Answering the Burning Question: What is Acid Reflux?
Did you know that acid reflux is one of the highest searched topics on the web? Diseases related to acid reflux are among the most common gut issues to be seen in US hospitals and affect 50% of Americans. I was surprised when I read this because I did not realize it was so prevalent. I was familiar with acid reflux because I have had the pleasure of experiencing it at times, however, I did not know much about it. Since acid reflux affects so many people, I decided to do some research and learn more about it.
Digestion begins in our mouths when we chew our food and the enzyme amylase, also present in our stomach, is released and starts to break down what we are eating. When we swallow, our food moves from our mouths down our esophagus or food pipe, which is the tube stretching from the throat to the stomach. When it reaches the stomach, it goes through a valve, known as the lower esophageal sphincter (LES) or the gastroesophageal sphincter into our stomach. The LES lets food into the stomach and is supposed to prevent the stomach contents from moving back into the esophagus. Our stomach contains hydrochloric acid, which protects us against unwanted food-borne bacteria and further digests our food before it moves along to the small intestine for further processing. The lining of the stomach produces mucus protecting itself from its strong acid content. If there is a faulty LES, which does not close tightly enough or relaxes too often, then some of the contents of the stomach, including the acid can move back up into the esophagus and sometimes into the throat and mouth. Because the esophagus does not have the same mucosal protective lining, this results in a burning feeling in the lower chest area, also known as heartburn. Acid reflux is also known as acid indigestion and pyrosis.
If one experiences acid reflux often, typically more than two times a week, the person is diagnosed with gastroesophageal reflux disease (GERD) also known as peptic ulcer disease. Ten to thirty percent of people in Western countries experience symptoms of GERD every week, including infants, children, and adults. In addition to alleviating acid reflux, it is important to manage GERD since the prolonged exposure to acid can lead to damage of the esophagus. This can result in esophagitis where the esophagus becomes inflamed and irritated resulting in bleeding and ulcers; strictures, where the esophagus tightens because of scarring resulting in trouble swallowing and food getting lodged in the esophagus; Barrett’s esophagus, where normal cells in the esophagus lining are swapped and look like ones found in the lower gastrointestinal tract, which can lead to cancer; throat and vocal cord cancer; and bleeding.
In addition to heartburn, the symptoms of acid reflux include regurgitation of a sour or bitter tasting acid in the throat or mouth, difficulty swallowing, wheezing, chest pain, the esophagus and laryngitis (voice box) becoming irritated and/or inflamed, hoarseness, a dry persistent cough, sore throat, burping, dysphagia, which is the narrowing of the esophagus making you feel you have food stuck in your throat, hiccups, nausea, weight loss, asthma if acid moves into breathing passages, dental erosion, bad breath, bloating, black stools, and bloody vomit.
There are many different causes of acid reflux, which can either relax the LES or increase its symptoms. These include the following:
- Smoking weakens the lower esophageal sphincter and increases reflux.
- Alcohol, carbonated drinks, coffee, or tea.
- Fatty and fried foods, chocolate, garlic, onions, acidic foods (citrus fruits and tomatoes), spicy foods, too much salt, too little fiber, and mint and mint flavorings.
- These foods and alcohol relax the valve, raising the chance that acid will enter the esophagus from the stomach.
- Spicy and acidic foods and coffee can increase the acid reflux symptoms.
- Eating large meals results in more acid being produced to help digest the food.
- Eating too quickly.
- Rapid weight gain and obesity.
- Not enough physical activity.
- Eating too close to bedtime or lying on your back.
- Avoid slouching. Having a good posture assists food to pass through the stomach and reduces the chances of the food and acid entering the esophagus.
- Certain medications (ask your physician).
- Pregnancy caused by baby adding pressure to organs.
- Hiatal hernia is when the upper part of the stomach protrudes into the diaphragm (muscle that divides the lungs and heart from the stomach and has a role in our breathing. The diaphragm also assists the LES to prevent the stomach acid moving into the esophagus. Continuous coughing, vomiting, or physical strain may cause a hiatal hernia. It can be fixed with physical therapy, chiropractic care, or surgery.
- H. pylori is a bacteria that has a role in small intestinal bacterial overgrowth and may also have a role in acid reflux.
- Low stomach acid prevents the proper elimination of food borne bacteria and the quick digestion of foods so they can move to the intestines.
If your doctor recommends you see a gastroenterologist, they may conduct the following tests to help figure out if you have acid reflux.
- A barium swallow also known as an esophagram is a series of X-rays that tests for ulcers and the tightening of the esophagus.
- An endoscopy allows your doctor to see what is going on in the esophagus and stomach, including looking for damage and to take a biopsy if needed.
- Esophageal manometry determines the functions of the LES and the motor function of the esophagus.
- pH testing assays the pH of the acid in your stomach.
- A biopsy can test for cancer and infections.
The first step is to make changes in one’s diet and lifestyle. This includes avoiding the trigger foods listed above, eating small meals throughout the day instead of two or three big meals, and drinking ginger tea because ginger is an alkaline root and can absorb stomach acid and allows for proper digestion. Avoiding belts and tight clothing around your stomach area and losing weight, even 5-10 pounds can make a difference. Avoiding working out, bending, or laying down after eating to help move food out of your stomach and reducing acid content. Propping the head of your bed up about 6-8 inches to allow for gravity, which can prevent heartburn while you sleep. Speaking to your physician about your medications. And, eating fermented foods like sauerkraut, cabbage juice, yogurt, probiotics and avoiding processed foods. This can both produce stomach acid if you have low stomach acid and restore and maintain a healthy gut, which can limit your chances of acid reflux.
If diet and lifestyle changes do not help, then speak to your physician about over the counter medications such as antacids and H2-blockers. Antacids neutralize the acid in your stomach and some include foaming agents preventing acid moving back into the esophagus. H2-blockers reduce acid production. There are also prescribed medications including proton pump inhibitors, which prevent the synthesis of an enzyme used to produce stomach acid. Like H2-blockers, this can be a problem for patients who are experiencing acid reflux due to less stomach acid. Therefore, they tend to be used for bleeding ulcers, extreme cases of acid reflux where the esophagus is damaged, and the rare case of Zollinger-Ellison syndrome where your stomach creates an abundance of stomach acid. There are also coating agents, which creates a protective barrier for the linings in the stomach and esophagus and promotility agents, which assists in keeping the LES tight and helps food move from the stomach into the intestines to be further digested and processed.
In severe cases and when all other options do not alleviate the acid reflux, surgery may be recommended. One option is fundoplication, where a section of the stomach is wrapped around the lower part of the esophagus to help with the closing capability of the LES. This can be done laparoscopically and is also used to heal hiatal hernias. Another option is when the LINX device made up of magenetic beads is added to the LES to tighten it.
Having acid reflux once in awhile is uncomfortable. However, when it occurs more often and it becomes gastroesophageal reflux disease then it needs to be taken seriously before the esophagus becomes damaged. Luckily, most people improve with dietary and lifestyle changes with some needing over the counter medications once in awhile. It is rare that one needs surgery.
Do you have acid reflux? How do you manage your symptoms?
2. Altmomare, A., et. al (2013) Gastroesophageal reflux disease: Update on inflammation and symptom perception. World Journal of Gastroenterology, 19(39): 6523–6528