Acid Reflux: Symptoms, Causes and Treatment
Acid reflux happens when the lower esophageal sphincter(LES) does not close properly which leads to acid being pushed back from the stomach to the esophagus.
The lower esophageal sphincter is a muscle ring at the opening of the stomach which lets food in and closes immediately as it passes down.
Acid reflux symptoms that occur more than 2 times in a week may lead to acid reflux disease also known as gastroesophageal reflux disease (GERD)
Symptoms of Acid Reflux
Primarily, acid reflux causes an uncomfortable strong burning sensation in your stomach that can move to your chest.
Moreover, you may also feel a sour acid in your mouth as a result of the backwash.
This may eventually lead to regurgitating food and drinks from the stomach back into your mouth.
It leads to difficulty in swallowing.
You may undergo bloatedness along with excessive burping and hiccups.
In extreme cases, you may even vomit blood or have bloody stools.
You may have constant nausea and if your symptoms occur at night then you may even undergo excessive coughing and wheezing along with a sore throat.
These symptoms will not let you sleep properly.
You may also develop asthma or existent asthma could worsen.
You may also undergo unexplained weight loss.
What causes Acid Reflux?
Acid reflux mainly occurs when the esophagus ring relaxes and opens but does not tighten up and closes as food goes down.
This lower esophageal sphincter may weaken and relax to an abnormal amount due to which the stomach fluids and acids may their way back.
This backwash can irritate the esophagus lining and making it thin and inflamed.
Another cause of acid reflux is hiatal hernia.
In this condition, the upper part of the LES and the stomach goes upward above the diaphragm.
The diaphragm helps keep the acids in the stomach from going up, acting as a muscle separation between the chest and stomach.
However, in the hiatal hernia, the separation is disturbed therefore the acid and digestive juices can go into the esophagus.
Risks of Acid Reflux
Risk factors for acid reflux include:
- Consuming fried fatty foods
- Lying down after a meal
- Being obese
- Lying on your back after a heavy meal
- Being a smoker
- it does not heal beyond 2 weeks
- Drinking carbonated and caffeinated drinks
- Having Scleroderma
These risk factors can increase your chances of getting acid reflux disease.
Your doctor will carry out a physical exam and take your history.
Your symptoms, especially heartburn, will be enough to diagnose acid reflux but the doctor will also check if your symptoms occur more than twice a week. Hence, resulting in GERD.
If they do not, your doctor may carry out a series of tests:
A thin tube is inserted in your throat. This tube carries a light and camera that allows the doctor to see clearly.
This endoscopy observes your stomach and esophagus to look for any inflammation.
It can also be used to detect Barret’s esophagus by collecting a tissue sample.
The acid reflux itself does not indicate any abnormality in the result but the upper endoscopy can eliminate any doubts of other diseases.
This examines the muscle contraction of your esophagus and lower esophagus sphincter when you swallow.
It can identify if the lower esophagus sphincter is unable to tighten up or is abnormally relaxing after swallowing any food or drink.
It measures how much force and coordination are the muscles of the esophagus exerting.
Ambulatory acid pH probe test
This test is used to check the regurgitation of stomach acid in your esophagus.
A monitor is usually a thin tube called a catheter placed in your nose to get through the esophagus but it is connected to a computer strapped around your waist.
The doctor may also insert a clip in your esophagus that gets out of your body in the form of stool by one or two days.
You may be told to swallow a barium pill to have a close look at your esophagus to detect any narrowness that hinders swallowing and to look for ulcers.
Or you may be told to drink a chalky liquid that allows the doctor to see your upper digestive tract.
This includes the stomach, esophagus and intestine.
All these tests will determine if you have acid reflux disease or not so that they can be further treated.
More on this in the next section!
Treatment of Acid Reflux
Most patients are advised to incorporate lifestyle changes and use over-the-counter medicines.
Surgery may be required for GERD as well if medicines also fail to cure acid reflux.
Over the counter medications
Antacids are used for immediate relief. Mylanta and Rolaids are antacid that can neutralize the stomach acid.
However, they cannot cure the inflamed lining of the esophagus caused by stomach acid.
In fact, overuse of antacids may also lead to side effects in the kidney and cause diarrhea.
