We usually say “what goes up must come down.” But what if things moved backward? What if everything that went down, bubbled back up? This is all too common in the world of acid reflux. Acid Reflux (simply called reflux) is a condition where stomach contents are not able to stay where they should… which is of course, in the stomach. Food, drink, medications, stomach acid, etc, travel back up into your throat for various reasons. It is often called acid indigestion.
Reflux is an acute or chronic condition that occurs when stomach acid and/or bile irritatingly flow up into the esophagus. Specifically, we call this Gastroesophageal Reflux. During an episode, you may taste regurgitated food or liquid that is very sour.1 Occasional reflux is minimal and does not regularly interfere with overall health. Small lifestyle changes, discussed later, can help alleviate the frequency of episodes. If symptoms worsen, it could be GERD, a more serious condition. Acid reflux occurring more than twice a week indicates a condition known as Gastroesophageal Reflux Disease (GERD). While reflux and GERD are very similar, they don’t necessarily mean the same thing. GERD is a more serious condition presenting with additional symptoms.
It is important to remember that while some symptoms are attributed to occasional reflux episodes, more radiating symptoms could be a sign that you have GERD. The most common reflux symptom is burning pain in the throat after eating or lying down. The pain tends to be worse when resting. Lying down after meals is a sure way to trigger reflux in these patients. Reflux can also bring bouts of nausea and vomiting. As food and liquid bathe the throat, it isn’t always able to stay down far enough. Sometimes it is severe enough as to wash up into the throat and induce vomiting. Nausea and vomiting are much more common after eating large, fatty meals. Some reflux patients experience increased saliva. This is the body’s way of flushing out irritants that are potentially damaging. Nausea is more common in patient who experience excessive saliva. The reflux and saliva combined can present with a bitter taste. While the saliva can buffer the acid, it cannot completely wash the taste away. Stomach contents are the most acidic substances in the body and are highly dangerous in repeated exposures. Damage can make it difficult to swallow by a narrowing of the esophagus. These patients have trouble moving food into the stomach. Scar tissue from the body’s continuous healing process can inhibit the successful passage of food.
Burning pain can lead to more severe chest pain that can radiate into the lungs. Patients may also experience pain in the throat, both esophagus and trachea. Esophageal pain, a sore throat, can be caused by the burning acid that continually bathes the area. Over time, the soreness worsens from progressive damage. Asthma sufferers may also experience an increase in their symptoms. Breathing can become labored and difficult. These patients have a higher tendency to develop a chronic cough. Reflux irritates the nerves of the throat and lungs, exacerbating asthmatic conditions. Many reflux patients report feeling horse or scratchy in the throat. The repeated acid exposure can damage vocal cords and air flow when speaking. The voice can become crackly and raspy.
Reflux occurs when the muscular ring at the base of the esophagus, called the lower esophageal sphincter (LES), isn’t strong enough to hold stomach contents inside. Any condition or malady that weakens the LES brings on potential for reflux. Medical causes include prematurity in infants, muscle atrophy, and malformation of the LES. Smoking has also been shown to weaken the LES.3 Patients with hiatal hernias have a higher prevalence of reflux. Hiatal hernias occur when a portion of the stomach is push through the diaphragm. Hiatal hernias weaken the LES. Other causes are obesity, pregnancy, and certain dietary choices. Chocolate, peppermint, fried and fatty foods, and alcohol are all strong food triggers.
There are a few ways to examine reflux. An upper gastrointestinal series (Upper GI) is an x-ray that views the upper portion of the gastroesophageal tract. The administrator can view the esophagus, stomach, and first third of the small intestines. Movements are made visible on the x-ray by swallowing a barium infused liquid.2 The liquid is seen in dark contrast. Upper GI series happen in real-time; meaning you can physically watch the movement. A large imaging machine is placed overhead while the patient lies down on a flat table. The test may also be performed while a patient is sitting upright. If reflux is present, the administrator can see the liquid move backward in the gastrointestinal tract.
A pH probe is another common and minimally invasive test. A thin flexible tube is placed through the nose and into the stomach. The probe is attached to a small machine that measures acidity over a period of 24 hours. The administrator is able to watch the fluctuations in pH, to see if acid levels drop below normal levels in dangerous areas. The frequency of exposure can help identify the severity of reflux, and help doctors decide which course of treatment is best.
An endoscopy is a more invasive procedure where a small camera is placed down through the throat or nose. Doctors performed this test under general anesthesia. They collect images of esophageal damage and can view the musculature and movement of the upper gastrointestinal tract. Biopsies are also collected through an endoscopy. Biopsies check for cellular changes or chronic damage to surrounding tissues.
There are various treatment options. The first line of treatment is making lifestyle changes. Eliminating food triggers is often recommended first. Quitting alcohol and smoking are also common lifestyle recommendations. Doctors also often recommend sleeping in a semi-reclined position. Propping up the head of the bed, or elevating a pillow can use gravity to your advantage. Some patients sleep in a recliner or adjustable bed to find a more comfortable upright position. By eliminating triggers that exacerbate reflux, frequency may be minimal enough as to not need medicinal therapy.
There are both over the counter and prescription medications that can help alleviate the causes and symptoms of acid reflux. H2 blockers such as Ranitidine (Zantac), Famotidine (Pepcid), and Cimetidine (Tagament) are over the counter medications that neutralize acid in the stomach. These medications attack the acid after it is produced. Proton Pump Inhibitors blocked acid production. Lansoprazole (Prevacid) and Omeprazole (Prilosec) are the most common medications in this classification. They can be both prescription dosage and over the counter.
It’s always best to meet with your doctor to discuss the best path of treatment. Isolated reflux can easily be treated at home, but persistent acid exposure is dangerous and should be discussed with your doctor. When lifestyle changes are not enough, a doctor can help you find the best course of management.
About the Author: Very happy to have Kathryn Rohr from the Canadian Pharmacy World Blog. She is a freelance writer about digestive and nutritional health. She believes accurate and valuable information should be easy to find.