Taming the Flames Within
What is Acid Reflux and GERD?
Acid reflux occurs when stomach acid flows back up into the esophagus. The esophagus is the tube that carries food from your mouth down to your stomach. At the bottom of the esophagus is a ring of muscle known as the lower esophageal sphincter or LES. The LES is supposed to close after allowing food through to prevent backflow of acid. But when it malfunctions or weakens, the acid can flow up and cause irritation and lead to what is known as acid reflux.
The pyloric sphincter is also supposed to prevent backflow from the small intestine into the stomach. If this malfunctions, you can also get bile reflux along with acid reflux, which can make symptoms worse.
GERD is short for gastroesophageal reflux disease. This is when you have frequent or severe acid reflux symptoms, such as heartburn or regurgitation. Heartburn is a burning pain in the middle of the chest, while regurgitation is when you can taste stomach acid or food/liquid coming back into the mouth.
Who Gets Acid Reflux and GERD?
Around 10-20% of Americans have GERD. It can affect people of any age, including children and even infants. Various risk factors that predispose you to reflux are:
- Obesity and pregnancy – the increased pressure in the abdomen can force open the LES
- Hiatal hernia – when the upper part of the stomach pushes up through an opening the diaphragm
- Certain medications, like NSAIDs
- Smoking
- Eating large, fatty meals pushes LES open
- Eating late meals or lying down after eating
Symptoms of Acid Reflux and GERD
The most common acid reflux and GERD symptoms include:
- Heartburn – a painful burning feeling in middle of the chest or upper abdomen, especially after meals
- Regurgitation – taste of sour food or liquid coming back into the mouth
- Excessive burping or belching
- Chest pain that feels like a heart attack
- Chronic cough, hoarseness, or sore throat
- Waking up gasping for air due to acid
- Tooth erosion from acid damaging tooth enamal
- Feeling like there’s a lump in the throat (globus sensation)
- Problems swallowing (dysphagia)
- Nausea after eating
Less common symptoms that may indicate advanced GERD include:
- Unexplained weight loss
- Bleeding from ulcers
- Spasms or tightness in the middle of the chest
- Recurrent pneumonia or bronchitis
- Asthma that’s difficult to control
If you experience shortness of breath, chest pain, trouble swallowing that prevents eating, or vomiting blood, seek medical help immediately.
Diagnosing Acid Reflux and GERD
A gastroenterologist can diagnose GERD and treat severe or difficult cases. However, you can try self-diagnosis with an over-the-counter acid reflux home test like the Restech Dx pH test. This is a small capsule attached to a catheter that you swallow to directly measure acidity levels in your esophagus. Results sync to an app to indicate if you have excess acid reflux.
Other medical tests that can be used to confirm acid reflux and GERD include:
- Endoscopy – A tiny camera put down your throat lets the doctor view signs of damage from stomach acid, like ulcers. Biopsies can also test for precancerous cell changes called Barrett’s esophagus.
- Manometry – Measures muscle contractions and coordination in the esophagus. Checks if poor muscle movement allows backflow of stomach contents.
- X-ray with Barium Swallow – You swallow a thick, chalky barium liquid that coats the inside of your GI tract. X-ray images show anatomical issues allowing acid reflux. Also detects hiatal hernias.
- Acid Perfusion Test – A tube put through your nose and down your throat measures acid sensitivity by exposing different parts of the esophagus to acid. Checks how likely acid triggers your symptoms.
- Esophageal pH Monitoring – The current gold standard for diagnosing GERD. A thin tube with a sensor is placed in the esophagus via the nose to record acid levels over 48 hours during normal activity.
- Wireless pH Monitoring – A small wireless acid sensor is clipped to the LES during endoscopy and transmits data to a recorder you wear. More natural results but can accidentally dislodge.
- Impedance testing – Uses electrical resistance to detect flow direction in the esophagus and confirm acid or non-acid reflux events.
Treatment depends on the frequency and severity of your symptoms.
Acid Reflux and GERD Treatment Options
Lifestyle and Home Remedies
Making certain lifestyle changes and using home remedies can often successfully treat mild reflux:
- Lose weight if overweight- reduces pressure on the LES that causes leakage
- Avoid foods triggering reflux – fatty foods, chocolate, caffeine, alcohol, onions, mint, citrus fruits, tomato. Keep a food diary to identify personal triggers.
