Acid Reflux and GERD
Acid reflux, or gastroesophageal reflux (GER), is a condition where acid from the stomach flows up into the esophagus, causing burning discomfort in the chest known as heartburn. Someone with gastroesophageal reflux disease (GERD), a more serious type of acid reflux, has heartburn two or more times a week.
More than 60 million people experience heartburn from acid reflux at least once a month in the United States, according to the American College of Gastroenterology. More than 15 million Americans have symptoms daily. About 20 percent of Americans have GERD.
Acid reflux is common and it can come and go, especially after eating certain foods. Normal people may have acid reflux for an hour a day and not feel anything. It may disappear without the help of medication.
But people with chronic heartburn need some form of treatment. If left untreated, GERD can lead to esophageal damage, cancer and other complications.
With the right treatment, the body may be able to heal. Depending on the severity of symptoms, a health care provider may recommend lifestyle changes, medications, surgery or a combination of these.
The most common symptom of acid reflux is heartburn. It feels like a burning pain that people feel mid-chest below the sternum. Sometimes, a person may taste food or stomach acid in the back of the mouth. It can get worse at night, when a person lays down or after meals.
When heartburn happens regularly two or more times a week, a person may have GERD. But not all adults with GERD have heartburn, according to the National Institute of Diabetes and Digestive and Kidney Diseases.
Some symptoms of GERD come from its complications. These include Inflammation of the esophagus and breathing problems. These symptoms alone may be caused by other conditions and aren’t sufficient to diagnose GERD.
- Difficult or painful swallowing
- Foul breath
- Pain in the upper abdomen or chest
- Problems with teeth wearing away
- Respiratory problems
When to Call Your Doctor
If you have persistent symptoms that don’t go away with a change in diet or over-the-counter acid reducers, see your doctor right away.
- Blood in vomit
- Difficulty breathing after vomiting
- Difficulty swallowing
- Green or yellow vomit
- Large amounts of vomit
- Pain in the mouth or throat when eating
- Pain when swallowing
- Projectile or forceful vomiting
- Vomit that looks like coffee grounds
Causes and Risks of Acid Reflux
Acid reflux is caused by a weak or improperly closed lower esophageal sphincter — the muscle that closes the opening between the esophagus and the stomach. When people eat, the sphincter opens to allow food into the stomach. When people are not eating, this muscle stays closed.
When the muscle is weak or becomes relaxed when it isn’t supposed to, the contents of the stomach —including stomach acid, digestive juices and food — flow up into the esophagus, causing heartburn.
Most risk factors for acid reflux and GERD are related to lifestyle and are preventable.
- Being overweight or obese
- Inhaling cigarette smoke
- Sedentary lifestyle
- Drinking too much alcohol
- Eating too many large, fatty meals
- Eating large meals too close to bed time
One unpreventable cause of acid reflux is a hiatal hernia. A hiatal hernia causes the upper part of the stomach to move into the chest. This causes the esophageal sphincter to relax and let stomach contents flow up into the esophagus.
Pregnant women also have an increased risk of reflux and GERD because being pregnant increases the pressure in the abdomen.
Some medications such as antidepressants, painkillers, sedatives, blood pressure medications and antihistamines may weaken or relax the esophageal sphincter and lead to reflux.
A primary health care provider or gastroenterologist — a doctor that specializes in digestive disorders — may recommend a few tests to diagnose GERD.
Upper GI Series
In an upper GI series, the patient swallows a liquid called barium. Then a radiologist takes x-rays of the barium as it travel down the esophagus and into the stomach.
After using a spray anesthetic on the throat, the health care provider passes a flexible tube in through the nose. The tube travels down the esophagus and into the stomach. It measures the pressure and function of the esophagus.
This test is the most accurate for detecting acid reflux, according to the National Institute of Diabetes and Digestive and Kidney Diseases. It monitors the amount of acid that passes into the esophagus when a person is sleeping, eating or performing other activities over a 24-hour period.
A gastroenterologist will place a thin tube through the nose or mouth and into the stomach. The other end attaches to a monitor. It’s removed after 24 hours.
Doctors may also use another type of temporary device called a Bravo Capsule. The doctor will place it on the wall of the esophagus to measure acid reflux for about 48 hours. The data goes to a receiver the patients wears on their waistband or belt.
An endoscopy involves passing a flexible tube with a lighted tip and camera through the mouth, down the esophagus and into the stomach. Health care providers can see abnormalities in the stomach or esophagus, especially if the provider suspects the patient has Barrett’s esophagus. Patients are usually sedated for the procedure. Sometimes the doctor may perform a biopsy and take a small piece of the tissue to examine in the lab.
Complications of GERD
If left untreated, GERD can cause a number of complications. It can cause bleeding and scarring in the esophagus. The most serious complication is an increased risk of esophageal cancer.
