Acid Reflux

What is acid reflux?

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Acid reflux is a common, persisting pain in the esophagus. It occurs when a ring of muscle at the end of the esophagus does not close the way it should. That ring of muscle between the stomach and the esophagus is called the lower esophageal sphincter. The opening provides a way for stomach contents to enter the esophagus. Acid reflux occurs when stomach acid leaks back into the esophagus. Known more generally as reflux, this causes significant irritation.

Acid reflux is very common amongst American adults. More than 60 million Americans experience the condition at least once each month. Some people experience it far more frequently. If you have acid reflux more than twice each week, you may have acid reflux disease, also known as gastroesophageal reflux disease, or GERD. Around 20% of people in the United States have GERD. Infants and children are also able to have GERD. It is not typically a life-threatening disorder, though it might require surgery or medication as treatment. If left untreated, GERD can cause serious health problems.

If you have any significant or ongoing digestive discomfort, seeing a doctor can help. A physician can provide a diagnosis or treatment plan to help manage symptoms. Most people with acid reflux self-medicate with over-the-counter remedies like Pepto Bismol and Tums. But, if you experience significant pain, or frequent acid reflux, seeing a doctor can yield a longer-term solution.

What causes acid reflux?

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The lower esophageal sphincter is a circular band of muscle at the end of the esophagus. It relaxes and opens while swallowing. The lower esophageal sphincter does this to let food into the stomach. After swallowing is complete, the muscle tightens and closes. This is the normal digestive process.

When the lower esophageal sphincter does not close or tighten as it should, then acid reflux can occur. Digestive juices and stomach contents can rise into the esophagus. This opening can happen because the lower esophageal sphincter is weak, or if it relaxes when it should not relax. Patients report feeling an acidic liquid at the bottom of their esophagus. Many compare it to feeling the need to vomit.

What are symptoms of acid reflux?

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Acid indigestion is a common symptom of acid reflux. Many may know this by its colloquial nickname: Heartburn. Those who experience heartburn describe it as a chest pain that burns behind the sternum and travels up to the neck or throat. Some might experience it as feeling like food comes back up the throat into the mouth, with an acidic or bitter aftertaste. Acid indigestion, or heartburn, can last for up to two hours.

Other symptoms of acid reflux include:

  • Nausea
  • Lump in the throat
  • Difficulty swallowing
  • Difficulty breathing
  • Vomiting
  • Wearing away of tooth enamel
  • Bad breath

Acid reflux can occur at any time of day. Most often, however, it occurs when a person is lying down, typically several hours after a meal. If you experience acid reflux at night, while asleep, you may develop the following symptoms and conditions:

  • Increased asthma issues
  • Sleep problems
  • Laryngitis
  • Lingering cough

Are there any risk factors or groups for acid reflux?

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In America over 60 million adults experience heartburn at least once a month. More than 15 million adults experience heartburn everyday. Chronic acid reflux is even common in infants and children. However, some people are more prone to acid reflux than others. Common risk factors include being overweight or obese and being pregnant. Other risk groups include those who experience delayed emptying of the stomach, or gastroparesis, and folks with certain connective tissue disorders.

There are some lifestyle choices that could increase someone’s chances of developing acid reflux and, over time, GERD:

  • Eating before bed
  • Eating big meals
  • Smoking
  • Eating specific foods and drinks like fried food, alcohol, coffee, or chocolate
  • Taking some types of medication like aspirin or Ibuprofen
  • Lying down or sleeping right after eating

Some doctors believe that having a hiatal hernia might increase chances of developing both temporary and chronic acid reflux. A hiatal hernia is when the upper part of the stomach rises into the chest through the diaphragmatic hiatus, a small opening in the diaphragm. The diaphragmatic hiatus supports the low end of the esophagus.

A hiatal hernia can weaken the lower esophageal sphincter and increase chances of acid reflux. Though not everyone with a hiatal hernia will experience associated digestive issues, a hiatal hernia might provide more room for stomach contents to leak back into the esophagus.

How are acid reflux diagnosed?

