Acid Reflux (GERD): symptoms, treatment, causes and more
Gastroesophageal reflux disease (GERD), commonly known as acid reflux, is a prevalent gastrointestinal disorder affecting millions of people worldwide. It occurs when stomach acid, and sometimes other stomach contents, flow back into the esophagus, causing discomfort and various symptoms. The esophagus is the tube that carries food and liquids from the mouth to the stomach. This article explores the causes, symptoms, risk factors, diagnosis, and management of GERD, providing valuable insights into understanding and addressing this condition.
Acid reflux, also referred to as heartburn, acid indigestion, or pyrosis, becomes a more concerning issue when it occurs frequently, surpassing two episodes a week.
In such cases, it is diagnosed as gastro-oesophageal reflux disease (GORD), which is a more severe condition than simple acid reflux.
What causes acid reflux?
Acid reflux occurs when the lower esophageal sphincter (LES), a ring of muscle that acts as a valve between the stomach and the esophagus, weakens or relaxes abnormally. This allows stomach acid and sometimes stomach contents to flow back up into the esophagus, leading to the symptoms associated with acid reflux. Several factors contribute to the weakening or dysfunction of the LES, causing acid reflux:
Hiatal hernia: A hiatal hernia occurs when a portion of the stomach protrudes through the diaphragm into the chest cavity. This can weaken the LES's ability to keep stomach acid from flowing back into the esophagus.
Lifestyle factors: Certain lifestyle habits can trigger or worsen acid reflux. These include smoking, consuming large meals or lying down immediately after eating, and excessive consumption of alcohol or caffeine.
Dietary triggers: Some foods and beverages are known to relax the LES or stimulate stomach acid production, leading to acid reflux. Common trigger foods include spicy, fatty, greasy, acidic, and citrus-rich foods, as well as chocolate, onions, garlic, and tomatoes.
Obesity: Excess weight and obesity can put pressure on the stomach, leading to increased pressure on the LES, which may contribute to acid reflux.
Pregnancy: Hormonal changes and pressure on the abdomen during pregnancy can promote acid reflux symptoms.
Certain medications: Some medications, such as antihistamines, calcium channel blockers, nitrates, and certain asthma medications, can relax the LES or irritate the esophagus, leading to acid reflux.
Medical conditions: Conditions such as scleroderma, a connective tissue disorder, and gastroparesis, a condition where the stomach takes longer to empty its contents, can contribute to acid reflux.
Smoking: Smoking weakens the LES and reduces saliva production, which normally helps neutralise stomach acid in the esophagus.
Delayed stomach emptying: If the stomach doesn't empty efficiently, there is an increased risk of acid reflux.
Position during sleep: Lying down or bending over after eating can increase the likelihood of acid reflux.
It's important to note that while these factors can contribute to acid reflux, not everyone will experience symptoms due to the same triggers. Individual sensitivity to certain foods or lifestyle habits varies, and identifying personal triggers can be essential for effective management. If acid reflux symptoms are persistent, seeking medical advice is recommended to identify the underlying cause and develop an appropriate treatment plan.
What makes acid flow back to the oesophagus?
Under normal circumstances, a muscular ring called the lower esophageal sphincter (LES) acts as a valve that opens to allow food and liquid into the stomach and closes to prevent stomach acid from flowing back up into the esophagus. In individuals with acid reflux, the LES weakens or relaxes abnormally, allowing stomach acid to rise up, causing a variety of symptoms.
Symptoms of acid reflux
The symptoms of acid reflux can vary in severity and may differ from person to person. The most common symptoms of acid reflux include:
Heartburn: A burning sensation or discomfort in the chest, often behind the breastbone. Heartburn can sometimes radiate to the throat, neck, or back.
Regurgitation: The sensation of stomach contents, including stomach acid, rising back into the throat or mouth. It can leave a sour or bitter taste.
Dysphagia: Difficulty swallowing or a feeling of food getting stuck in the chest or throat.
Chest pain: Chest pain related to acid reflux can be mistaken for heart-related issues. However, it typically differs from a heart attack's intense, crushing pain and is more of a burning discomfort.
Chronic cough: A persistent, dry cough that is not related to a respiratory infection but may be triggered by acid irritating the throat.
Hoarseness or sore throat: Irritation of the vocal cords due to stomach acid can lead to hoarseness or a sore throat.
Belching: Frequent belching or burping may be a symptom of acid reflux.