- Don’t overeat – smaller meals put less pressure on the LES and are less likely to force it open
- Avoid eating late meals and don’t lie down within 3 hours of eating – keeps acid where it belongs
- Elevate the head in bed with wedge pillows or blocks under bed posts – uses gravity to keep acid down
- Quit smoking and vaping – nicotine and flavoring relaxes the LES
- Wear loose clothing – avoids squeezing the abdomen and pushing acid upwards
- Slow down when eating – prevents excessive air swallowing that can push open the LES
- Chew gum – increases saliva production which helps neutralize acids
- Take slippery elm, ginger root, licorice root, marshmallow or aloe vera juice – natural remedies that coat and soothe the irritated esophagus
Over-the-Counter Medications
A variety of effective over-the-counter medications are available without prescription for mild to moderate acid reflux and heartburn symptoms:
- Antacids (Tums, Rolaids, Mylanta) – Rapidly neutralize stomach acids but effects only last 1-2 hours
- H2 Blockers (Pepcid, Zantac, Tagamet) – Blocks acid production for up to 12 hours
- Proton Pump Inhibitors (Nexium 24HR, Prilosec OTC) – Shuts off acid pumps in the stomach for 24 hours
- Pro-Motility Drugs (Reglan) – Helps tighten the LES to prevent backflow
- Alginate Drugs (Gaviscon) – Foam barrier prevents acid rising into the esophagus
Use chewables, liquids or rapidly dispersing tablets for faster relief.
Prescription Medications
If over-the-counter medications don’t provide adequate relief or you have moderate to severe GERD symptoms frequently, stronger prescription drugs are available.
- H2 Blockers (Axid, Pepcid, Tagamet, Zantac) – more potent long-lasting versions of OTC medication
- Proton Pump Inhibitors (Prilosec, Nexium, Aciphex, Prevacid) – more potent and faster acting acid suppressors
- Prokinetics (Reglan, Urecholine) – increase muscle contractions to strengthen the LES
- Baclofen – a muscle relaxant that can relax the LES in some patients
- Antibiotics (amoxicillin, tetracycline) – if H. pylori infection is causing excess acid production
Injection Treatments
If GERD symptoms persist despite prescription medications, a doctor can inject bulking agents at the LES:
- Injected Bulking Agents – materials like Durasphere or Deflux injected into the LES externally solidify to tighten the opening and prevent leakage. Multiple repeat injections may be needed as the bulking effect wears off.
- Stretta Procedure – the LES is heated with radiofrequency energy causing tiny scars that tightens and fuses tissue together reducing reflux. Pain relief may not last more than 2 years and multiple repeat procedures may be needed.
- Medigus Ultrasonic Surgical Stapler (MUSE) – special staples and an ultrasonic energy scalpel are used to fold over upper stomach tissue around the LES for support and tighter closure.
Surgery for Acid Reflux and GERD
Surgery to tighten the LES or repair hiatal hernias may help those insufficiently helped by medications or lifestyle changes.
- Nissen Fundoplication – Gold standard surgery where the upper part of the stomach is wrapped around the LES like a collar to strengthen the sphincter and prevent acid backflow. Laparoscopic procedures have quicker recovery times.
- LINX Device – A ring of magnetic titanium beads placed around the LES stays open to allow swallowing but uses magnetic attraction to cinch closed to prevent reflux. Requires no tissue alteration or adjustments.
- Transoral Incisionless Fundoplication (TIF) – The EsophyX device is inserted through the mouth to tighten esophageal tissues or correct hiatal hernia defects internally without any incisions.
- Hiatal Hernia Repair – classic open or laparoscopic surgery can reduce a portion of the stomach bulging through the diaphragm back into place. Sutures reinforce weakened areas. Mesh may also support improved LES function.
Alternative Treatments
Some alternative and natural medicine practitioners also use:
- Acupuncture – thin needles precisely placed in the skin stimulate nerve pathways connected to internal organs. May reduce acid production or intestinal spasms pushing up stomach acid.
- Hypnosis and Meditation – Relaxation techniques relieve stress that can trigger excess stomach acid production in some patients.
- Chiropractic Treatments or Osteopathic Manipulation – Spinal adjustments and mobilization of the stomach, esophagus, diaphragm can promote proper functioning of these components involved in preventing reflux for some people.
Preventing GERD Flareups
Following doctor’s orders for proper use of prescribed medications should help prevent GERD flareups. It is important not to abruptly stop PPI medications without guidance.
