What is acid reflux? Causes, Types, Treatment

What is acid reflux? Causes, Types, Treatment

What is acid reflux? Causes, Types, Treatment

1. Acid Reflux- an overview


Globally, 30% of adults suffer from acid reflux problems. The health problem may occur in people at any age including the babies.

The stomach contains hydrochloric acid- a strong powerful acid that helps breakdown food and protects against bacteria. The lining of the stomach is specifically adapted to protect it from powerful acid (but the esophagus is not protected).

Acid reflux is a condition in which acidic gastric fluid flows backward into the esophagus (It is a muscular tube connecting the throat, more specifically the pharynx, with the stomach. The esophagus is 8 inches long and is lined by moist pink tissue called the mucosa. The esophagus runs behind the windpipe called the trachea and the heart and lies in front of the spine. If the mouth is the gateway for the foods and drinks to enter, then the esophagus is the highway for the foods and drinks to travel to the destination- the stomach. This is the simple function of the esophagus, but having many possible disorders).

Sometimes the acidic fluid travels even up to the throat irritating the lining tissues. Acid reflux results in the most common symptom heartburn which is nothing but discomfort in the lower chest area (particularly after eating). Despite the name, heartburn has nothing to do with the heart. Pyrosis is a medical term for ‘heartburn’ (But heartburn is a popular non-medical term).

Conclusively, If acid reflux symptoms occur more than twice a week, one may have acid reflux disease known as GERD (Gastro-esophageal Reflux Disease. The disease is caused by acid reflux back into the esophagus. Some common foods and drinks we take, stimulate acid secretion from the stomach triggering the primary symptom of heartburn).

2. Causes and risk factors


Causes are the agents directly responsible for the occurrence of a disease. On the other hand, a risk factor is not necessarily a cause. A risk factor may be anything that increases the likelihood for a patient to develop the disease (For instance, aging and sedentary lifestyle are vital risk factors for most of the diseases including acid reflux. But they cannot cause)

2.1) Causes of acid reflux


Acid reflux occurs when the upper part of the stomach and LES (Lower Esophageal Sphincter is a bundle of muscles lying at the lower end of the esophagus where it meets the stomach) move above the diaphragm (It is a thin skeletal muscle that sits at the base of the chest. It separates the chest from the abdomen. Skeletal muscles are under voluntary control stimulated by the brain and somatic nervous system). The diaphragm is the muscle wall separating the stomach from the chest.

Hiatal Hernia is the root cause of acid reflux. It occurs when the junction between the esophagus (the food tube) and the stomach (where the food stays) slips up to the chest. A hole in the diaphragm allows the upper part of the stomach to enter the chest cavity, sometimes leading to GERD.

When the digestive mechanism works correctly, the diaphragm normally helps keep acid from rising into the esophagus. But if one has Hiatal Hernia, it becomes easier for the acid to travel upward into the esophagus.

At the entrance of the stomach, there lies the LES (which is a ring of muscles) that normally acts as a valve to let the food into the stomach, but not back up to the esophagus. LES closes as soon as the food passes through it. But, when the valve fails,  the stomach contents (including the hydrochloric acid produced by the stomach) are regurgitated into the esophagus triggering various symptoms, primarily chest pain- which is popularly known as ‘heartburn’.

Acid reflux can be aggravated by a host of factors that include: diet/lifestyle/medication/ health condition (such as, pregnancy and obesity).

2.2) Risk factors of acid reflux


risk factors of acid reflux

 

The 3 major risk factors that trigger the symptoms of acid reflux are obesity/ smoking/ alcohol. All the 3 risk factors can be avoided/ controlled by following a healthy lifestyle. These are stated below.

2.2.1) Obesity

Obesity (which is a risk factor for many diseases including acid efflux) )is measured in terms of BMI (Body Mass Index) = over 30.

Where, BMI is defined as (BMI= W/H2. W=weight in kg. And H2= square of height in meter. For instance, assuming average height= 1.7 meters, a person having BMI over 30 will be considered obese).

Excessive body weight (as compared to height) increases abdominal pressure making the stomach having acid leakage.