Esophagitis is inflammation of the esophagus. If it persists for many years, it increases the risk for precancerous changes in the esophagus.
Narrowing of the Esophagus
Narrowing of the esophagus or esophageal stricture can lead to problems swallowing or food getting stuck in the throat.
This condition makes the lining of the esophagus resemble the lining of the intestine. It is more likely to affect adult men. Researchers estimate it affects up to 6.8 percent of people. People with this condition are more likely to get esophageal cancer.
Stomach acid may enter the lungs of people with GERD. It can irritate tissues in the lungs and throat. This can cause wheezing, pneumonia, chest congestion, asthma, chronic throat clearing or cough and laryngitis.
Treatment options for acid reflux and GERD include lifestyle changes, medications, surgery or a combination of these. In cases where symptoms are not too severe, a health care provider may recommend lifestyle changes and over-the-counter acid reducers such as such as Prevacid, Rolaids or Tums. Zantac made with ranitdine was a popular choice until it was withdrawn from the market in April 2020. After the market withdrawal, Sanofi made a new Zantac 360 over-the-counter formula made with famotidine which is available in the United States.
In more serious cases, treatments may include prescription medications such as proton pump inhibitors including Nexium or Prevacid. If all non-invasive recommendations fail, a patient may consider surgery to strengthen the natural barrier between the stomach and esophagus.
Surgery and proton pump inhibitors scored the highest for suppressing acid, healing esophagitis, managing complications and maintaining remission of acid reflux, according to the American College of Gastroenterology.
According to an article by the Institute for Quality and Efficiency in Health Care in Germany published in the U.S. Library of Medicine, 45 out of 100 people had an improvement in their acid reflux symptoms. In contrast, 14 out of 100 people who took H2 blockers saw improvement.
|Drug Class||Brand Name (generic)|
|Antacids||Maalox, Mylanta, Riopan, Rolaids|
|H2 Blockers||Tagamet HB (cimetidine), Pepcid AC (famotidine), Axid AR (nizatidine), Zantac (ranitidine) (withdrawn from the market)|
|Proton Pump Inhibitors (PPIs)||Nexium (esomeprazole), Prevacid (lansoprazole), Prilosec (omeprazole), Protonix (pantoprazole), AcipHex (rabeprazole)|
|Prokinetics||Urecholine (bethanechol), Reglan (metoclopramide)|
Home Remedies for Acid Reflux
A common home remedy recommended for acid reflux is apple cider vinegar, and several people online claim it works. But there is no scientific evidence that supports this claim, Dr. Marcelo Campos wrote in an article for Harvard Medical School.
Dietary changes, such as avoiding fried foods, may improve acid reflux. Nutritional improvements may also boost overall digestive health, which is important to immune functioning because an estimated 70 percent to 80 percent of immune cells live in the gut.
People who want to try and control acid reflux without medication or surgery are better off trying lifestyle changes.
- Don’t overeat
- Try not to eat two to three hours before bedtime
- Wear lose-fitting clothes that don’t squeeze your abdomen
- If you are overweight, lose some weight
- Quit smoking
- Stay upright for 3 hours after meals and don’t slouch or recline when sitting
- Try raising the head of your bed by six to eight inches to sleep at an incline
- Avoid foods or drinks that trigger reflux such as high fat or spicy foods, carbonated beverages and alcohol
- Avoid vigorous exercise right after eating
- Check medications for any side effects that might increase risk of reflux
Acid Reflux and GERD in Babies
Even children and babies can have acid reflux. Babies with acid reflux usually spit up food. Acid reflux and GERD are common in babies because the valve that separates the stomach from the esophagus isn’t fully developed yet. Once it develops, babies typically stop having reflux.
- Back arching during or right after feeding
- Crying lasting for more than 3 hours a day, also called colic
- Difficulty breathing
- Infections in the lungs such as pneumonia
- Irritability after feeding
- Low weight, weight loss
- Not wanting to feed
- Trouble swallowing
- Wheezing while breathing
Treatment for infant reflux typically involves feeding changes, medications and in rare instances, surgery. For the first 3 months of their lives, most babies regurgitate or spit up many times a day. It typically goes away by the time they are one year old. Only 10 percent of babies have GERD after their first birthday.
There is no official diet for GERD or acid reflux, but most health providers recommend some foods that could help control symptoms.
“Diet plays a major role in controlling acid reflux symptoms and is the first line of therapy used for people with GERD,” according to Dr. Ekta Gupta, a gastroenterologist with Johns Hopkins Medicine.
This list of foods is high in fiber and water and higher on the pH scale (foods high on the scale are less acidic) which may help control acid.
- Whole grains
- Root vegetables
- Green vegetables
- Herbal tea
- Broth-based soups
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