In addition:
- Stick to a low-fat diet and make healthy meal choices
- Avoid trigger foods and large meals, especially before bedtime
- Elevate the head when sleeping and avoid constricting waistbands
- Use relaxation techniques to reduce stress
- Exercise in moderation and avoid activities putting pressure on the abdomen right after eating
- Ask your doctor before taking NSAIDs known to weaken the sphincters
- See your doctor regularly to make sure treatment is working or adjust if bothersome symptoms return
Complications from Untreated GERD
Chronic exposure to acid can seriously damage tissues of the digestive tract leading to:
- Esophagitis – irritation and inflammation of the esophageal lining which can become extensively scarred
- Esophageal Strictures – severely scarred narrow areas causing difficulties swallowing
- Barrett’s Esophagus – abnormal precancerous changes in cells increases cancer risk
- Esophageal Adenocarcinoma – a highly lethal type of esophageal cancer
- Asthma – microaspiration of stomach contents triggers difficult to control asthma in some patients
- Chronic Cough, Laryngitis – acid injury to vocal cords or aspiration into lungs causes respiratory issues
- Dental Erosion – acidic bile and stomach contents wears away tooth enamel and causes decay
Thus, adequately treating of acid reflux and GERD is crucial for preventing serious complications down the road. Monitoring Barrett’s esophagus via frequent endoscopies also allows early detection and removal of any cancerous changes before tumors can extensively spread.
When to See Your Doctor About Acid Reflux Symptoms
You should consult your doctor if:
- You experience acid reflux symptoms more than twice per week
- Symptoms persist despite lifestyle changes and OTC medication use
- You wake up frequently choking or coughing at night
- You have difficulty swallowing
- You experience weight loss without trying or loss of appetite
- You have bloody or black stools – sign of GI bleeding
Seeking proper diagnosis and more aggressive treatment early rather than allowing GERD symptoms to go unchecked may prevent progression and complications.
In summary, acid reflux and GERD are very common digestive disorders affecting millions of Americans. They occur due to dysfunction of the lower esophageal sphincter muscle which allows stomach contents to abnormally leak upwards into the esophagus. This causes symptoms like heartburn, regurgitation, coughing, and chest pain which negatively impact quality of life. While anti-reflux medication can provide symptom relief, inadequate treatment allows ongoing tissue damage, leading to complications like esophageal scarring, strictures, Barrett’s esophagus precancerous changes, and even esophageal adenocarcinoma.
If you experience any persistent troublesome digestive issues, don’t hesitate to talk to your doctor. Left unchecked, acid reflux symptoms tend to worsen over time and predispose you to developing full-blown GERD. Getting an accurate diagnosis via testing like endoscopy, manometry, or pH monitoring is important for understanding the severity of acid exposure so the most appropriate treatment plan can be determined. This may range from lifestyle modifications for mild reflux to prescription proton pump inhibitors for frequent GERD flareups. Additional therapies like bulking agent injections or even hiatal hernia and LES-tightening surgery may be warranted depending on your case.
The key is tailoring management based on how debilitating your individual symptoms are. Tracking flareups and avoiding dietary triggers also helps prevent acid reflux episodes. Smaller meal portions, not eating before bed, tobacco cessation, weight control, wedge pillows, elevation of the head, and stress reduction techniques are worthwhile lifestyle changes providing additive benefits. Educating yourself on all available medical and home treatment options allows working jointly with your physician to formulate an action plan giving you the best chance of relief. Staying on top of acid reflux now safeguards against advanced tissue damages that compromise function, reduce quality of life exponentially more, and necessitates riskier interventions later.
While antireflux therapy helps manage the symptoms well in many patients, some continue experiencing residual issues like heartburn, choking sensations, or chest discomfort stemming from irreversible underlying anatomical defects. Thankfully huge leaps have been made in our understanding of the pathological mechanisms behind reflux disease. Advanced diagnostic tests help characterize damaged tissues, impaired muscle coordination, and sphincter deficiencies fueling acid backflows. Cutting-edge techniques like radiofrequency energy remodeling, injectable bulking agents strengthening the LES valve, magnetically augmented sphincter rings, and minimally invasive endoscopic/laparoscopic fundoplication procedures now provide enhanced corrective capabilities with quicker recovery times compared to traditional open surgery.
The expanding medical arsenal against acid-mediated injury continues evolving rapidly. New pharmacological agents that more effectively block signaling pathways triggering acid secretion are on the horizon. Novel barrier methods better isolating the lower esophagus from irritating refluxates show great promise as well. Exciting neurostimulatory devices modifying nerve input into sphincter and esophageal muscles may soon help normalize motility disorders contributory to backward leakage. Researchers also seek new ways of fostering tighter sphincter integrity using regenerative tissue engineering and stem cell regeneration rather than prosthetics. Overall, a multifaceted battle against reflux-induced symptoms and complications continues making significant headways to alleviate suffering related to esophageal damage from stomach juices. Patients today face an encouraging forecast with an ever-increasing array of both medication and interventional tools providing meaningful improvements in reflux control.