Excessive salivation: Some individuals may experience increased salivation, especially before or after regurgitation.
Nausea or vomiting: In severe cases, acid reflux can lead to nausea or even vomiting.
Bitter taste in mouth: The regurgitation of stomach acid can leave a persistent bitter or acidic taste in the mouth.
It's important to note that not everyone with acid reflux will experience all of these symptoms, and the severity of symptoms can vary. Some individuals may have atypical symptoms, such as respiratory issues (e.g., asthma exacerbation) or dental problems caused by acid erosion on the teeth.
If you experience frequent or persistent symptoms of acid reflux, especially more than twice a week, it's essential to consult with a healthcare professional for proper diagnosis and to discuss appropriate management strategies. Chronic acid reflux can lead to complications, so early intervention is crucial.
Treatment of acid reflux
The treatment for acid reflux aims to alleviate symptoms, reduce the frequency of reflux episodes, and prevent complications. The approach to treatment may vary based on the severity of the condition, individual factors, and response to different interventions. Here are common treatments for acid reflux:
Lifestyle modifications:
Elevate the head of the bed: Raising the head of the bed by 6 to 8 inches can help gravity keep stomach acid from flowing back into the esophagus during sleep.
Avoid trigger foods: Identify and avoid foods and beverages that trigger or worsen acid reflux symptoms, such as spicy, fatty, greasy, acidic, and citrus-rich foods, as well as chocolate, onions, garlic, and tomatoes.
Eat smaller meals: Consuming smaller, more frequent meals can help reduce the pressure on the stomach and lower the likelihood of reflux.
Avoid lying down after meals: Stay upright for at least two to three hours after eating to prevent acid from flowing back into the esophagus.
Quit smoking: Smoking weakens the lower esophageal sphincter and increases acid production.
Over-the-counter (OTC) medications:
Antacids: OTC antacids, such as calcium carbonate, magnesium hydroxide, or aluminum hydroxide, can help neutralise stomach acid and provide quick relief from heartburn.
H2 blockers: Histamine-2 receptor antagonists, such as ranitidine or famotidine, reduce stomach acid production, offering longer-lasting relief from acid reflux symptoms.
Prescription medications:
Proton pump inhibitors (PPIs): Stronger acid-suppressing medications like omeprazole, esomeprazole, lansoprazole, or pantoprazole can reduce stomach acid production more effectively than H2 blockers. PPIs are often prescribed for more severe or persistent GERD cases.
Prokinetics: These medications help improve stomach emptying, reducing the likelihood of reflux.
Surgery:
Fundoplication: In some cases, surgical intervention may be recommended if lifestyle changes and medications do not effectively control acid reflux. Fundoplication involves wrapping the upper part of the stomach around the LES to strengthen it and prevent acid reflux.
Endoscopic treatments:
Stretta procedure: Radio-frequency energy is used to strengthen the LES and reduce reflux episodes.
LINX device: A small, flexible ring of magnetic beads is placed around the LES to help it stay closed, preventing acid reflux.
Dietary management:
For individuals with severe GERD, a dietitian can provide personalised dietary recommendations to manage symptoms effectively.
It is crucial to work with a healthcare professional to determine the most appropriate treatment plan for individual cases of acid reflux. Long-term or chronic acid reflux should be evaluated by a doctor to prevent potential complications such as esophagitis, Barrett's esophagus, or dental issues. Lifestyle changes, medications, and, in some cases, surgical options can significantly improve the quality of life for individuals with acid reflux.
Frequently Asked Questions
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Reducing acid reflux at night can be achieved by making certain lifestyle modifications and adopting sleep position changes that help minimise the risk of stomach acid flowing back into the esophagus. Here are some strategies to reduce acid reflux at night:
Elevate the head of the bed: Elevating the head of the bed by 6 to 8 inches can help gravity keep stomach acid down in the stomach and reduce the likelihood of reflux during sleep. This can be accomplished by placing blocks or risers under the bed's legs or using a wedge-shaped pillow to prop up the upper body.
Avoid eating late at night: Try to finish eating meals at least 2 to 3 hours before bedtime. This allows the stomach enough time to digest the food, reducing the amount of stomach acid present when lying down.
Avoid trigger foods: Identify foods that trigger or worsen your acid reflux symptoms and avoid consuming them, especially in the evening. Common trigger foods include spicy, fatty, greasy, acidic, and citrus-rich foods, as well as chocolate, onions, garlic, and tomatoes.
