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Acid Reflux Disease GERD Symptoms Causes Treatment Preventions

Acid reflux disease is called heartburn in laymen. The condition causes burning pain in the lower mid-chest area. The underlying cause of heartburn or acid reflux is the backflow of stomach contents into the esophagus (the lower part of the food pipe). The pain most often starts after consuming a meal. Acid reflux is also known as Gastroesophageal reflux disease (GERD) or pyrosis when referred clinically. Experiencing heartburn at least twice a week merits the diagnosis of GERD.

Acid reflux is a common complaint. The sedentary lifestyles and the unhealthy eating habits, food, and lifestyle choices contribute to the condition.

As per the American College of Gastroenterology, more than 60 million U.S. adults experience heartburn once a month.

Heartburn is manageable and treatable. However, overlooking the condition can result in serious complications over extended periods.

Acid Reflux Disease Symptoms Causes Treatment Preventions

Causes of Acid Reflux Disease GERD

Contrary to the name, heartburn and heart are not related. Since the pain is felt in the chest area close to the heart, it is named so.

In heartburn, the acidic content of the stomach regurgitates or spews up into the esophagus. The stomach content is highly acidic because of the presence of hydrochloric acid. Hydrochloric acid is a strong chemical that is involved in the digestive process of food. It also helps to combat any bacterial influx which may accidentally follow the food intake.

The hydrochloric acid of the gastric juice does not damage the stomach. This is because the stomach lining is designed to protect it from acidic action. However, the protective lining only lines the stomach and does not extend into the esophagus.

The esophagus has its safeguard against gastric juice, though. This is in the form of a muscular ring-like sphincter present at the junction of the esophagus and stomach. It is called the gastroesophageal sphincter that functions to prevent the backflow of stomach contents into the esophagus.

As we swallow, this band relaxes to allow the passage of food into the stomach. After the passage of food, the sphincter closes. This mechanism helps prevent the backflow of stomach contents into the esophagus.

However, some factors may cause the sphincter to lose its functional capacity. Failure of the gastroesophageal sphincter allows spilling back of the acidic stomach content, which exhibits itself as heartburn or acid reflux.

Some of the conditions that predispose to abnormal relaxing of the sphincter or weak functioning include;

  • Connective tissue disorders (scleroderma)
  • Conditions that delay stomach emptying
  • Any condition that increases the abdominal pressure; obesity, pregnancy, etc.
  • Eating late at night  
  • Consuming large meals
  • Consuming certain foods or drinks that act as triggers
  • Taking some medications

Symptoms of Acid Reflux Disease GERD

Acid reflux is associated with burning pain in the lower chest area. It may happen as a single episode or as recurrent episodes of GERD.

Heartburn is an intense pain that is uncomfortable enough to be confused with heart pain. Felt behind the central chest bone, the sternum, the burning sensation worsens on movements like bending or lying down.

The pain of acid reflux is typically worse after consuming a meal. It may last for some minutes to several hours.

The heartburn of acid reflux may be severe enough to move up and be felt in the throat. Sometimes, the throat receives the backlash of acid flow, and you may feel a regurg or a sore and bitter taste in the mouth.

Frequent episodes of heartburn, occurring at least twice a week, are labeled as GERD.

Some other occasional signs and symptoms that may accompany heartburn include;

  • A feeling as if a lump is sitting in the throat
  • Regurgitation of bitter-tasting fluid into the throat
  • Heartburn that worsens at night
  • nausea
  • vomiting
  • sore throat issues
  • hoarseness of voice
  • inflammation of the larynx
  • throat pain while swallowing
  • upper abdominal pain
  • dry and persistent cough
  • wheezing
  • disturbed sleep
  • asthma and recurrent episodes of lung infection as pneumonia
  • dental erosion due to stomach acids reaching the mouth
  • bad breath

Complications

Acid reflux may start as benign heartburn that may occur occasionally. Yet, it tends to complicate and involve other organs of the GIT and the neighboring lung and larynx. If overlooked for a long time, the symptoms can further deteriorate the stomach wall and may even cause cancer.

