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Gastro Health

Acid Reflux

Written by Dr. Vasantha K S.  

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Contents


What is Acid Reflux?

The esophagus is the food pipe connecting the mouth to the stomach. It pushes the food down to the stomach by a rhythmic, involuntary wave-like movement of muscles, a process known as peristalsis.

Once the food is in the stomach, it releases acids such as hydrochloric acid to help digest the food and kill the bacteria. The stomach has special cells lining it to protect it from the strong acids.

At the lower end of the esophagus, at the point where it joins the stomach, there is a valve known as lower esophageal sphincter (LES) that prevents the food from re-entering the esophagus back from the stomach. The special cells that protect the internal lining from acid attack are absent in the esophagus. Hence, if the food does reflux back, it leads to heartburn. The acids then erode the cells of the esophagus, causing inflammation and pain. This is experienced by the person as a burning sensation in the chest.

Acid Reflux

Risk Factors of Acid Reflux

Certain medical conditions and lifestyle choices make us more prone to experiencing acid reflux. They are:

Hiatal hernia:

A condition when the stomach bulges through the diaphragm into the chest.

Overeating:

while one-off instances can cause heaviness, bloating and gas, a long-term habit of overeating causes metabolic disorders such as obesity, heart diseases, and diabetes apart from acid reflux.

Lying down right after a meal:

This can cause the meal to come back up in the throat and cause bouts of coughing and pain.

Obesity:

Being obese can slow down your system and cause many digestion-related issues.

Consumption of acidic foods:

Acidic foods such as citrus fruits, spices, etc., increases the chances of acid reflux in those already prone to hyperacidity. Alcohol, caffeine, and carbonated drinks cause an acidic environment.

Smoking:

Nicotine in the cigarette is known to relax the LES and cause the acidic stomach contents to trickle back into the esophagus and cause heartburn.

Pregnancy:

In pregnancy, the hormone progesterone plays an important role in gradually relaxing the smooth muscles to help ease the baby out smoothly at the time of birth. This hormone also causes the valve muscles to relax, thereby allowing the food to reach back the food pipe. Also, the growing fetus competes for space with the stomach forcing the acid contents back up.

Drugs:

Certain drugs such as NSAID (nonsteroidal anti-inflammatory drugs) are notorious for causing heartburn.

What are the Symptoms of Acid Reflux Diseases?

Heartburn:

It is a painful, burning sensation in the chest. It is often confused by many patients to be chest pain due to a heart attack.

Bitter taste in the mouth:

Acid reflux can cause a foul and rancid taste in the mouth which gives a very unpleasant sensation.

Bloating:

It is a sensation of the belly feeling swollen and full, especially after eating.

Belching or burping:

It is the forceful expulsion of gas from the upper stomach through the mouth.

Nausea:

Nausea is an uneasiness or unsettled feeling that gives a sensation you are about to vomit.

Dryness of the throat and cough:

Acid reflux can pass beyond the upper esophageal sphincter and go into the throat causing dryness, hoarseness of voice and cough.

Dental erosion:

When the stomach acid contents regurgitate back into the mouth, they can erode the enamel and dentin layers of the teeth causing cavities and decay.

Complications of Reflux Disease

Ulcers:

Over a period of time, reflux can cause a break in the protective lining of the stomach causing intense pain.

Internal bleeding:

If an ulcer perforates the entire layers of the stomach, there can be internal bleeding and infection.

Esophageal stricture:

It is a scar formation and narrowing of the food pipe as a result of acid effect.

Barrett's esophagus:

It is a serious complication of repeated exposure to stomach acid contents. In this condition, the cells lining the food pipe change to abnormal cells resembling those of the intestine.

Esophageal cancer:

It is a malignant change of the cells of the food pipe and occurs in a small percentage of those with recurrent exposure to acid.

How is Acid Reflux Disease Diagnosed?

Since heartburn causes pain in the chest, it is often confused to be a heart attack. It is diagnosed by carrying out tests such as:

X-ray:

An X-ray of your esophagus and stomach may be taken to visualize the internal organs structurally.

Biopsy:

A tissue sample may be taken for examination by passing a thin tube through the nose into your esophagus.

Barium swallow:

It is a special type of X-ray procedure where you will be asked to swallow a solution of barium before taking the radiograph in order to better visualize the internal organs and problems, if any.

pH monitoring:

In this method, a thin tube with a pH-sensitive end is passed into the esophagus to detect the pH level of your insides. It is left in place for 24 hours and the results are interpreted by the doctor after this period. A newer, wireless method is also available, which is felt to be more convinient by the patient.

How is Acid Reflux be Treated?

Treatment includes a combination of lifestyle modifications and medications. Sometimes, if medication does not provide relief, surgery may be indicated.

1. Lifestyle modification

  • Prefer smaller and lighter meals than heavy ones.
  • Leave a gap of two to three hours between meal and bedtime.
  • Avoid triggers such as alcohol, spicy food and coffee.
  • Stop smoking.
  • Elevate the head of the bed by placing blocks under the legs on the head side.
  • Avoid tight-fitting clothes.
  • Avoid night-time snacking.
  • Exercise regularly and stay physically active.
  • Regular medications that you take may be causing your heartburn and need to be changed after consulting with your doctor.

2. Medication

Antacids are usually available over-the-counter in the form of chewable tablets as well as liquids. They are helpful in relieving mild symptoms. They neutralize the excess acids in the stomach. They are mostly composed of a combination of aluminum, magnesium, and calcium. Apart from this, prescription drugs are available as two types: H2 blockers and proton-pump inhibitors.

H2 blockers

It is a class of drugs that help decrease the production of the stomach acids. H2 blockers include Cimetidine, Ranitidine and Famotidine. They start acting slowly compared to antacids but provide a more lasting relief from acidity.

Proton-pump inhibitors (PPI)

PPI are medications that block the acid production. They are the most effective medication and are recommended for patients with a more severe and frequent form of acid reflux. Some commonly prescribed PPIs include Omeprazole, Pantoprazole, and Rabeprazole.

3. Surgery

If medication does not help or if symptoms have lasted very long, the doctor may recommend surgical procedures such as:

Fundoplication:

In this procedure, the surgeon tightens the LES (lower esophageal sphincter) to help prevent reflux. It is usually done as a laparoscopic procedure. The uppermost portion of the stomach is known as the fundus. It is cut and sewn in such a way as to tighten the valve (lower esophageal sphincter). If a person suffers from reflux due to hiatal hernia, the same procedure will be used to provide relief too.

Linx device:

A small ring made up of titanium beads with magnetic cores is surgically implanted at the junction of the stomach and food pipe (LES) to help tighten the valve and keep it closed so that the contents of the stomach do not regurgitate back into the esophagus even under pressure from gastric contents.

Know the Facts about Heartburn

Heartburn

What is the Best Way to Manage Acid Reflux in the Long Run?

Hence, acid reflux, although common, is a troublesome condition that causes discomfort and pain in the short-term and more serious complications in the long-term. Often lifestyle modifications are the first-suggested modes of treatment. If lifestyle changes, along with over-the-counter medications do not help, and if symptoms last two weeks or longer, only then a stronger prescription medication is suggested by the doctor.

Irrespective of the severity of your condition, it is important to change your pattern of eating. Many have reported that shifting to a healthier diet and adding in some physical exercise brings about positive changes by themselves.

Last reviewed at: 13.Nov.2018

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