Acid Reflux (Gastroesophageal Reflux Disease / Heartburn)
Also known as gastroesophageal reflux disease or GERD, acid reflux occurs when stomach acid (and sometimes food and liquid) backs up into your esophagus, the muscular tube that connects your throat and stomach.
What is acid reflux?
Acid reflux occurs when stomach acid (and sometimes food and liquid) backs up into your esophagus, the muscular tube that connects your throat and stomach. Normally, the lower esophageal sphincter (LES), a ringlike muscular valve located at the bottom of your esophagus, keeps acid and other substances in your stomach. With acid reflux, the sphincter malfunctions, relaxing when it shouldn’t and allowing acid to reflux (move up) into your esophagus. Because the tender lining of your esophagus doesn’t protect against stomach acid, you suffer heartburn or indigestion.
Persistent acid reflux can lead to scarring of the esophagus. Pneumonia or bronchitis may occur as stomach acid refluxes and seeps into your lungs through the trachea (windpipe), usually while you’re sleeping. Acid reflux also destroys tooth enamel when stomach acid backs up into your mouth.
Who is at risk for acid reflux?
Some people experience acid reflux because they have a hiatal hernia. In this disorder, the upper portion of the stomach moves into the chest by way of an opening in the diaphragm, the band of muscle that separates the chest and stomach. A hiatal hernia impairs the functioning of the LES, allowing acid and other stomach contents to reflux into the esophagus, causing the symptoms of acid reflux.
Treatment for acid reflux
Most people can control moderate acid reflux by avoiding foods that trigger it, making certain lifestyle modifications, and taking over-the-counter (OTC) drugs. If these steps aren’t enough, see your doctor. You may need to take a prescription drug. Severe cases may require surgery.
Medications for acid reflux
Over-the-counter (OTC) antacids neutralize stomach acid and ease an attack that’s already started. They include Maalox, Mylanta, Rolaids, and Tums. H2 blockers block the action of histamine, a chemical that encourages stomach-acid production. They can actually help prevent an attack if you take them before eating (how long before eating varies from drug to drug). H2 blockers include cimetidine, famotidine (Pepcid), nizatidine (Axid), and ranitidine (Zantac). If you find yourself taking these drugs often, see your doctor.
Prescription drugs called proton pump inhibitors, such as lansoprazole (Prevacid), omeprazole (Losec), and pantoprazole (Pantoloc), disable the cell-level pumps that move acid into the stomach. Another prescription drug, metoclopramide (Reglan), increases pressure on the LES to decrease acid reflux. Metoclopramide also helps move food out of the stomach, easing pressure.
Move things along. Exercise keeps the gastrointestinal system working normally. And gentle exercise done regularly can help ease Acid Reflux by reducing stress. But avoid exercises that involve bending over, because this can aggravate heartburn.
Stay upright. You have a greater risk of acid reflux when you lie on your back after a meal, so sit up for several hours after eating.
Wash it down. Drink plenty of water—eight 8-ounce glasses a day—to wash stomach acid down to the stomach where it belongs.
Get lean. Extra weight can make it more difficult for the LES to stay closed, contributing to acid reflux. Start a sensible diet and exercise program to shed any extra pounds.
Start grazing. Eat smaller meals more frequently—perhaps five times a day—and eat them slowly to help avoid stomach bloating and pressure. Sit down and relax at each meal.
Related procedures for acid reflux
Acid reflux is usually identified by its symptoms, but certain tests can help your doctor confirm the diagnosis or check for complications.
Barium esophagram or X ray helps your doctor see the upper part of your digestive tract. You’ll need to drink a barium solution (a chalky liquid that shows up on X rays) before this procedure so your organs can be visualized.
Endoscopy involves inserting a small, lighted, flexible tube through your mouth and into your esophagus and stomach so your doctor can check for abnormalities.
Esophageal manometry tests the pressure of your esophagus and LES, while esophageal pH confirms or rules out the presence of excess acid reflux. For both tests, a small flexible tube is inserted through your nose and into the esophagus.
In the past, if lifestyle changes and drug therapy were not effective, surgery (called fundoplication) was performed to tighten the LES muscle between the stomach and the esophagus. In this procedure, the surgeon folds and secures a portion of the stomach to establish a tighter sphincter. In a less invasive type of fundoplication the surgeon uses miniature instruments and a camera—inserted through small incisions in the abdomen—to perform the surgery.
A newer method involves electrodes on the end of the endoscope that burn the muscle that opens and closes the LES, creating scar tissue. The scar tissue either calms the nerves that make the sphincter malfunction or tightens the sphincter itself—doctors aren’t sure yet how it works. Another procedure uses a tiny stitching device—like a sewing machine—to gather up and tighten the valve. Each of these new outpatient procedures takes only about an hour, and the side effects are minor: You may feel a little pain in your stomach or chest for a few hours after the surgery.
Prevention of acid reflux
Avoid trigger foods. Stay away from alcoholic beverages, chocolate, citrus fruits and juices, caffeinated drinks, carbonated drinks, fatty and fried foods, peppermint and spearmint, spicy foods, garlic, onions, peppers, and tomatoes and tomato-based foods (tomato juice, ketchup, spaghetti sauce, chili, and pizza).
Timing is everything. Eat and drink at least three hours before going to bed, and don’t snack at bedtime.
Some over-the-counter drugs, including ibuprofen and aspirin, may lead to the burning of acid reflux. Prescription drugs that can cause heartburn include some tricyclic antidepressants, some calcium channel blockers, and some bronchodilators (such as theophylline). Ask your doctor if one of your prescription drugs might be contributing to your acid reflux.
Drinking chamomile tea between meals three to four times a day may relieve inflamed or irritated mucous membranes in your digestive tract and helps promote normal digestion. Ginger tea may also provide relief. Boil 1 1/2 teaspoons of fresh ginger (or 1/2 teaspoon of powdered ginger) in one cup of water for about 10 minutes before drinking.
Licorice protects the esophagus by boosting production of mucin, a substance that forms a protective barrier against stomach acid. Before meals, chew licorice-root tablets in deglycyrrhizinated form (which doesn’t increase blood pressure or cause water retention as licorice does).
Look for herbal relief. Mix 1/2 teaspoon of goldenseal extract with 3 tablespoons water and drink the mixture at the first sign of burning to soothe the membranes that line the gastrointestinal tract. Also, try drinking 1/2 cup aloe vera juice three times a day between meals. If indigestion is your main problem, several herbs can help, including fennel, yarrow, and barberry.
Drink cabbage juice. Visit a health food store to find cabbage juice, whose glutamine content may calm the burning of acid reflux.
Sip a baking-soda cocktail. Baking soda can help neutralize stomach acid. Mix 1 teaspoon baking soda in a glass of room-temperature water and sip at the first sign of burning pain.
One study found that chewing a stick of sugarless gum provided heartburn relief in 70 percent of participants. The chewing action stimulates the production of saliva, which helps wash stomach acid back down the esophagus.
Adapted from Looking After Your Body: An Owner's Guide to Successful Aging, Reader's Digest