Some of the complications of untreated acid reflux include;

  • Esophagitis or the inflammation of the esophageal lining may become severe enough to cause bleeding and ulceration. It increases the risk of cancer.
  • Strictures due to persistent damage and scar formation result in difficulty in swallowing or food getting stuck in the esophagus.
  • Esophageal sores or ulcers
  • Barrett's esophagus is a serious complication with precancerous changes arising from repeated exposure to stomach acid. The changes in the cells lining the esophagus develop the potential to turn cancerous.

Risk factors for Acid Reflux

Acid reflux affects people of all ages. Though lifestyle factors play a huge role in GERD, other factors predispose a person to suffer from acid reflux. These include;

  • Hiatal or hiatus hernia (A hole in the muscular diaphragm in the chest through which the stomach may enter the chest cavity)
  • Weight gain and obesity
  • Smoking
  • Lack of exercise
  • A side effect of some medications (anti-asthmatic drugs, calcium-channel blockers, antihistamines, painkillers, sedatives, and antidepressants)
  • Increased abdominal pressure in pregnancy
  • Excess intake of caffeine-containing drinks
  • Excess alcohol intake
  • Intake of foods high in salt
  • A low fiber diet
  • Consuming large meals
  • Immediately lying down after meal consumption
  • Consuming other foods like chocolate, carbonated drinks, and acidic juices

Diagnosis of heartburn

The diagnosis of acid reflux is based on the history of the presenting complaints and detailed physical examination.

Acid reflux and heartburn are relatively easy to diagnose in most cases. However, occasionally the condition may be confused with other diseases related to the chest organs. These include;

  • heart attack
  • pneumonia
  • pain in the chest wall
  • pulmonary embolus

The confirmation of GERD or acid reflux and the extent of damage to the esophageal mucosa is carried out by different tests.

  • Endoscopy

Endoscopy identifies any mucosal damage to the esophagus and allows for collecting a tissue sample to rule out a condition called Barrett's esophagus.

  • Ambulatory acid (pH) probe test

A monitor is placed in your esophagus to investigate the frequency and extent of reflux into the esophagus.

  • Esophageal manometry

It is the measure of rhythmic muscle contractions that occur with swallowing in the esophagus.  

  • X-rays with a barium meal

X-rays are taken with a liquid that shows the lining of the digestive tract. The x-ray shows any damage in the esophagus, stomach, and the upper part of the intestine.

Treatment of Acid Reflux Disease GERD

The treatment is started with lifestyle modifications and over-the-counter medications. Prescription medicine follows in case the signs and symptoms are not relieved within a few weeks. Surgery is undertaken in resistant cases. 

  1. Over-the-counter medications

There are different options available that provide quick relief to heartburn.

  • Acid-neutralizing medications

The drugs that neutralize the stomach acid are the primary agents suggested for managing mild symptoms. These include brands like Mylanta, Rolaids, and Tums. These are readily available and bring quick relief.

Though antacids are effective at providing relief, they do not aid the healing of the damaged mucosa. They have their share of side effects as well as diarrhea or kidney complications.

  • Acid-reducing medications

These medications are also known as H-2-receptor blockers. These include names like cimetidine, famotidine, and nizatidine.

This class of drugs does not bring quick relief. However, when they do, the effects last longer, decreasing the acid production from the stomach for up to twelve hours at a time.

  • Acid-blocking medications

These medications, also known as proton pump inhibitors, are potent and bring relief by completely blocking stomach acid production. They are more effective than H-2 receptor blockers as they allow a healing time for any damaged esophageal or stomach mucosa. Some of the examples of OTC proton pump inhibitors include lansoprazole and omeprazole.

  • Prescription medications

Prescription medicines are more potent than the OTC brands for treating acid reflux and GERD. The options of drugs in this category include;

  • Prescription-strength H-2-receptor blockers

The prescription-strength drugs in this class include famotidine and nizatidine. These medicines have good patient compliance, but they may cause weak bones and vitamin B12 deficiency with extended use.

