Acid reflux happens when the muscle at the bottom of the esophagus (tube that carries food to the stomach from the mouth), called the esophageal sphincter (LES), does not close properly and stomach acid leaks back into the esophagus. This can cause a burning sensation in the chest area. Acid reflux is caused by a number of things, including certain foods like citrus foods and onions, alcohol, and conditions like pregnancy and being overweight.
When you develop acid reflux, your esophageal sphincter relaxes between swallows, allowing stomach acid to flow into your esophagus. Your stomach creates hydrochloric acid to digest the food you eat. The lining of your stomach produces mucous to protect it against corrosion, but your esophagus does not. When reflux occurs, digestive acid from your stomach irritates the lining of your esophagus.
Complications can occur including scarring of the esophagus (strictures) and Barrett’s esophagus (see link), dysplasia and esophageal adenocarcinoma.
What Are the Symptoms?
Although not everybody who develops acid reflux experiences heartburn, it is the most common symptom. Heartburn is a burning pain in the center of your chest. It often begins in your upper abdomen and then spreads upward to your neck. It can last up to two hours and is usually worse after you eat.
Other symptoms include:
- Regurgitation
- A bitter taste in your mouth
- A persistent cough
- Hoarseness especially in the morning
- Wheezing
- Shortness of breath
What Causes Reflux?
The cause of acid reflux is unknown. There are several factors that can increase your risk, including:
- Lifestyle factors, such as cigarette smoking, alcohol use, obesity
- Medications, such as calcium channel blockers, theophylline, nitrates and antihistamines
- A diet high in fatty and fried foods, chocolate, garlic and onions, caffeinated drinks, acidic foods, such as citrus fruits and spicy foods
- Eating large meals or eating just before bedtime
- Having a hiatal hernia, which displaces the LES and moves it into the chest
- Being pregnant
- Having diabetes
- Rapidly gaining weight
What Are the Treatment Options?
Your primary care provider or pediatrician will often refer you to an ENT (ear, nose, and throat) specialist, or otolaryngologist, for evaluation, diagnosis, and treatment if you are having related symptoms.
Different types of acid reflux are usually suspected based on symptoms, and can be further evaluated with tests such as an endoscopic examination (a tube with a camera inserted through the nose), biopsy, special X-ray exams, a 24-hour test that checks the flow and acidity of liquid from your stomach into your esophagus, esophageal motility testing (manometry) that measures muscle contractions in your esophagus when you swallow, and emptying of the stomach studies. Some of these tests can be performed in an office.
Options for treatment include lifestyle and dietary modifications (see below), medications, and rarely surgery. Medications that can be prescribed include antacids, ulcer medications, proton pump inhibitors, and foam barrier medications. To be effective, these medications are usually prescribed for at least one month, and may be tapered off later after symptoms are controlled. For some patients, it can take two to three months of taking medication(s) to see effects.
Children and adults who do not improve with medical treatment may require surgical intervention. Surgical treatment includes “fundoplication,” a procedure that tightens the lower esophageal muscle gateway (lower esophageal sphincter, or LES). Newer techniques allow this to be done in an endoscopic or minimally invasive manner. Another surgical option uses magnetic beads to tighten the LES.
What Changes Can I Make to Prevent Reflux?
For adults, you can take certain steps to reduce or prevent occurrences of reflux, including:
- Lose weight.
- Cut down or stop smoking tobacco products.
- Limit or avoid alcohol.
- Wear clothing that is looser around the waist.
- Eat three to four small meals a day, instead of two to three large ones, and eat slowly.
- Avoid eating and drinking within two to three hours of bedtime.
- Limit problem foods, such as caffeine, carbonated drinks, chocolate, peppermint, tomatoes, citrus fruits, fatty and fried foods, and/or spicy foods.