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 strong acids.
At the lower end of the esophagus, when it joins the stomach, there is a valve known as the 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 esophagus cells, causing inflammation and pain. The person experiences this as a burning sensation in the chest.
What Are the 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., increase 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 into the food pipe. Also, the growing fetus competes for space with the stomach forcing the acid contents back up.
Drugs: Certain drugs such as NSAIDs (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. Many patients often confuse it with chest pain due to a heart attack.
Bitter Taste in the Mouth: Acid reflux can cause a foul and rancid taste in the mouth, giving 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 teeth' enamel and dentin layers, causing cavities and decay.
What Are the Complications of Reflux Disease?
Ulcers: Over some time, reflux can cause a break in the stomach's protective lining, 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 due to the 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 the intestines.
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. Therefore, 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 X-ray procedure where you will be asked to swallow a barium solution before taking the radiograph to visualize the internal organs and problems better.
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 doctor interprets the results after this period. A newer, wireless method is also available, which is more convenient for the patient.
How Is Acid Reflux Be Treated?
Treatment includes a combination of lifestyle modifications and medications. Sometimes, surgery may be indicated if the medication does not provide relief.
1. Lifestyle Modification:
- Prefer smaller and lighter meals to 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 help relieve 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 in two types such as H2 blockers and proton-pump inhibitors.
- H2 Blockers: It is a class of drugs that help decrease the production of stomach acids. H2 blockers include Cimetidine, Ranitidine, and Famotidine. They start acting slowly compared to antacids but provide more lasting relief from acidity.
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Proton-Pump Inhibitors (PPIs): PPIs are medications that block 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:
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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 a hiatal hernia, the same procedure will also be used to provide relief.
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Linx Device: A small ring made up of titanium beads with magnetic cores is surgically implanted at the stomach junction and food pipe (LES) to help tighten the valve. It keeps it closed so that the stomach contents do not regurgitate back into the esophagus even under pressure from gastric contents.
Know the Facts About Heartburn -
What Is the Best Way to Manage Acid Reflux in the Long Run?
Hence, although common, acid reflux 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, the doctor suggests a stronger prescription medication.
Irrespective of the severity of your condition, it is important to change your eating pattern. Many have reported that shifting to a healthier diet and adding physical exercise brings about positive changes.
Conclusion:
Acid reflux is a chronic digestive disease. These can be treated with OTC antacids, and some lifestyle changes can usually create relief. But when the heartburn occurs more than twice a week, and no lifestyle changes are giving you relief, you may be dealing with GERD (gastroesophageal reflux disease). If left untreated, it can cause problems such as ulcers, strictures, and even cancer.