  • Prescription-strength proton pump inhibitors

These are high strength proton pump inhibitors and include names like esomeprazole, lansoprazole, omeprazole, pantoprazole, rabeprazole, and dexlansoprazole.

These medicines are also well-tolerated but may cause side effects like nausea, diarrhea, headache, and vitamin B-12 deficiency. Long-standing use is linked to a high risk of hip fractures.

  • Lower esophageal sphincter strengthening medications

Baclofen is a dug that cuts back on the frequency of relaxation of the lower esophageal sphincter. This decreases the episodes of acid reflux.

  • Surgery and other procedures

Resistant cases of GERD are addressed with surgical intervention. Since the medications for managing GERD symptoms are associated with side effects, especially with long-term use, surgery may be a better option in some cases.

The following procedures are suggested according to the specifics of each case. Your doctor can advise you better on which one may help you as a lasting solution.

  • Fundoplication; the top part of the stomach is joined with around the lower esophageal sphincter. This tightens the sphincter and prevents reflux.  It is a minimally invasive procedure done via a laparoscope.
  • LINX device; a ring comprising tiny magnetic beads is wrapped at the site where the esophagus and stomach meet. The magnetic ring caters to enough closure to prevent reflux while remaining compliable to the passage of food. This is also a minimally invasive surgery.
  • Trans-oral incisionless fundoplication (TIF); is a newer procedure where the lower esophageal sphincter is tightened by partially wrapping the lower esophagus with polypropylene fasteners. The procedure is done via endoscopy with a quick recovery time and high patient compliance.

Hiatal hernia is usually required repair via intensive surgery.  

  • Lifestyle and home remedies

Lifestyle changes are part-n-parcel of the management of acid reflux symptoms. They are suggested as part of the medication or surgical regime.  

  • Maintain a healthy weight to prevent Acid Reflux Disease GERD

The patient with acid reflux is advised to lose weight if obese and maintain healthy figures on the weighing scale. The excess fat around the belly and waist puts pressure on the stomach and esophagus, increasing the chances of acid reflux.

  • Stop smoking to prevent Acid Reflux Disease GERD

Smoking is observed to decrease the functional efficacy of the lower esophageal sphincter. So quitting or limiting smoking is advised for patients with acid reflux.

  • Raise the head side of the bed

If acid reflux is a common occurrence while sleeping, then elevating the head-end side of the bed or propping up on pillows might help. It is seen that the latter is not a good strategy to address the reflux. Raising the head end of the bed is a more appropriate measure.

  • Avoid lying down after a meal to prevent Acid Reflux Disease GERD

Take your last meal at least two to three hours before sleeping. This should give ample time for the food to pass down into the intestine and out of the stomach.

  • Eat food slowly

Eating food slowly and chewing the food properly is a remedy that helps many complaints associated with digestion. The same is true for GERD.

  • Avoid trigger foods and drinks

Some foods that commonly trigger acid reflux include fatty or fried foods, tomato sauce, alcohol, chocolate, garlic, onion, and caffeine.

  • Wear comfortable clothing

Try to avoid clothes that sit tight against the waist. Such clothing can put pressure on the esophageal sphincter and worsen the symptoms.

  • Improve posture by sitting up straight

Posture is an important factor that keeps smooth food passage and fair functioning of the lower esophageal sphincter. If you have a desk job, make sure your posture is correct. Avoid sitting for extended periods.

  • Alternative medicine

Alternative medicine therapies are not proven to treat or reverse the symptoms of GERD. However, they are best at providing symptomatic relief to the condition. Always consult with your doctor before adopting any such therapy.

  • Licorice
  • Chamomile
  • Relaxation techniques
Abdur Rashid
Medically Reviewed By Abdur Rashid
MSC Public Health, MCSP, MHCPC
BSC (Hon) Physiotherapy
Consultant Neuro-spinal & Musculoskeletal Physiotherapist

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