2.2.2) Smoking

Smoking (as well as alcohol) is an expensive bad habit that has no social recognition. That is branded as a silent killer as it acts as a great risk factor for most of the malignancies. Only due to smoking-related diseases, on average 1 person dies every 10 seconds in the world (according to the World Health Organization).

Nicotine - a key part of tobacco, is thought to relax the muscle ring in the lower esophagus triggering acid contents lying in the stomach. When the ring relaxes, acid runs up from the stomach causing a burning sensation in the chest as well as the throat.

Conclusively, smoking damages mucous membrane/ impairs muscle function in the throat/ increases acid secretion/ reduces LES muscle function/ interferes with normal salivation needed to neutralize the effect of acid.

2.2.3) Alcohol

Alcohol is another harmful and expensive bad habit. So far as the impact of alcohol on acid reflux is concerned, it affects different people differently.

Lying flat immediately after drinking, can increase the risk to experience acid reflux. This is because alcohol can relax the lower part of the esophagus making it easy to cause acid reflux.

Other risk factors that trigger the symptoms of acid reflux include:

  • Lying down right after a meal (particularly after heavy meal)

  • Eating rich, spicy, fried foods in addition to citrus fruit, tomato, chocolate, garlic, onion (that worsen the symptoms of acid reflux)

  • Regularly taking carbonated drinks

  • Certain medications, such as antibiotics (tetracycline), Alendronate (Fosamax), Ibandronate (Boniva), Risedronate (Actonel) and iron supplements.


3. Symptoms of acid reflux


Symptoms are subjective phenomena observed and experienced by the patient (while signs are objective phenomena detected by the doctor through suitable test results). That is experienced by the patient include:

3.1) Bloating

Bloating occurs when the belly feels swollen after eating. It is usually caused by excess gas production or disturbances in the movement of muscles in the digestive system. Bloating can invite pain/ discomfort/ uneasy feelings in the stomach. It can also make the stomach look bigger.

Stomach bloating may persist hours after a meal. In addition to acid reflux, other contributing factors that arouse bloating include food allergies, lactose intolerances, and digestive disorders.

To relieve bloating, one may abide by the following rules

  • Go for a walk

  • Try yoga poses

  • Do abdominal massage

  • Use essential oils

  • Take a warm bath

  • Increase fiber consumption

  • Take digestive enzyme supplements

  • Take gas relief capsules

  • Stay away from constipation

  • Avoid eating a large meal at a time

  • Avoid food allergies and intolerances

  • And avoid drinks that make swallowing air and gases.


3.2) Burping or Belching


Burping is mostly caused by swallowing excess air. Most often, the air never reaches the stomach, instead, it accumulates in the esophagus. One may swallow excess air if he eats or drinks too fast.

Soda, beer all other bubbly drinks are made with gas (carbon dioxide). Consuming the drinks adds extra gas into the stomach, which finds its way back up in the same way it entered through the mouth. Sipping them causes one to swallow air and could bring about of belching.

Burping or belching is the body’s natural way to expel excess air (from the stomach swallowed before). Burping brings normal relaxation.

Remedial measures to check to burp are almost the same as (those for bloating). Additionally, one needs to eat and drink slowly. In that case, it is less likely to swallow excess air.

3.3) Heartburn


It is a burning pain or discomfort that moves from the stomach to lower chest (after eating) and sometimes even up to her throat.

3.4) Regurgitation


It is a condition with a sour or bitter-tasting of acid raveling up to the throat or mouth.

3.5) Dysphagia


It is one of the major symptoms that also act as a health complication. It refers to difficulty while swallowing certain foods and drinks.

3.6) Wheezing


With acid reflux, the stomach acid that creeps into the esophagus, can enter the lungs particularly during sleep and cause swelling of the airways. Such airway damage can affect breathing in terms of coughing or wheezing.

With air reflux, the stomach acid gets into the lungs directly. The acid irritates the airways that make one wheeze, cough and feel tightness in the chest.

