What is acid reflux?

Acid reflux is a common condition in the lower chest area which features a burning pain, known as heartburn. As stomach acid flows back into the food pipe it happens.

Gastroesophageal reflux disease (GERD) is diagnosed on incidence of acid reflux more than twice a week.

Exact numbers vary but acid reflux-related diseases are the most common gut problem seen by medical departments in the U.S.

According to the American College of Gastroenterology, over 60 million Americans suffer heartburn at least once a month, and at least 15 million as often as every day.

In Western countries, GERD is most common, affecting an estimated 20 to 30 percent of the population.

Chronic heartburn can carry severe complications.

Fast facts on acid reflux

  • Acid reflux is also known as heartburn, acid indigestion, or pyrosis.
  • It happens when some of the acidic stomach contents go back up into the esophagus.
  • Acid reflux creates a burning pain in the lower chest area, often after eating.
  • Lifestyle risk factors include obesity and smoking.
  • Drug treatments are the most common therapy and are available on prescription and over the counter (OTC).

Causes

Diet
A person’s diet can increase their risk of acid reflux.

Acid reflux occurs when some of the stomach’s acid content travels into the esophagus, into the gullet, and pushes food from the mouth downwards. Heartburn has nothing to do with the heart, in spite of its name.

The stomach contains hydrochloric acid, a strong acid that helps break down food and protect against bacterial pathogens.

The stomach lining is specially adapted to shield it from the infectious acid, but it does not protect the esophagus.

A muscle ring, the gastroesophageal sphincter, usually functions as a valve allowing food to get into the stomach but not back into the esophagus. The signs of acid reflux, such as heartburn, are felt when this valve fails and stomach material is regurgitated into the esophagus.

Risk factors

GERD affects people of all ages, sometimes for reasons unknown. It is often attributed to a factor in lifestyle but it can also be due to factors that can not always be avoided.

A hiatal hernia (or hiatus) is one condition that is not preventable. A break in the diaphragm allows the upper part of the stomach to enter the cavity of the chest, occasionally contributing to GERD.

Other risk factors are more easily controlled:

  • obesity
  • smoking (active or passive)
  • low levels of physical exercise
  • medications, including drugs for asthma, calcium-channel blockers, antihistamines, painkillers, sedatives, and antidepressants

Pregnancy can also cause acid reflux due to extra pressure being placed on the internal organs.Diet

Food and dietary habits that have been linked to acid reflux include:

  • caffeine
  • alcohol
  • a high intake of table salt
  • a diet low in dietary fiber
  • eating large meals
  • lying down within 2 to 3 hours of eating a meal
  • consuming chocolate, carbonated drinks, and acidic juices

A recent study suggests that dietary choices may be as effective as using proton pump inhibitors (PPIs) in treating acid reflux.

Treatment

Zantac drugs
Zantac is one medication for heartburn relief.

The main treatment options for acid reflux are:

  • PPIs, including omeprazole, rabeprazole, and esomeprazole
  • H2 blockers, including cimetidine, ranitidine, and famotidine
  • Over-the-counter treatments, such as antacids,
  • Alginate drugs, including Gaviscon

The key treatment options for people who experience persistent acid reflux in GERD are either PPIs or H2 blockers, both drugs.

PPIs and H2 blockers reduce the acid production and decrease the potential for acid reflux damage.

These drugs are usually safe and effective but they are not ideal for all people with reflux disease like any prescription drug and can cause side effects.

They can cause nutrient absorption problems, for example. That can result in malnutrition.

OTC remedies for acid reflux

OTC medications are available for people who rarely experience heartburn or indigestion, perhaps in combination with occasional food and drink causes, to reduce the acidity of the stomach contents.

These formulations of liquids and tablets are called antacids, and hundreds of brands are available, all having similar effectiveness. These should not operate for everybody so there should be talk with a doctor about the need for regular use.

Antacids provide fast, yet short-term relief by reducing stomach acidity.

