When you have acid reflux, it means some of the digestive juice from your stomach moves up into your oesophagus, causing a burning sensation in your chest, which we call heartburn. If this happens often, it might mean you have a more serious condition called GERD.
Even though people sometimes mix up the terms, heartburn is actually a sign of acid reflux, which doctors also call gastroesophageal reflux or GER. But despite its name, acidity isn’t related to your heart.
GERD is a more severe type of acid reflux. Doctors will say you have GERD if you keep getting acid reflux regularly, normal more than two times a week for a few weeks in a row.
GERD is quite common in countries like the US and Europe, where about 20% of people have it. In the US alone, around 20% of Americans have GERD, making it the most commonly diagnosed digestive issue.
Interestingly, GERD affects more women than men, with about 60% of those diagnosed being women. And among all people with GERD, African Americans are the second-biggest group after white people.
Reason for acid reflux
Acid reflux happens when the strong acid in our stomach, called hydrochloric acid, goes the wrong way. Usually, it stays in our stomach to help break down food and fight off bad bacteria. But sometimes, it sneaks up into our food pipe, which is called the esophagus.
Our stomach has a tough lining that can handle this strong acid, but our esophagus doesn’t. There’s a special muscle ring called the gastroesophageal sphincter that acts like a gatekeeper between the stomach and the esophagus. Normally, it opens to let food into the stomach but stays closed to keep the acid from coming back up.
But if this muscle ring doesn’t work properly, stomach acid can come back up to the esophagus. That’s acid reflux. When this happens, it feels like a burning feeling in the esophagus, which we call heartburn.
Risk factors of Acid reflux
Anyone, no matter their age, can experience acid reflux. Sometimes, it happens without any clear reason. However, certain things can make it more likely to occur.
Lifestyle Factors
- Being overweight: If you carry extra weight, it can put pressure on your stomach, making acid more likely to splash back up.
- Smoking: Whether you smoke yourself or are around others who smoke, it can weaken the muscle that keeps acid in your stomach.
- Not being active enough: Regular exercise helps keep your body healthy, including your digestive system. Not moving around much can make acid reflux more likely.
Medications
Some medicines can make acid reflux worse. These include medicines for asthma, some heart medications, allergy medicines, painkillers, sleeping pills, and antidepressants.
Pregnancy
When you’re pregnant, your body goes through lots of changes. Some of these changes can make acid reflux more likely.
Eating and Drinking Habits
Certain foods and drinks can trigger acid reflux. These include:
- Found in coffee, tea, and some sodas
- Alcohol
- Fatty and spicy foods
- Tomato sauces
- Garlic and onions
- Eating big meals
- Sleeping too soon after eating
- Chocolate, fizzy drinks, and juices that are very acidic
Avoiding these triggers and making healthy lifestyle choices can help reduce the chances of having acid reflux.
Treatment
Doctors often prescribe medications to help with acid reflux, especially if it happens a lot.
PPIs (Proton Pump Inhibitors) and H2 blockers
These medicines reduce the amount of acid your stomach makes, which can help prevent acid reflux and protect your esophagus from damage. They’re usually safe, but like any medicine, they can have side effects. For example, they might make it harder for your body to absorb some nutrients, which could lead to not getting enough of what you need from your food. Doctors usually recommend taking these medicines for a short time to avoid problems. Examples of PPIs are rabeprazole, omeprazole, and esomeprazole. Examples of H2 blockers include famotidine (Pepcid) and cimetidine (Tagamet).
These medicines can help ease symptoms and prevent damage from acid reflux, but it’s important to talk to a doctor before starting any new medication. They can help figure out the best treatment plan for each person.
Antacids
For those who only occasionally experience indigestion or heartburn, typically triggered by certain drinks or foods, there are over-the-counter (OTC) options available to alleviate symptoms by reducing stomach acidity.
These remedies, known as antacids, come in liquid or tablet forms and are offered by numerous brands, all boasting same effectiveness. However, it’s important to recognize that while antacids can be helpful for many, they might not provide relief for everyone. If there’s a regular need for antacid use, it’s advisable to consult a doctor to explore potential underlying causes and ensure appropriate management.