3.7) Hoarseness or chronic sore throat


If acid reflux gets past the upper esophageal sphincter, it can enter the pharynx and even the voice box ‘larynx’ causing hoarseness or sore throat. (Pharynx is the part of the throat behind the mouth and the nasal cavity and above esophagus and larynx. The upper portion of the trachea is known as larynx. The larynx extends from the base of the skull until it becomes continuous with the esophagus).

3.8) Dry mouth


It is another symptom of acid reflux when the salivary gland is affected. In consequence, less saliva (than normal) oozes out leading to a feeling of dry mouth.

3.9) Hiccup


It is an involuntary action involving a reparatory spasm. It triggers the contraction of the diaphragm followed by the closure of vocal cords which results in the classic sound Hic.

3.10) Nausea


People with acid reflux, often experience a sour taste in the mouth due to stomach acid. Frequent burping (belching) associated with sour taste can create nausea and even vomit in some cases. (Nausea and vomiting are not the same. Nausea is a repetitive feeling of discomfort. As if evacuating the bowel of its contents through the mouth will relieve the patient. Whereas, vomiting may be caused by food poisoning).

4. Diagnostic tests of acid reflux


Diagnosis is identifying the root problem through applying various tests, observing symptoms and additionally interrogating the patient about his feelings, observation, genetic history and personal history including his lifestyle.

To confirm the diagnosis of GERD (or to check for the complications), The doctor might recommend the upper endoscopy. The endoscopy may detect the inflammation of the esophagus.

Upper endoscopy (also known as EGD) is a procedure in which a thin scope (with a light and camera at its tip) is used to look inside the upper digestive tract (the esophagus/ stomach/ first part of the small intestine).

5. Health complications


 Severe health complications that crop up in the wake of acid reflux are stated below.

5.1) Dysphagia

It is a medical term for swallowing difficulty. Some people with dysphagia, have the problem of swallowing certain foods or liquids. While others can’t swallow at all. Other signs of dysphagia include: coughing or chocking (while eating or drinking) and bringing back foods up and sometimes through the nose.

5.2) Odynophagia 

It is the medical term for painful swallowing (felt in the mouth/ throat/ esophagus). One may experience painful swallowing while drinking or eating foods. Odynophagia is mainly caused by acid reflux tumors or injuries. Additionally, it may cause breathing or chest pain.

5.3) Anemia

Over time, chronic acid reflux (otherwise known as GERD) can erode the esophagus and in consequence, cause bleeding and iron deficiency. As such, anemia can develop due to blood loss.

5.4) Gastrointestinal bleeding

It is also known as gastrointestinal hemorrhage. It includes all types of bleeding in the gastrointestinal tract beginning from the mouth to the rectum. Often a significant amount of blood loss occurs within a short time.

Stomach acid that returns or refluxes back into the esophagus (from the stomach) can cause irritation and inflammation of the esophagus leading to bleeding.

5.5) Acid reflux is a chronic relapsing condition associated with morbidity and poor quality of life.

6. Types of acid reflux


Type of any disease is determined by the signs, symptoms, causes, risk factors and more importantly, the body part where it affects.

Acid reflux disease (GERD) is a chronic condition that develops when gastric contents (in the stomach) reflux back into the esophagus causing typical symptoms of heartburn as well as other symptoms. This reflux may appear with or without mucosal erosion and other complications. Acid reflux disease (GERD) may be classified into the following types.

6.1) NERD (Non-erosive Reflux Disease) 

It is a subcategory of GERD characterized by reflux-related symptoms without having esophageal erosions/ breaks (which are observed in the conventional endoscopy). NERD patients are less responsive to PPI therapies (PPI or Proton Pump Inhibitors are medicines with a name that end in ‘Prazole’. PPI are medicines that lower the production of acid in the stomach. They are used to treat acid reflux in addition to other conditions, such as an ulcer).

6.2) EER (Extra-esophageal Reflux )

When GERD manifests itself atypically as respiratory/laryngopharyngeal/nasopharyngeal/cardiac or silent symptoms, it is referred to as EER. Some of the atypical symptoms are stated below.

