Usually at night, we may feel a sour liquid in our throat coming from beneath or burning sensation in our upper tummy. The pain goes up through our chest to the throat. Sometimes we fear it as a heart attack. This is called heartburn or gastroesophageal reflux disease (GERD) in medical terms.
How Does It Happen?
The food we eat starts getting digested right from the mouth up to the large bowel. Food passes through the mouth to the throat and then food pipe, stomach, small and large bowels, rectum and at last excreted as feces. Every part of the digestive system plays its role in digesting food. Stomach is unique from other parts as it has acid in it. Yes, stomach produces hydrochloric acid (HCl). This helps in digestion and also kills germs that may be present in unhygienic food.
The hydrochloric acid is present only in the stomach. A functional valve at the lower end of the food pipe called the lower esophageal sphincter preventes the reflux of acid back into the food pipe. It remains closed most of the time and opens for a short time while we swallow food or liquid and then closes again. Sometimes, it opens for short times even without food, to eliminate the air that is swallowed or gas that is produced by some chemical reactions in the stomach. These transient openings are for very short periods. In some individuals, the openings of this valve are recurrent or for longer duration. In that case acid may come back into the lower part of the food pipe and cause burning of walls of the pipe. This causes pain or burning sensation and it is due to acid reflux.
Risk Factors of Acid reflux
Some common risk factors of acid reflux are as follows:
- Binge eating.
- Lying down just after eating.
- Taking lot of coffee, tea and citrus juices.
- Taking some medicines that contain acid such as Aspirin and medicines that loosen this valve, for example nitrates.
- Tight fitting clothes.
- With some medical conditions such as hernia, in which a part of our stomach is pulled upwards into the chest.
Heartburn is very common. Most of us experience it three to four times per month. Unless you do not have danger symptoms, this condition is of no concern. Danger symptoms or red flags are weight loss, persistent vomiting, blood vomiting, black colored feces and difficulty in swallowing. If you experience these danger symptoms, then go straight to your doctor without delay.
Usually no investigations are required, but sometimes when the diagnosis cannot be made, few investigations are done to check acid reflux.
1. Esophageal Manometry:
In this, a probe is inserted into food pipe’s lower end, which measures its pressure. If it is decreased, then it causes acid to reflux back.
2. Monitoring Ph:
In this also, a pH probe is inserted into the food pipe through mouth to measure pH of the food pipe continuously for 24 to 48 hours. If it is less than 4, then it gives clue to acid reflux. Normal pH is around 6. This test is also called Bravo test.
In this test a flexible probe is passed through the mouth to the stomach, which has a camera to view inside the food pipe and stomach. It is also used to remove a small piece of tissue from there to test, which is known as biopsy.
4. Acid Suppressing Medicines:
Sometimes a medicine that suppresses acid production is given and if there is symptomatic improvement, then the treatment will be continued.
- Antacids: As we know acid is neutralized by alkali, an alkaline medicine is given. Usually Sodium bicarbonate (baking soda) and Magnesium bicarbonate is used to neutralize the acidic environment. It gives relief in a very short time.
- Surgery: Rarely, surgery is needed, especially in case of hernia.
Complications of Heartburn
- Usually there are no complications of acid reflux, but rarely may arise. There may be stricture formation in which the lower end of food pipe is narrowed or blocked thus causing pain and difficulty following swallowing especially solid foods.
- If acid reflux remains for a long time, there appears some changes at the microscopic level in our food pipe that sometimes are precancerous and later may lead to cancer. Do not worry as the chance of it is very less.
- An ulcer may develop in food pipe due to longstanding damage from acid.
- Sometimes, the acid along with liquid we had drunk short time ago refluxes up to the throat and mouth. It may cause decay of tooth enamel and if this sour fluid goes into the windpipe (trachea), especially if reflux occurs during sleep can cause pneumonia that is inflammation of the lungs.
If you suffer from recurrent heartburn, then the following steps may be taken to decrease or prevent further episodes.
- Do not eat full stomach. Avoid fatty foods, excessive coffee, tea or other caffeinated beverages.
- Stop smoking and drinking. Do not wear tight clothes.
- Don't go to sleep just after having meal. Go to bed about 2 hours after meal. Keep the head end of your bed about 6 to 8 inches above the foot end, so that acid may gravitate down.
- Do not have acidic foods such as lemon, orange and tomatoes. Avoid acidic medicines such as Aspirin or medicines that cause more reflux such as nitrates, with your doctor's advice.
- Do not take stress as it causes more acid production and more acidity.
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Frequently Asked Questions