Limit alcohol and caffeine: Avoid consuming alcohol and caffeinated beverages close to bedtime, as they can relax the lower esophageal sphincter (LES) and increase the likelihood of acid reflux.
Maintain a healthy weight: If you are overweight or obese, losing weight can reduce pressure on the stomach, helping to prevent acid reflux.
Sleep on your left side: Sleeping on your left side can help reduce acid reflux at night. This position keeps the stomach lower than the esophagus, making it more difficult for stomach acid to flow back up.
Wear loose-fitting clothing: Tight clothing around the abdomen can put pressure on the stomach, leading to acid reflux. Wear loose-fitting sleepwear to avoid this pressure.
Avoid smoking: Smoking can weaken the LES and increase acid production, making acid reflux worse. If you smoke, quitting can help reduce symptoms.
Use extra pillows: If elevating the entire head of the bed is not possible, you can use extra pillows to elevate your upper body slightly. However, a wedge-shaped pillow or elevating the bed is more effective.
Stay upright after meals: Avoid lying down or bending over immediately after eating. Instead, stay upright for at least two to three hours after meals to aid digestion and prevent acid reflux.
Remember that individual responses to these strategies may vary, and it's essential to find the most effective combination for your specific situation. If you experience persistent acid reflux at night despite lifestyle modifications, consult a healthcare professional for further evaluation and personalised advice.
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If you experience acid reflux or gastroesophageal reflux disease (GERD), certain foods can trigger or exacerbate symptoms. Avoiding these trigger foods can help reduce the likelihood of acid reflux episodes. Keep in mind that individual tolerance to specific foods may vary, so it's essential to identify your personal triggers. Here are some common foods to avoid for acid reflux:
Spicy foods: Spices, such as chili pepper, black pepper, and hot sauce, can irritate the esophagus and contribute to acid reflux.
Fatty and fried foods: High-fat foods, including fried foods, fatty meats, and full-fat dairy products, can slow down stomach emptying and increase the risk of reflux.
Citrus fruits: Oranges, lemons, grapefruits, and other citrus fruits are highly acidic and can irritate the esophagus.
Tomatoes and tomato-based products: Tomatoes are acidic and can trigger reflux. This includes tomato sauces, tomato paste, and ketchup.
Onions and garlic: These pungent vegetables can weaken the lower esophageal sphincter (LES) and promote acid reflux.
Chocolate: Chocolate contains substances that can relax the LES and increase the risk of acid reflux.
Mint: Peppermint, spearmint, and other minty foods or candies can relax the LES and worsen reflux symptoms.
Carbonated beverages: Soda, carbonated water, and other fizzy drinks can increase stomach pressure and trigger acid reflux.
Caffeinated beverages: Coffee, tea, and other caffeinated beverages can relax the LES and stimulate stomach acid production.
Alcohol: Alcoholic beverages can weaken the LES and increase stomach acid production, leading to acid reflux.
Highly acidic foods: Other highly acidic foods, such as vinegar, pickles, and certain fruit juices, should be consumed in moderation or avoided.
Peppery and spiced foods: Foods with added spices, like black pepper or chili powder, can irritate the esophagus.
Processed and high-sodium foods: Processed foods and those high in salt can contribute to acid reflux symptoms.
High-fat desserts: Desserts like ice cream and high-fat pastries can lead to increased stomach pressure and reflux.
Remember that maintaining a food diary can help you track which foods trigger your acid reflux symptoms. Avoiding trigger foods and adopting a balanced diet with a focus on whole grains, lean proteins, fruits, vegetables, and low-fat dairy products can support overall digestive health and reduce the likelihood of acid reflux episodes. Additionally, eating smaller, more frequent meals and staying upright after eating can further aid in managing acid reflux. If you have persistent or severe symptoms, consult a healthcare professional for personalised advice and treatment.
GERD is a prevalent and often uncomfortable gastrointestinal disorder caused by the backward flow of stomach acid into the esophagus. Understanding the factors contributing to GERD, recognising its symptoms, and adopting appropriate lifestyle changes and treatments can effectively manage the condition and improve the quality of life for individuals affected by GERD. Early diagnosis and appropriate management are essential to prevent complications and ensure long-term well-being. If you suspect you may have GERD, it is crucial to seek medical advice and guidance for an accurate diagnosis and personalised treatment plan.