflux
Acid reflux can progress to gastroesophageal reflux disease (GERD), which without treatment can cause severe complications in the long term, such as:
Esophagitis
Esophagitis refers to inflammation of the esophagus, which often causes difficult and painful swallowing. Other symptoms may include the feeling of food getting stuck in your food pipe, chest or abdominal pain, heartburn, regurgitation, cough, sore throat, mouth sores, et cetera. If left untreated, esophagitis can lead to esophageal stricture, tears in the lining of the esophagus, and Barett’s esophagus.
Esophageal stricture
When stomach acid damages the lining of your esophagus, it may cause scar tissue to form, which, in turn, narrows the esophagus. The narrowing of your food pipe is what is known as esophageal stricture, a condition that’s also characterized by difficult or painful swallowing.
Barrett’s esophagus
Barrett’s esophagus is a condition that causes changes in the cells lining your esophagus. Between 10-15% of people with GERD develop Barrett’s esophagus. The disorder in itself doesn’t cause symptoms, but since many people with Barrett’s esophagus have GERD, symptoms such as frequent heartburn and chest pain may be experienced.
Note: People with Barrett’s esophagus are more likely to develop a rare type of cancer called esophageal adenocarcinoma.
Respiratory problems
GERD can cause you to breath stomach acid into your airways, irritating them and causing respiratory problems, such as:
Asthma: A chronic disease that causes the inflammation and narrowing of your airways and the production of extra mucus. All these symptoms can trigger wheezing, difficulty breathing, and coughing.
Pneumonia: An infection that inflames the air sacs in one or both lungs. Pneumonia, even with treatment, may result in complications such as bacteria in the bloodstream (bacteremia), lung abscess, and build-up of fluid in the pleural space (pleural effusion).
Acid Reflux in Pregnancy
Acid reflux during pregnancy is a common occurrence, and associated symptoms should go away once a woman gives birth. Lifestyle changes such as eating smaller meals, wearing loose-fitting clothes, avoiding foods that trigger heartburn are recommended for treating acid reflux and heartburn during pregnancy. Some medications are also suitable for pregnant women.
See your doctor if you experience severe or persistent heartburn that isn’t responding to over-the-counter or at-home treatments. Severe heartburn can be a sign of preeclampsia, a pregnancy complication characterized by high blood pressure. Without the necessary treatment and regular monitoring, preeclampsia can be fatal to both mother and fetus.
References ⌵- National Insitute of Diabetes and Digestive and Kidney Diseases (nih), Acid Reflux (GER & GERD) in Adults, (n.d)
- Harvad Health publishing, Ways to relieve acid reflux without medication, September 10, 2019.
- NHS, Heartburn and acid reflux, August 15, 2019.
- Mayo Clinic Staff, Gastroesophageal reflux disease (GERD), May 22,2020.