6.2.1) Laryngitis

It is characterized by chronic cough /hoarseness/ voice disturbances. It is inflammation of larynx i.e. vocal box. Symptoms can begin suddenly and usually get worse within 2-3 hours.

6.2.2) Bronchitis

It is the inflammation of bronchial tubes (the airways that carry air to the lungs). It causes a cough that often brings up mucus. Bronchitis can also cause shortness of breath/ wheezing/ chest tightness/ low fever.

6.2.3) Asthma

Under the condition, the bronchial tubes or airways allow air to come in and out of the lungs. In asthma, the airways are always inflamed and sometimes get more swollen. And the muscles around the airways can tighten when swelling triggers the symptoms.

6.2.4) Recurrent Pneumonia 

A common cause of recurrent pneumonia is asthma. Recurrent pneumonia will be confirmed when at least 2 pneumonia episodes during 1 year or at least 3 during the lifetime occur.

6.2.5) Sleep apnea

Under the condition, the breathing stops for a while during sleep. know more about sleep apnea

6.2.6) Acid erosion of teeth

Tooth erosion occurs when acid wears away the enamel of the teeth.

6.2.7) Chest pain

The most non-cardiac chest pain is related to the esophagus caused by acid reflux disease (GERD).

6.2.8) Abnormal heart rhythm

With GERD, one may feel tightness in the chest so that air is trapped in the esophagus causing palpitations.

All forms of EER are the outcome of the rapid transit of gastric contents to the esophagus (and even up to the larynx/ bronchi/ lungs/ sinuses). This category of reflux disease might occur in association with other appearances of reflux disease in the esophagus.

6.3) Silent Reflux


It is the reflux that does not produce typical symptoms. The condition has been called the silent killer. Because undisguised chronic reflux can lead to BE (Barrett’s Esophagus) or ‘Esophageal cancer’. It is thought to be the result of chronic GERD. But it usually occurs in the lower esophagus.

Conclusively, BE develops as a result of mucosal destruction and tissue transformation (associated with bile damage to esophageal tissue). If left untreated or unidentified, it can invite esophageal cancer.

7. Prevention


Prevention is better than cure. Because, preventive measure involves the least cost in terms of money, cares and anxieties. To cure the disease, medication or surgery involves a huge cost in terms of side effects as well as monetary expenses. But prevention has none. The following preventive measures may significantly help overcome the symptoms.

7.1) Avoid overeating

Overeating can trigger heartburn. Because the stomach gets distended when there are large quantities of food in it. There is a muscle between the esophagus and the stomach. When the muscle is not closed, it fails to prevent food and stomach juices from rising back up to the esophagus.

7.2) Lose excess weight 

Obesity exerts abdominal pressure upon the stomach increasing the likelihood of acid leakage.

7.3) Avoid tight dress

Wearing tight pants/ trousers (around the stomach) can trigger acid reflux. It happens when the valve (at the lower end of the esophagus) is abnormally relaxed and allows the stomach’s acidic contents to flow back into the gullet.

7.4) Stay away from stress

Stress can also deplete the production of substances called prostaglandins (This normally protects the stomach from the effects of acid . Stress could aggravate feelings of abdominal discomfort)

Conclusively, stress coupled with exhaustion may lead to increased acid reflux.

7.5) Avoid foods and drinks that trigger acid reflux

It is important to avoid fried and fat-rich foods which cause LES to relax allowing more stomach acid to return into the esophagus. Eating fried and fat-rich foods puts one at greater risk for reflux symptoms.

It is equally important to avoid the drinks (such as, citrus fruit juice including lemon as well as orange juice which are very acidic) that trigger acid reflux symptoms.

8. Cure of acid reflux


To cure and treat a disease, there are various options, such as home remedies, medications, and surgery. Whatsoever, the signs, symptoms and diagnostic test results affect the treatment procedures to a large extent.

As the 1st line of defense, treatment procedure for any disease emphasizes a healthy lifestyle eating healthy foods and drinks and avoiding those that worsen the symptoms.

