About Acid Reflux

Gastroesophageal reflux disease (GERD) is a condition in which the esophagus becomes irritated or inflamed because of acid backing up from the stomach. The esophagus or food pipe is the tube stretching from the throat to the stomach. When food is swallowed, it travels down the esophagus.

The stomach produces hydrochloric acid after a meal to aid in the digestion of food.

•The inner lining of the stomach resists corrosion by this acid. The cells that line the stomach secrete large amounts of protective mucus.

•The lining of the esophagus does not share these resistant features and stomach acid can damage it.

•The esophagus lies just behind the heart, so the term heartburn was coined to describe the sensation of acid burning the esophagus.

Normally, a ring of muscle at the bottom of the esophagus, called the lower esophageal sphincter, prevents reflux (or backing up) of acid.

•This sphincter relaxes during swallowing to allow food to pass. It then tightens to prevent flow in the opposite direction.

•With GERD, however, the sphincter relaxes between swallows, allowing stomach contents and corrosive acid to well up and damage the lining of the esophagus.

GERD affects 25% to 40% of the adult population of the United States to some degree at some point. About 10% of adults experience GERD weekly or daily. Not just adults are affected; even infants and children can have GERD.

 

Acid Reflux (GERD) Causes

No one knows the exact cause of gastroesophageal reflux. The following are contributing factors that weaken or relax the lower esophageal sphincter, making reflux worse:

•Lifestyle: Use of alcohol or cigarettes, obesity, poor posture (slouching)

•Medications: Calcium channel blockers, theophylline (Tedral, Hydrophed, Marax, Bronchial, Quibron), nitrates, antihistamines

• Diet: Fatty and fried foods, chocolate, garlic and onions, drinks with caffeine, acid foods such as citrus fruits and tomatoes, spicy foods, mint flavorings

• Eating habits: Eating large meals, eating quickly or soon before bedtime

• Other medical conditions:  Hiatal hernia, pregnancy, diabetes, rapid weight gain

Hiatal hernia is a condition when the upper part of the stomach protrudes up above the diaphragm (the strong muscle that separates the organs of the chest from those of the abdomen).

•Normally, the diaphragm acts as an additional barrier, helping the lower esophageal sphincter keep acid from backing up into the esophagus.

•Hiatal hernia can be caused by persistent coughing, vomiting, straining, or sudden physical exertion. Obesity and pregnancy can make the condition worse.

•A hiatal hernia makes it easier for the acid to back up.

•Hiatal hernia is very common in people older than 50 years of age.

•Hiatal hernia usually requires no treatment. In rare cases when the hernia becomes twisted or is making GERD worse, surgery may be required.

 

Acid Reflux (GERD) Symptoms

Persistent heartburn is the most common symptom of GERD.

•Heartburn is a burning pain in the center of the chest, behind the breastbone. It often starts in the upper abdomen and spreads up into the neck or throat.

•The pain can last as long as 2 hours.

•Heartburn is usually worse after eating.

•Lying down or bending over can bring on heartburn or make it worse.

•The pain usually does not start or get worse with physical activity.

•Heartburn is sometimes referred to as acid indigestion.

•Not everyone with GERD has heartburn.

Other symptoms of GERD include the following:

•Regurgitation of bitter acid up into the throat while sleeping or bending over

•Bitter taste in the mouth

•Persistent dry cough

•Hoarseness (especially in the morning)

•Feeling of tightness in the throat, as if a piece of food is stuck there

•Wheezing

The most common symptoms in children and infants are repeated vomiting, coughing, and other respiratory problems

 

Diagnosis

Your health care professional usually can diagnose reflux disease by the symptoms you report.

• They will probably recommend diet and lifestyle changes first and perhaps an over-the-counter antacid.

•If symptoms continue for more than 4 weeks despite this therapy, you may be referred to a gastroenterologist.

 

The gastroenterologist may perform an upper GI series.

•This is a series of X-rays of the esophagus, stomach, and upper part of the intestine.

•It is taken after you drink a contrast liquid that makes certain features show up better on the X-rays.

•This series is sometimes called a barium swallow for one type of contrast liquid that is used.

•This test gives less information than endoscopy but is ordered to rule out other conditions such as ulcers or blockage of the esophagus. The upper GI series is skipped altogether.

 

The gastroenterologist may perform an upper GI endoscopy, also called  esophagogastroduodenoscopy or EGD, a procedure that can be done as an outpatient.

•You receive some sedation, then a flexible probe with a tiny camera on the end is passed down your throat.

•The camera allows the doctor to see damage to the esophagus, how severe the GERD is, and rule out serious complications.

•Your esophagus may appear normal if you have mild GERD.

•This procedure allows the specialist to make diagnoses, assess damage, take biopsies if necessary, and even treat certain conditions on the spot.

Esophageal manometry is a test that measures the function of the lower esophageal sphincter and the motor function of the esophagus. A tube is passed down your throat until it reaches the esophagus. It is often performed along with 24-hour pH probe study.