They contain chemical compounds such as carbonate of calcium, bicarbonate of sodium, aluminium and hydroxide of magnesium. They can also inhibit absorption of nutrients, which leads to deficiencies over time.

Alginate drugs such as Gaviscon

Gaviscon is probably the best-known heartburn treatment. It has a different mode of action than antacid drugs. Alginate medications such as Gaviscon vary slightly in structure, but they usually contain an antacid.

The alginic acid works by creating a mechanical shield against the stomach acid, forming a foamy gel that sits at the top of the gastric pool itself.

Some reflux is then relatively harmless as it consists of alginic acid and not destroying stomach acid.

The active ingredient — alginate — is found naturally in brown algae.

Other options

Other possible treatment methods include:

  • Sucralfate acid suppressants
  • Potassium-competitive acid blockers
  • Transient lower esophageal sphincter relaxation (TLESR) reducers
  • GABA(B) receptor agonist
  • mGluR5 antagonist
  • Prokinetic agents
  • Pain modulators
  • Tricyclic antidepressants
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Theophylline, a serotonin-norepinephrine reuptake inhibitor

If GERD is serious and unresponsive to medical treatment, it may require surgical intervention known as fundoplication.

Lifestyle

Lifestyle measures that may help include:

  • improving posture, for instance, sitting up straighter
  • wearing loose clothing
  • losing weight if overweight or obese
  • avoiding increased pressure on your abdomen, such as from tight belts or doing sit-up exercises
  • stopping smoking

Symptoms

Acid reflux usually causes heartburn, whether it is due to an overeating or prolonged GERD episode.

Heartburn is an unpleasant feeling of burning that occurs in the esophagus, and is felt behind the breastbone. Lying down or leaning over seems to get worse. It can take several hours to last and sometimes worsens after eating food.

Heartburn pain can move upward towards the neck and throat. In some cases, stomach fluid can reach the back of the mouth, causing a bitter or sour taste.

If heartburn happens twice a week or more, it is known as GERD for short.

Other symptoms of GERD include:

  • dry, persistent cough
  • wheezing
  • asthma and recurrent pneumonia
  • nausea
  • vomiting
  • throat problems, such as soreness, hoarseness, or laryngitis (voice box inflammation)
  • difficulty or pain when swallowing
  • chest or upper abdominal pain
  • dental erosion
  • bad breath

Risks and complications

Without medication, GERD can lead to serious long-term complications including increased cancer risk.

Persistent exposure to gastric acid can harm the esophagus, resulting in:

  • Esophagitis: the lining of the esophagus is inflamed, causing irritation, bleeding, and ulceration in some cases
  • Strictures: damage caused by stomach acid leads to scar development and difficulties swallowing, with food getting stuck as it travels down the esophagus
  • Barrett’s esophagus: a serious complication where repeated exposure to stomach acid causes changes in the cells and tissues lining the esophagus with potential to develop into cancer cells

Both esophagitis and Barrett’s esophagus are associated with a higher risk of cancer.

During pregnancy

30 to 50 percent of women in the U.S. develop heartburn during pregnancy, even though they hadn’t had it before.

Changes to diet during pregnancy, such as not eating too late at night and preparing small meals, are recommended.

Every woman who suffers from severe reflux during pregnancy should explore treatment options with her doctor.

Diagnosis

Acid reflux and heartburn are normal and relatively easy to diagnose, but other chest problems such as:

  • heart attack
  • pneumonia
  • chest wall pain
  • pulmonary embolus

GERD is often diagnosed simply by finding little improvement in the symptoms of heartburn in response to changes in diet and acid reflux medications.

Gastroenterologists may also coordinate the investigations as follows:

  • endoscopy: camera imaging
  • biopsy: taking a tissue sample for laboratory analysis
  • barium X-ray: imaging the esophagus, stomach, and upper duodenum after swallowing a chalky liquid that helps provide contrast on images
  • esophageal manometry: pressure measurement of the esophagus
  • impedance monitoring: measuring rate of fluid movement along the esophagus
  • pH monitoring: acidity testing

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