8.1) Food menu (Acid reflux friendly diets)



  • Cereal/ oatmeal/ quinoa/ bread/ pasta/ brown rice

  • Fruits (Banana/ apple/ pineapple/ watermelon. Banana is a low acid fruit and hence can curb acid reflux by coating an irritated esophageal lining and thereby helping to reduce discomfort)

  • Salad greens/ steamed broccoli/ other fresh green vegetables.

  • Skim milk and low-fat yogurt

  • Lean meat  

  • Skinless chicken

  • Egg white (Stay away from egg yolk which is high in fat and may worsen acid reflux symptoms)


8.2) Sleep position/ physical activities/ other activities


8.2.1) Elevating head of the bed during sleep

Sleep is an important and integral part of our daily life. In general, we spend about 1/3rd of the whole day (8 hours) on enjoying sleep. Quality sleep (free of stress and anxieties) is essential for a quality life. But sleep position is also an important matter to counter the symptoms of acid reflux.

Elevating the bed (during sleep) is an effective lifestyle treatment to fight acid reflux. It is suggested to insert a wedge between the mattress and the box spring to elevate the body from waist up. Just using additional ordinary pillows will not be effective.

The height of the bed head elevation must be at least 6 inches to check gastric contents on account of acid reflux.

In a research study (published in 2012 in the Journal of Gastroenterology and Hepatology ), the researchers found that when a group of patients (experiencing acid reflux symptoms) slept for 1 week in bed with the bed head raised 8 inches, the bed head elevation significantly reduced the esophageal acid exposure.

Additionally, if sleeping lying on the back is uncomfortable and contrary to normal habit, then the best option is to sleep on the left side. The left side sleep allows gravity to work well on the organs.

8.2.2) Physical activities

Regular physical exercise may help prevent or relieve the symptoms of acid reflux by helping lose weight and support the good digestive system. In this connection, it needs to be mentioned that exercise with vigorous-intensity (such as running) should be avoided as it provokes and worsens the acid reflux symptoms. Exercise with low intensity (such as walking/ light jogging/ swimming) will improve the symptoms. For instance, walking is good as it keeps the body upright allowing gravity to aid digestion.

8.3) Medication


Medications include:

  • PPI (Proton Pump Inhibitors): PPIs include: Omeprazole/ Rabeprazole/ Esomeprazole

  • H2 Blockers (that include Cimetidine / Ranitidine /Famotidine)

  • OTC (Over the Counter treatment, such as antacids)

  • Alginate drugs 


Conclusively,

  1. PPIs are effective to heal irritation of the esophagus (tube between the throat and the stomach). But in most of the cases, PPIs are not needed for heartburn

  2. PPI s and H2 Blockers decrease acid production and reduce the potential damage caused by acid These medications are mostly safe and effective. But they are not appropriate for all types of patients suffering from acid reflux. In some cases, side effects may crop up in terms of malnutrition.

  3.  For people experiencing heartburn/ indigestion (arising on account of foods and drink triggers), OTC treatment to reduce acidity may be used. Antacids (in tablet and liquid form) are available that provide rapid but short term relief to fight acidity.


8.4) Anti-Reflux Laparoscopic Surgery


The surgical procedure is also known as Nissen Fundoplication which is used in the treatment of GERD where medication fails to treat the disease.

Anti-Reflux Laparoscopic Surgery is a Minimally Invasive Procedure (It is a surgical procedure which is carried out by entering the body through the skin or anatomical opening with minimum possible damage to the structures. Most of the surgical procedures administered are minimally invasive) that connects the gastroesophageal reflux by creating an effective valve mechanism at the bottom of the esophagus. This is the standard surgical treatment for GERD.

The surgical procedure tightens and reinforces the LES. The upper part of the stomach is wrapped around the outside of the lower part of the esophagus to strengthen the sphincter (It is a circular muscle that normally maintains constriction of a natural body passage. Sphincter relaxes as required by normal physiological function).

The laparoscopic surgery is administered by creating one or more incisions using small tubes, tiny cameras, and surgical instruments. In the procedure, surgery is performed by using thin needles and an endoscope to visually guide the surgery.

