Acid Reflux

Overview

Acid reflux (also known as gastroesophageal reflux disease or GERD) happens when stomach acid regularly flows back into the tube connecting your stomach and mouth (the esophagus). This backwash of acid may irritate the lining of your esophagus. This happens because the valve at the entrance of your stomach (called the LES) either opens too often or does not close completely. There are other acid reflux symptoms to watch out for.  

Plenty of people experience acid reflux symptoms occasionally. GERD, however, is mild acid reflux occurring at least twice a week, or it can be moderate to severe acid reflux that happens at least once weekly. 

Most people are able to manage the discomfort of GERD using over-the-counter medications as well as lifestyle changes. Some people might need stronger medications or even surgery to help with their acid reflux symptoms.

Symptoms

A common cause of acid reflux disease is a hiatal hernia (a stomach abnormality). Hiatal hernias occur when the LES and upper stomach move above your diaphragm. Normally, the diaphragm helps to keep acid in the stomach. If you have a hiatal hernia acid can more easily move up into the esophagus and cause the symptoms of acid reflux disease. 

Here are some other common risk factors for acid reflux disease: 

  • Being overweight or obese
  • Snacking close to bedtime
  • Eating large meals or lying down immediately following a meal
  • Smoking
  • Being pregnant
  • Taking certain medications including blood pressure medications, ibuprofen, or aspirin.

What Are Some Acid Reflux Symptoms? 

Some more common acid reflux symptoms are: 

  • Regurgitation: bitter or sour acid backing up into your throat or mouth
  • Heartburn: a burning feeling that may move from your stomach up to your throat through the abdomen or chest. 

Other acid reflux symptoms are: 

  • Weight loss for no known reason
  • Burping
  • Hiccups that don’t stop
  • Bloating
  • Nausea
  • Wheezing, hoarseness, chronic sore throat, or dry cough
  • Bloody vomiting or stools
  • Dysphagia (the sensation of food being stuck in your throat)

Diagnosis

If you have acid reflux symptoms twice per week or more, or if over the counter medications are not bringing you relief you should see your doctor. Acid reflux symptoms like heartburn are essential to the diagnosis of GERD, especially if you have already tried other measures such as over the counter medications or lifestyle changes and they are reducing the acid reflux symptoms. 

If these steps aren’t helping or if you have more frequent and severe symptoms your doctor may require you to take some tests in order to confirm a diagnosis and check for other issues. You may need one or more of the following tests: 

  • Barium Swallow: this test is used to check for ulcers as well as a narrowing of the esophagus. You swallow a solution which shows up on X-rays to help doctors see structures. 
  • Esophageal manometry: this is able to check the movement and function of the esophagus as well as the lower esophageal sphincter. 
  • pH monitoring: checks for acid in your esophagus. Your doctor will insert a device into your esophagus and will leave it in place for a day or two to measure the amount of acid in your esophagus. 
  • Endoscopy: this test checks for issues in your stomach or esophagus. The test will involve inserting a flexible, lighted, long tube with a camera down your throat. Your doctor will first spray the back of your throat with anesthetic and also give you a sedative to make it more comfortable. 
  • Biopsy: a biopsy could be taken during endoscopy in order to check tissue samples under a microscope for abnormalities or infection. 

Treatment

There are a few different options for the treatment of acid reflux symptoms. From lifestyle changes to surgery, here are some treatment options you can explore with your doctor. 

Lifestyle Changes

One of the best options for treating acid reflux disease is to avoid eating and drinking things that trigger your acid reflux symptoms. 

There are additional steps you can take:

  • Quit smoking
  • Eat 2-3 hours before you lie down
  • Taking steps to lose weight if you’re overweight
  • Talk to your doctor to ensure that this isn’t a side effect of your medication
  • Don’t wear tight clothing
  • Sleep in a chair if you take daytime naps
  • Eat smaller meals more often throughout the day
  • Put blocks under the head of your bed to raise it 4-6 inches. 

Over-the-counter medications

There are a variety of non-prescription drugs that can help your acid reflux symptoms. 

These medications include: 

  • Medications to reduce the production of acid. These medications (called H-2-receptor blockers) include famotidine, ranitidine, cimetidine, and nizatidine. These medication won’t work as quickly as antacids, but they provide a longer lasting relief and are able to decrease stomach acid production for up to 12 hours. You can get stronger versions by prescription. 
  • Medications that heal the esophagus and block acid production. These medications are called proton pump inhibitors and they’re stronger acid blockers than the H-2-receptor blockers. They also allow time for the damaged esophageal tissues to heal. OTC proton pump inhibitors include omeprazole and lansoprazole. 
  • Antacids that neutralize stomach acid. Antacids can provide quick relief, but they will not heal an inflamed esophagus alone. The overuse of some antacids may cause side effects.

Prescription medications

If lifestyle changes and over-the-counter products do not work to reduce the acid reflux symptoms, you may need to get your doctor to prescribe you prescription medication. 

Some options for prescription strength GERD treatment include: 

  • Prescription-strength proton pump inhibitors. These medications include omeprazole, esomeprazole, dexlansoprazole, rabeprazole, and pantoprazole. Though usually well-tolerated, these medications may have negative side effects and cause vitamin B-12 deficiency. Chronic use can also increase the risk of hip fracture. 
  • Medication to strengthen the LES. Baclofen is a medication that can help ease GERD by decreasing the frequency of the lower esophageal sphincter’s relaxations. 
  • Prescription-strength H-2-receptor blockers. These medications include nizatidine, famotidine, and ranitidine. These medications are generally tolerated quite well, but can be associated with a slight risk of bone fractures and vitamin B-12 deficiency. 

Surgery and other procedures

Acid reflux disease can usually be kept under control with the use of medication. However, if medications don’t help, or you want to avoid long-term medication use there are some procedures your doctor can recommend: 

  • LINX device. This is a ring of tiny magnetic beads. This ring gets wrapped around the junction of the esophagus and stomach. The magnetic attraction between the beads is weak enough to allow food to pass food, but strong enough to keep the junction closed to refluxing acid. The Linx device is implanted using a minimally invasive surgery. 
  • Fundoplication. This procedure is where the surgeon wraps the top of your stomach around the LES in order to prevent reflux and tighten the muscle. Fundoplication is done usually with a minimally invasive procedure. The wrapping of the top section of the stomach may be complete or partial.