Antacids typically contain various chemical compounds such as sodium bicarbonate, calcium carbonate, magnesium hydroxide and aluminium. These ingredients work swiftly to neutralize excess stomach acid, offering rapid but short-lived relief from symptoms like heartburn and indigestion. Despite their immediate effectiveness, prolonged use of antacids may present drawbacks, including potential interference with nutrient absorption, which could lead to deficiencies over time. Notable brands of antacids available in the market include Rolaids, TUMS, and Alka-Seltzer, among others.
Alginate antacids
Alginate antacids, like Gaviscon, are a type of medicine that helps with heartburn and indigestion. They work in a unique way compared to other antacids. Along with the usual antacid ingredients, they also contain something called alginic acid, which comes from brown algae, a type of seaweed.
The alginic acid in these medicines does something special: it creates a kind of barrier in your stomach. This barrier forms a foamy gel that sits on top of the acid in your stomach, like a protective layer. So, if any acid tries to come back up into your food pipe, it’s not the strong stomach acid—it’s this safer alginic acid.
Other treatment options
In addition to the common treatments like antacids and acid blockers, there are several other options available to help manage acid reflux and GERD. These include medications such as sucralfate acid suppressants, potassium-competitive acid blockers, and drugs that target TLESR, which is a factor in acid reflux.
Other medications like GABA(B) receptor agonists, prokinetic agents, mGluR5 antagonists, and pain modulators may also be prescribed depending on the severity of the condition and individual response to treatment. In some cases, antidepressants like tricyclic antidepressants or selective serotonin reuptake inhibitors (SSRIs) may be recommended to help alleviate symptoms. Additionally, drugs like theophylline, which affects serotonin and norepinephrine levels, may be used in certain situations. However, if GERD is severe and doesn’t respond well to medications, surgery called fundoplication may be necessary to alleviate symptoms and prevent complications.
Lifestyle changes
Making certain changes to your lifestyle can also help manage acid reflux. These changes include:
- Making better posture: Sitting or standing up straight can help reduce pressure on your stomach, which can lessen the likelihood of acid reflux.
- Maintaining a good weight: Being overweight can put extra pressure on your stomach and increase the chances of acid reflux. Losing weight, if needed, can help reduce symptoms.
- Halting smoking: Smoking can weaken the muscle that controls the opening between your esophagus and stomach, making acid reflux more likely. Quitting smoking can improve your symptoms.
- Consuming more fiber: Fiber-rich foods, like fruits, vegetables, and whole grains, can help prevent constipation, which can worsen acid reflux.
- Stay away from late-night meals: Eating close to bedtime can trigger acid reflux symptoms. Try to eat your last meal at least two to three hours before lying down.
- Raising the bed while sleeping: Placing blocks under the head of your bed can help elevate it, preventing stomach acid from rising up into your esophagus while you sleep.
A recent study found that making healthy food choices can be just as effective as taking proton pump inhibitors (PPIs) in managing acid reflux. This highlights the importance of a balanced diet in managing this condition.
Diagnosis
Diagnosing heartburn and acid reflux is usually straightforward, but they can sometimes be confused with other chest problems like a pneumonia, heart attack, chest wall pain, or a deep vein thrombosis. Doctors often diagnose GERD by seeing if symptoms improve with lifestyle changes and acid reflux medicines.
To confirm the diagnosis, a gastroenterologist (a doctor who specializes in digestive issues) might recommend some tests:
- Endoscopy: This involves using a tiny camera to see inside your esophagus and stomach to check for any signs of damage.
- Biopsy: Taking a small tissue sample from your esophagus or stomach to examine it more closely in a lab.
- Barium X-ray: You’ll drink a chalky liquid that shows up on X-rays, allowing doctors to see the inside of your esophagus, stomach, and upper duodenum (the first part of the small intestine).
- Esophageal manometry: This measures the pressure in your esophagus to check how well it’s working.
- 24-hour pH impedance observation: This test measures the quantity of acidity in your esophagus over a 24-hour period to see if acid reflux is happening frequently.
Summary
In simple terms, acid reflux happens when stuff from your stomach comes back up into your food pipe, causing a burning feeling called heartburn. If this happens a lot, it might be a sign of GERD, a more serious problem.
Luckily, there are ways to help with acid reflux. You can buy over-the-counter antacids to ease the burn, or your doctor might prescribe stronger medicine if it’s really bad. Changing your lifestyle can also make a big difference, like eating healthy foods, staying active, and sleeping with your head raised up. These simple steps can help you feel better and manage acid reflux and GERD.