Surgical risks 

Like most of the operations, the surgery of the esophagus has some risks. Short term risks involve a reaction to anesthesia/ excess bleeding/ infection/ blood clot in the lungs or elsewhere.

Conclusively, most people will have at least some pain after the operation which can, however, be mitigated with pain medications. In general, a Minimally Invasive Procedure is associated with less pain, shorter hospital stay, and the least complications.

9. Acid reflux in babies / in women (during pregnancy/ in the throat) has been separately discussed as those arouse greater concerns.


Acid reflux in babies

9.1) Acid reflux in babies

Since acid reflux can occur at any age, so the babies are no exception.

9.1.1) Symptoms

It is a common symptom for the babies to spit up after a meal. The little spit oozing out from the little mouth indicates a strong symptom for GERD (Acid Reflux Disease).

Among the 10 most common symptoms, major symptoms include: spitting up and vomiting/ difficulty in feeding/ refusal to eat/ irritability during feeding.

In babies, GERD can cause upward movement of stomach contents (including acid into the esophagus and sometimes out of the mouth when vomiting becomes repetitive). However, the severity of GERD in babies varies in terms of lasting period.

9.1.2) Causes

As regards the causes of GERD among the babies, reflux occurs mostly due to poorly coordinated gastrointestinal tract. Many babies with GERD are otherwise healthy. However, some babies (with GERD) can have problems affecting their nerves/ brain/ muscles.

According to NDDIC (National Digestive Diseases Information Clearinghouse), a child’s immature digestive system can be attributed to their 1st day following the birth.

 (It seems essential to know the various stages of the digestive system that operate to know the genuine cause of acid reflux in people irrespective of babies/ adult/ old. The digestive system is uniquely designed to turn the food one eats into nutrients which the body uses for energy, growth and cell repair. The mouth is the entrance of the digestive tract.

The journey of the digestive tract starts as soon as one takes the 1st bite of food. And chewing breaks the food into pieces when it is more easily digested. While saliva – the liquid lying in the mouth, mixed with food, begins the process of breaking it down to be easily absorbed by the body. The throat is the next destination for food one eats. From here, food travels to the esophagus or swallowing tube. By the process of a series of contractions, known as peristalsis- the esophagus delivers food to the stomach. Just before the connection to the stomach, there is a zone of high pressure called LES  which acts as a valve meant to keep the food from passing back into the esophagus.

Then comes stomach which is a sac-like organ with strong muscular walls. In addition to holding food, it also acts as a mixer and grinder. The stomach secretes acids and powerful enzymes that continue the process of breaking the food. When it leaves the stomach, food then becomes the consistency of a liquid or paste. From there the food moves to the small intestine which is made up of 3 segments: the 1st part of the small intestine called duodenum / the part of small intestine lying just aside the duodenum called the jejunum. The 3rd and the final part of the small intestine is called the ileum. The small intestine is a 20 feet long tube loosely coiled in the abdomen).

Although the babies may have acid reflux, most of them do not require treatment. If the babies spit up after feeding but are gaining weight, sleeping well and are not found fussy, then there seems to be no problem. However, if major symptoms appear, then medical intervention is needed.

9.1.3) Treatment procedures to fight acid reflux among the babies include the following option:


9.1.3.1) Home remedies


9.1.3.1.1) One of the lifestyle changes that the parents need to make is to protect the family clothing and furniture from the spit-up. It is also essential to avoid putting the baby in tight draperies and constricting clothing.

9.1.3.1.2) Another important matter is how the parents position the baby after feeding. The best position is to carry the babies (after feeding) in an upright position. Any deviation from this position will make things worse.

9.1.3.1.3) After feeding, the baby may be placed in the infant carrier in an upright carried position. However, it needs to be mentioned that placing in the carrier in the perfect upright position, maybe allowed only when the baby is away, but under the strict observation.

9.1.3.1.4) Another positioning technique is to elevate the head of the baby’s crib at 30 degrees.