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Acid reflux does not often receive a clinical diagnosis. Over time, patients will learn to identify when it is happening, and they can treat symptoms with over-the-counter pain relief. However, folks who experience frequent acid reflux should visit a doctor. If you have acid reflux more than twice each week, your doctor will likely diagnose you with GERD. A doctor might run any of the following tests to determine if a patient has this chronic form of acid reflux:

  • An endoscopy is when a long, flexible tube is inserted down the throat and into the esophagus. The doctor examines the esophagus, stomach, and small intestine with a tiny camera.
  • An upper GI series is a series of X-rays that allow doctors to study the GI tract, which includes the stomach, food pipe, and first part of the small intestine.
  • Esophageal pH testing measures the frequency and length of time that stomach acid enters the esophagus.
  • An esophageal manometry and impedance study is when a catheter is placed in the nose and down the esophagus to track the amount of reflux in the esophagus within a 24-hour period.
  • A barium swallow is just that: swallowing a solution of barium so that doctors can take X-rays of the esophagus.

How is acid reflux treated?

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Most Americans treat acid reflux upon onset. A variety of over-the-counter medications are available at most pharmacies and grocery stores. In many cases, this includes the following treatments:

  • Proton pump inhibitors (PPI) reduce stomach acid and GERD symptoms. Over-the-counter PPI include lansoprazole, omeprazole, and esomeprazole.
  • H2 receptor blockers treat excess stomach acid. Some examples include famotidine, cimetidine, and nizatidine.
  • Prokinetics assist with acid reflux. Some examples include cisapride, bethanechol, and metoclopramide.
  • Antacids help neutralize stomach acid, specifically in cases of excess stomach acid. Some examples include Tums, Alka-Seltzer, or Mylanta.

For individuals who have received a GERD diagnosis, a doctor may recommend surgery. Common surgeries to treat chronic acid reflux include:

  • Fundoplication, a surgical procedure that can treat some gastroesophageal conditions. The lower esophageal sphincter is attached to part of the stomach in an effort to curb acid reflux.
  • Transoral incisionless fundoplication, a non-surgical procedure used to treat acid reflux and GERD. The doctor inserts a device that uses preloaded forceps to repair the barrier that stops acid reflux.
  • Stretta procedure, an esophagus reconstruction that helps rebuild the reflux barrier. Low-frequency heat helps reshape the lower esophageal sphincter.
  • LINX surgery, a procedure that treats GERD patients who have recurring symptoms. A device is implanted at the lower end of the esophagus.

Can diet and lifestyle changes help with acid reflux?

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Yes, lifestyle and diet changes are often effective at treating acid reflux. People who suffer from mild cases of acid reflux can make some lifestyle changes to reduce symptoms.

  • Slow down while eating
  • Chew food thoroughly
  • Have smaller servings at mealtime
  • Wear loose clothing
  • Maintain a healthy weight
  • Try to avoid beverages and foods that might trigger acid reflux, like alliums, nightshades, and alcohol
  • Stop smoking
  • Keep head elevated after eating
  • Practice acupuncture

These diet and lifestyle changes can alleviate some of the symptoms of acid reflux and help prevent a GERD diagnosis. However, diet and lifestyle changes are not enough to mitigate symptoms for more severe cases. In such instances, seeing a medical professional for diagnosis and treatment is the best option.

Should you see a doctor for acid reflux?

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Acid reflux is not life-threatening with the proper medication and treatment. Someone experiencing symptoms of acid reflux and GERD can mitigate the discomfort and pain if they seek out the help of a doctor or care team.

As always, as soon as someone experiences unusual symptoms, it is best to get the perspective of a medical professional. Even though acid reflux and GERD are not necessarily life-altering diagnoses, it is best to treat them as soon as possible.

What is the outlook for people living with acid reflux and GERD?

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Although acid reflux and GERD are typically not life-threatening conditions, GERD can lead to harmful health complications. Some of those health complications include:

  • Lung problems
  • Barrett’s esophagus
  • Esophageal stricture
  • Esophageal ulcer

If a person experiencing acid reflux and GERD has help from a doctor and can manage the symptoms of the condition, then these conditions are usually mild. If left untreated, GERD specifically can cause serious health issues.

Please note that extreme cases are not the norm. The vast majority of people diagnosed with and treated for acid reflux and GERD will not experience associated health issues. However, people with acid reflux and GERD might experience some limitation to daily activities even with proper treatment.