Antacids that contain magnesium hydroxide and aluminum hydroxide can help decrease the probability of getting side effects.
2. H-2 Receptor blockers
H-2 Receptor blockers involve famotidine (Pepcid AC) and cimetidine (Tagamet HB).
They work by reducing the acid in the stomach.
They do not work as instantly as antacids but they can reduce the levels of stomach acid and contain them for a good half day.
Hence, they provide relief for a longer period of time and if required, strong doses can also be prescribed.
3. Proton pump inhibitors
These are the strongest of them all because they are acid blockers. Since they block acid so there is plenty of time for the esophageal lining to heal as it is not in contact with the stomach acid.
Therefore these inhibitors that contain lansoprazole (Prevacid 24 HR) and omeprazole are pretty effective against acid reflux.
If over the counter drugs do not work, your doctor may prescribe specific medications.
1. H2 receptor blockers
These are stronger drugs that contain nizatidine.
These medicines work well but long-term use may lead to side effects such as deficiency of vitamin B-12 making you more susceptible to bone fractures.
2. Proton pump inhibitors
They include pantoprazole (Protonix) and dexlansoprazole (Dexilant) among many others.
They are usually received well but prolonged use could lead to diarrhea, nausea and headache.
You may also get vitamin B12 deficiency and be susceptible to hip fractures.
3. Strengthening lower esophageal sphincter
Medicines such as Baclofen can reduce the frequency of the relaxation of the LES. ide effects like nausea and headache may follow.
Alongside strengthening the lower esophageal sphincter, prokinetics can help empty your stomach fastly hence reducing acid reflux.
If you wish to have a permanent solution for acid reflux, your doctor may proceed with these surgeries:
Your stomach’s top is wrapped around the LES. This tightens your esophageal muscles and stops reflux.
This surgery is minimally invasive and is carried out by a laparoscopic procedure.
2. LINX device
A ring of magnetic beads is placed between the stomach and esophagus.
There is a very well balance in the attraction of the magnetic beads.
The attraction is less for the food to pass through from the esophagus to stomach but strong enough to prevent acid reflux from the stomach back to the esophagus.
Transoral incisionless fundoplication (TIF)
This procedure uses no incision to create a wrap around the LES using polypropylene fasteners.
It tightens the LES and is inserted through the mouth using an endoscope.
It has fast recovery and good tolerance.
Life style and home remedies
Your doctor will first advise you to incorporate some lifestyle changes to improve your health.
Keep a healthy weight and reduce the excess. Obesity can put pressure on the abdomen pushing the stomach hence causing acid reflux.
Stop lying down after a meal and even stop lying down on your belly. At least wait for three hours after a meal before lying down.
Don’t east fast and take small bites. Chewing and swallowing should be done slowly and properly.
Avoid fatty fried foods and beverages that you know cause acid reflux. Tea, coffee, garlic, chocolate and carbonated drinks can trigger your reflux.
Do not wear tight clothes. These tight clothes can put pressure on the abdomen and LES.
Quit smoking! Smoking is injurious to health in many ways. One of which is that it reduces the LES’s functionality.
Increase the height of the head of the bed by putting brick blocks under the bed. Heartburn, especially during sleep, is reduced by elevating your bed.
Putting multiple pillows under your head may not help, hence try to raise your body from the waist by elevating the bed.
You can also try sleeping on a chair for naps instead of the bed and incorporating exercise in your routine will help you keep fit and healthy.
Regularly experiencing acid reflux can lead to complications.
These complications may also be cured by medications and surgery but should be treated timely.
Prolonged acid reflux damages the LES forming scar tissues.
This hinders the food pathway by narrowing it thus creating issues with swallowing.
Stomach acid can also damage the tissues in the esophagus, therefore, creating sores.
These open sores or ulcers are painful, create problems swallowing and even bleed.
Stomach acid can also destroy or change the tissues lining the LES.
These changes in the tissues may indicate the formation of cancer cells leading to esophageal cancer.
Babies can also suffer from GERD and if your baby vomits and spits food very frequently you should take them to a doctor.
Acid reflux is treatable by maintaining a healthy lifestyle and recognizing your symptoms early for effective treatment.
You can control most of the symptoms of acid reflux by simply improving your eating habits and if they still don’t stop then over-the-counter medicines will be enough for most patients.