9.1.3.1.5) A tucker sling (with or without wedge) can be helpful to keep the body in a good position (during sleeping) to minimize the acid reflux symptoms. Again some babies are found spitting more when they drink large amounts in one sitting. Therefore, drinking a smaller amount (but more frequently) and following the correct position (after feeding) can considerably reduce the acid reflux symptoms.

9.1.3.1.6) Baby food formula to fight acid reflux

Most pediatricians recommend thickening the baby drinks. This can be done by adding 1 teaspoonful of rice cereal (for ½ ounce baby drink). Under the condition, the drink being thicker is less likely to travel upwards. For being thicker, the baby will drink less amount than before. So is advised to feed less amount, but more frequently.

Again a larger nipple is needed when the drink is thickened so that the baby can easily consume the thickened drink.

9.1.3.1.7) Another option is to consume the product Enfamil (Added rice) and Similac Sensitive (Rice starch)

9.1.3.1.8) Some experts recommend for use (on trial) Nutramigen (or Alimentum) for 2 weeks (in case of acid reflux having sign of milk protein allergy).

9.1.3.2) Medication


Even after sticking to lifestyle changes as well as correct baby food formulas, the mainstay of acid reflux treatments are medications which include the following

9.1.3.2.1) Antacids

Maalox / Mylanta are prescribed for short term use.

9.1.3.2.2) Histamine- 2 Receptor Antagonists

Drugs included are Zantac/ Axid/ Pepcid/ Tagamet.

9.1.3.2.3) PPI (Proton Pump Inhibitor)

The medicines include: Prevacid/ Prilosec/ Nexium/ Aciphex/ Protonix.

Other medications include Reglan/ Bethanechol. These are described as pro-kinetic agents. These medicines work faster. But they should be least used as they have multiple side effects.

Conclusively, Zantac is the only acid reflux medication approved by the US FDA (Food and Drug Administration) to treat acid reflux in babies. Zantac is a common 1st line treatment for babies with acid reflux. But if it proves ineffective, then it is essential to talk to the doctor.  

9.1.3.3) Surgical option


9.1.3.3.1) Fundoplication

For children having severe acid reflux symptoms (who don’t respond to effective medical treatment), fundoplication is a good surgical option. In the treatment procedure, the upper part of the stomach (the fundus) is wrapped around the lower part of the esophagus.

A pediatric surgeon along with a pediatric gastroenterologist can help determine whether the baby deserves treatment with fundoplication.

Side effects of the surgical procedure include: swallowing disorder/ increased bloating/ flatulence/ inability to belch or vomit. All these inhibit the success of the surgery.

Conclusively, in most cases, the surgical procedure is considered safe and effective, but having a lot of side effects.

9.1.3.3.2) New Scar-less Endoscopic Treatment

The procedure allows the fundoplication through the mouth with no stitches and no scars.

9.2) Acid reflux in women (during pregnancy)


During pregnancy, the hormone progesterone causes LES to relax. This can increase the frequency of heartburn in pregnant women. Heartburn, as well as indigestion, is more common during the 3rd trimester. Because the growing pregnancy puts pressure on the uterus and the stomach. Although rare, a gallstone can also cause heartburn during pregnancy.

(Progesterone is a female hormone that regulates the menstrual cycle and is crucial for pregnancy. The hormone is released by the corpus luteum- a hormone-secreting structure that develops in an ovary after an ovum has been discharged. 

LES is the Lower Esophageal Sphincter acting as a valve.

Pregnancy period is divided into 3 trimesters- the 1st trimester extends from the 1st to the 12th week of pregnancy period, the 2nd trimester stays from the 13th to the 26th week of pregnancy period and the 3rd trimester begins from the 27th week till the delivery. The fetus undergoes many changes throughout the pregnancy period).

To treat acid reflux during pregnancy, OTC (Over the available Counter medicines without referring to prescriptions) medicine Antacids (such as Tums/ Rolaids/ Maalox) may help cope with heartburn.

During pregnancy, magnesium-rich diets should be avoided. Because magnesium could interfere with contraction during labor.

During pregnancy, it is essential to eat daily several small meals with 3 hours gap (instead of sticking to 3 large meals a day). It is also essential to drink less while eating and also drink fluids between meals (but not during meals).

