The American College of Gastroenterology estimates that over 60 million Americans experience heartburn at least once a month, and at least 15 million experience it daily. If you fall into the group that experience heartburn daily, you might be suffering from acid reflux.
What is Acid Reflux?
Gastroesophageal reflux disease, or GERD, is one of the most common causes of gastric discomfort. Also commonly referred to as acid reflux, GERD occurs when stomach acid flows from the stomach into the back of the esophagus. When the acid from your stomach touches your esophagus, it can cause a burning sensation in your neck or chest. This feeling is the all too familiar phenomenon of heartburn.
Acid reflux isn’t a major health concern if you experience it every so often. But, if you experience intense acid reflux symptoms regularly, you might have GERD. While GERD is not life-threatening, it can seriously impact your day to day activities and reduce your quality of life.
Although heartburn is the most common symptom of acid reflux, other symptoms include:
Persistent sore throat or cough
Hoarseness
Chest pain
Asthma
Pain when swallowing
Nausea
Burping
Throwing up
Feeling like food is coming back up into your mouth and may taste bitter
Feeling like food is sticking to your throat as you try to swallow
Bad breath
Dental erosion
Causes of Acid Reflux
There are many causes a person may be experiencing acid reflux.
Muscle Weakness
Acid reflux can occur when the lower esophageal sphincter, which is located in between your stomach and esophagus, doesn’t function properly. It’s supposed to close completely after food enters your stomach and stay closed when you’re not ingesting food. If the muscle isn’t working as it’s intended to, you can end up with the contents of your stomach coming back up the esophagus, resulting in reflux.
Some of the reasons a person might have a weak lower esophageal sphincter include:
Being overweight
Pregnancy
Smoking
Alcohol intake
Natural aging
Simple lifestyle changes such as weight loss, stopping smoking or drinking, wearing loose fitting clothing, improving posture, and avoiding pressure across your abdomen (tight belts, or sit-ups) can help mitigate acid reflux in some instances.
Foods That Cause Acid Reflux
There are certain foods that can worsen the effects of acid reflux. Eliminating or cutting back on some of the following might even relieve your heartburn immediately:
Acidic foods such as tomato-based products and citrus fruits
Spicy foods
Foods high in fat
Alcohol
Caffeine
Chocolate (that one makes us sad too)
The best way to leverage diet to reduce acid reflux is to avoid the foods listed above, eat small meals more frequently, eat a diet high in dietary fiber and low in salt, and avoid eating at least 3 hours before bedtime. Take advantage of gravity and try not to lay down after eating as it makes it easier for stomach acid to come up.
A recent study even suggests that dietary changes such as these may be as effective as proton pump inhibitors (PPIs) in treating and relieving the symptoms of acid reflux.
Hiatal Hernia
Another potential cause of acid reflux is a hiatal hernia. This is the bulging of the stomach through a hole in the diaphragm that’s actually intended for the lower esophageal sphincter. A hiatal hernia becomes more common with age and obesity.
Acid Reflux Medications
If changing your diet doesn’t relieve your acid reflux symptoms, you may need to supplement with medication. Taking over the counter antacids like Tums can help neutralize the acid making it less irritating in the esophagus. If you only experience occasional heartburn, maybe after eating something particularly spicy or acidic, over the counter antacids are a viable solution. However, if you’re experiencing acid reflux more regularly, they will only offer you temporary relief.
If the Tums just aren’t cutting it, it might be time to talk to your gastroenterologist about proton pump inhibitors (PPIs). PPIs actually reduce the amount of acid your stomach produces. You can buy small doses of PPIs without a prescription, but if you are suffering from severe acid reflux, your gastroenterologist will probably prescribe you a higher dose to take on a regular schedule. While it’s important to follow your doctor’s instructions, proton pump inhibitors typically work best when taken daily. Your doctor will likely recommend you take a pill about 30 minutes prior to eating breakfast in the morning.
Interactions and Side Effects
Antacids
Of course, with any medication, there is the possibility for side effects. Antacids either contain calcium which can cause constipation, or magnesium which can cause diarrhea. Look for antacids that contain both calcium and magnesium to prevent other kinds of digestive discomfort.
PPIs
Most people who take proton pump inhibitors experience little to no side effects. However, some people do experience headaches, nausea, constipation, or diarrhea.
It’s not recommended to take antacids and PPIs at the same time. Antacids can prevent PPI medications from being absorbed properly. If you feel that you absolutely need to take both antacids and another medication, space them out.
If you are talking to your gastroenterologist about starting a PPI, you must tell them if you are taking warfarin, a blood thinner, or phenytoin, for epilepsy as PPIs can negatively interfere with both of these medications.
If PPIs Aren’t Working
In general, PPIs are a good solution to lessening stomach acid and allowing the esophagus to heal. If the PPIs prescribed by your gastroenterologist aren’t working, they may opt to prescribe you prokinetics. Prokinetics encourage your stomach to empty its contents more quickly lessening the chances of the stomach acids backing up into the esophagus.
Surgery to repair the lower esophagus sphincter may be necessary in extreme cases.
Risks of Untreated Acid Reflux
If left untreated, acid reflux can cause long-term complications and damage to the esophagus leading to:
Esophagitis: inflammation of the esophagus lining which causes irritation, bleeding, and in some cases, ulceration.
Strictures: prolonged exposure to stomach acid can cause scarring in the esophagus making it difficult to swallow and causes food to get stuck in the esophagus when you swallow.
Barrett’s esophagus: repeated exposure to stomach acid can cause the cells and tissues lining the esophagus to change and potentially develop into cancer cells.