Acid reflux is a very common digestive illness. Many patients have questions about symptoms, causes and treatment. I read a very nicely written article on acid reflux from the American College of Gastroenterology and here is an edited version of that for your information.
More than 60 million Americans experience heartburn at least once a month and some studies have suggested that more than 15 million Americans experience heartburn symptoms each day.
Gastroesophageal reflux (or GERD) is a physical condition in which acid from the stomach flows backward up into the esophagus. People will experience heartburn symptoms when excessive amounts of acid reflux into the esophagus. Many describe heartburn as a feeling of burning discomfort, localized behind the breastbone, that moves up toward the neck and throat. Some even experience the bitter or sour taste of the acid in the back of the throat. The burning and pressure symptoms of heartburn can last for several hours and often worsen after eating food.
Normally, a muscular valve at the lower end of the esophagus called the lower esophageal sphincter or “LES” — keeps the acid in the stomach and out of the esophagus. In gastroesophageal reflux disease or GERD, the LES relaxes too frequently, which allows stomach acid to reflux, or flow backward into the esophagus.
Treatment of Occasional Heartburn
In many cases, doctors find that infrequent heartburn can be controlled by lifestyle modifications and proper use of over-the-counter medicines.
- Avoid foods and beverages that contribute to heartburn: chocolate, coffee, peppermint, greasy or spicy foods, tomato products and alcoholic beverages.
- Stop smoking. Tobacco inhibits saliva, which is the body’s major buffer. Tobacco may also stimulate stomach acid production and relax the muscle between the esophagus and the stomach, permitting acid reflux to occur.
- Reduce weight if too heavy.
- Do not eat 2-3 hours before sleep.
- For infrequent episodes of heartburn, take an over-the-counter antacid or an H2 blocker, some of which are now available without a prescription.
Over the counter Medications
Over-the-counter medications have a significant role in providing relief from heartburn and other occasional GI discomforts. More frequent episodes of heartburn or acid indigestion may be a symptom of a more serious condition that could worsen if not treated. If you are using an over-the-counter product more than twice a week, you should consult a physician who can confirm a specific diagnosis and develop a treatment plan with you, including the use of stronger medicines that are only available with a prescription.
Treatment of GERD
When symptoms of heartburn are not controlled with modifications in lifestyle, and over-the-counter medicines are needed two or more times a week, or symptoms remain unresolved on the medication you are taking, you should see your doctor. You may have GERD.
When GERD is not treated, serious complications can occur, such as severe chest pain that can mimic a heart attack, esophageal stricture (a narrowing or obstruction of the esophagus), bleeding, or a pre-malignant change in the lining of the esophagus called Barrett’s esophagus. A 1999 study reported in the New England Journal of Medicine showed that patients with chronic, untreated heartburn of many years duration were at substantially greater risk of developing esophageal cancer, which is one of the fastest growing, and among the more lethal forms of cancer in this country.
Symptoms suggesting that serious damage may have already occurred include:
- Dysphagia: difficulty swallowing or a feeling that food is trapped behind the breast bone.
- Bleeding: vomiting blood, or having tarry, black bowel movements.
- Choking: sensation of acid refluxed into the windpipe causing shortness of breath, coughing, or hoarseness of the voice.
- Weight Loss
GERD is a problem that is symptomatic by day but in which much damage is done by night. Treatment should be designed to: 1) eliminate symptoms; 2) heal esophagitis; and 3) prevent the relapse of esophagitis or development of complications in patients with esophagitis.
In many patients, GERD is a chronic, relapsing disease. Long-term maintenance is the key to therapy; therefore, continuous long-term therapy, possibly life-long therapy, to control symptoms and prevent complications is appropriate. Maintenance therapy will vary in individuals ranging from mere lifestyle modifications to prescription medication as treatment.
In order to decrease the amount of gastric contents that reach the lower esophagus, certain simple guidelines should be followed:
- Raise the Head of the Bed. The simplest method is to use a 4″ x 4″ piece of wood to which two jar caps have been nailed an appropriate distance apart to receive the legs or casters at the upper end of the bed. Failure to use the jar caps inevitably results in the patient being jolted from sleep as the upper end of the bed rolls off the 4″ x 4″. Alternatively, one may use an under-mattress foam wedge to elevate the head about 6-10 inches. Pillows are not an effective alternative for elevating the head in preventing reflux.
- Change Eating and Sleeping Habits. Avoid lying down for two hours after eating. Do not eat for at least two hours before bedtime. This decreases the amount of stomach acid available for reflux.
- Avoid Tight Clothing. Reduce your weight if obesity contributes to the problem.
- Change Your Diet. Avoid foods and medications that lower LES tone (fats and chocolate) and foods that may irritate the damaged lining of the esophagus (citrus juice, tomato juice, and probably pepper).
- Curtail Habits That Contribute to GERD. Both smoking and the use of alcoholic beverages lower LES pressure, which contributes to acid reflux.
Medical treatment of GERD
GERD has a physical cause, and frequently is not curtailed by these lifestyle factors alone. If you are using over-the-counter medications two or more times a week, or are still having symptoms on the prescription or other medicines you are taking, you need to see your doctor. If results are not forthcoming, medications may be used to neutralize acid, increase LES tone, or improve gastric emptying.
Surgical treatment of GERD
Surgical measures to prevent reflux can be considered if other measures fail or complications occur such as bleeding, recurrent stricture, or metaplasia (abnormal transformation of cells lining the esophagus), which is progressive. The surgical technique improves the natural barrier between the stomach and the esophagus that prevents acid reflux from occurring. Consultation with both a gastroenterologist and a surgeon is recommended prior to such a decision.
Your doctor or gastroenterologist may wish to evaluate your symptoms with additional tests when it is unclear whether your symptoms are caused by acid reflux, or if you suffer from complications of GERD such as dysphagia (difficulty in swallowing), bleeding, choking, or if your symptoms fail to improve with prescription medications. Your doctor may decide to conduct one or more of the following tests.
For the upper GI series, you will be asked to swallow a liquid barium mixture (sometimes called a “barium meal”). The radiologist uses a fluoroscope to watch the barium as it travels down your esophagus and into the stomach.
This test involves passing a small lighted flexible tube through the mouth into the esophagus and stomach to examine for abnormalities. The test is usually performed with the aid of sedatives. It is the best test to identify esophagitis and Barrett’s esophagus.
Esophageal Manometry or 24 hour pH testing
This test involves passing a small flexible tube through the nose into the esophagus and stomach in order to measure pressures and function of the esophagus. Also, the degree of acid refluxed into the esophagus can be measured over 24 hours.
Measure Yourself on the Richter Scale/Acid Test
How significant is your heartburn? What are the chances that it is something more serious? Here is a simple self-test developed by a panel of experts from the American College of Gastroenterology.
Take this “Richter Scale/Acid Test” to see if you’re a GERD sufferer and are taking the right steps to treat it.
- Do you frequently have one or more of the following:
- an uncomfortable feeling behind the breastbone that seems to be moving upward from the stomach?
- a burning sensation in the back of your throat?
- a bitter acid taste in your mouth?
- Do you often experience these problems after meals?
- Do you experience heartburn or acid indigestion two or more times per week?
- Do you find that antacids only provide temporary relief from your symptoms?
- Are you taking prescription medication to treat heartburn, but still having symptoms?
If you said yes to two or more of the above, you may have GERD. To know for sure, see your doctor or a gastrointestinal specialist. They can help you live pain free.
The above information was accessed and edited from the article on “Acid Reflux” in the Patient Education & Resource Center at the American College of Gastroenterology.