9.3) Acid reflux in throat


Instead of having heartburn, the harsh acid creates a burning sensation in the back of the throat. It can create a sour or bitter taste in the throat and the mouth. When acid reflux gets severer and more frequent (worsening to GERD), then one feels like food getting stuck in the throat.

When symptoms of acid reflux are experienced with a feeling of a hiccup (followed by a burning sensation in the throat and the chest), it is essential to loosen clothing/stand upright /elevate upper body/ drink water.

10. Key global information



  • Globally, 30% of adults suffer from some kind of GERD.

  • Globally, about 50% of babies spit up many times a day in the 1st 3 months of their lives and stop spitting between age 12- 14 months.

  • The most common symptoms of acid reflux are heartburn and acid regurgitation.

  • According to WGO (World Gastroenterology Organization), the prevalence of acid reflux disease is increasing worldwide.

  • Acid reflux disease affects about 20% population ( in USA), 4.1%- 7.3% population (in China) and 7.7% population (in Japan).


11. Popular questions and answers (Q= A= Answer)


11.1) Q: Why acid reflux symptom ‘heartburn’ has nothing to do with the heart?

      A: Although, the name heart is involved, ‘heartburn’ has nothing to do with the heart. Heartburn is a popular non-medical term for pain felt in the chest by burning sensation in the esophagus (lying close to the heart)

11.2) Q: Are acid reflux and acid reflux disease the same?

     A: Acid reflux and Acid reflux disease or GERD (Gastro-esophageal Reflux Disease) is not the same. But they are closely related. Acid reflux (or Gastro-esophageal reflux) is the backward flow of stomach acid into the esophagus when burning sensation in the chest ( in addition to the taste of sour liquid at the back of the mouth) is felt.

On the other hand, when the acid reflux symptoms worsen (occurring more than twice a week) and turn into severer form, one may have acid reflux disease (or GERD).

11.3) Q: Is milk good for acid reflux?

     A: Milk is well known as an ideal drink containing most of the food values (vitamins/ minerals/ nutrients). But it is also true that nutrients contained in milk (particularly fat), may stimulate the stomach to produce more acid. In that case, one may at best try fat-free skim milk.

11.4) Q: Can acid reflux kill the patient?

     A: Chronic acid reflux can invite the condition that increases the risk of developing esophagus cancer that can ultimately kill the patient.

11.5) Q: How can I make acid reflux go away immediately?

     A: If hiccup is felt followed by burning sensation (in the chest and the throat), then: loosen clothing/ stand up straight / elevate the upper part of the body.

12. Concluding remarks



  • Heartburn has nothing to do with the heart. Veritably, heartburn is a popular non- medical term for chest discomfort that occurs as a primary symptom of acid reflux.

  • As one grows older, other contributing factors come into play that makes the acid reflux symptoms worse and severer.

  • Acid reflux is a chronic condition. Once begins, it becomes lifelong (if here is an injury in the lining of the esophagus).

  • Acid reflux is a common and curable disease that is considered not serious. But serious complications may arise if the right treatment at the right time is not done.


10. TIPS



  • A=ACID (reflux occurs when the junction between esophagus and stomach slips up to chest)

  • C=CHEST(pain or heartburn is a primary symptom of acid reflux. It has no relation with heart)

  • I= IF(acid reflux symptoms occur more than twice a week, one may have acid reflux disease)

  • D=DIGESTIVE(mechanism if goes well, then diaphragm stops acid from entering esophagus)

  • R=REFLUX(that does not produce typical symptoms, then it is known ‘Silent Reflux’)

  • E=ESOPHAGUS(is the muscular tube connecting the throat with the stomach)

  • F=FOOS(that worsen the symptoms of acid reflux should be avoided)

  • L=LES(is a bundle of muscles at the lower end of the esophagus where it meets the stomach)

  • U=UNHEALTHY(foods/drinks should be avoided as the 1st line of defense against acid reflux)

  • X =X-RAY (in the chest along with other tests, may be needed to diagnose esophagus cancer)


 

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