What is Acid Reflux?

Acid reflux occurs when stomach acid flows back up into the esophagus — the tube connecting your mouth and stomach. This backflow is known as reflux. It can cause a burning sensation in the chest, commonly called heartburn.

When acid reflux happens more than twice a week or causes inflammation or damage to the esophagus, it may be diagnosed as GERD (Gastroesophageal Reflux Disease).

Causes of Acid Reflux:

1. Weak Lower Esophageal Sphincter (LES):

   • LES is a ring of muscle that acts like a valve between the stomach and esophagus.

   • If the LES relaxes at the wrong time or doesn’t close properly, stomach acid can flow back up.

2. Hiatal Hernia:

   • A condition where the upper part of the stomach pushes through the diaphragm.

   • Often contributes to reflux.

3. Delayed stomach emptying (gastroparesis)

4. Obesity:

   • Increases pressure on the abdomen.

5. Pregnancy:

   • Hormonal changes and abdominal pressure contribute to reflux.

6. Dietary and Lifestyle Factors:

   • Eating large meals

   • Lying down after eating

   • Smoking

   • Alcohol

   • Certain foods (see below)

Common Trigger Foods and Drinks:

• Spicy foods

• Fatty or fried foods

• Chocolate

• Citrus fruits (e.g., oranges, lemons)

• Tomatoes and tomato-based products

• Garlic and onions

• Caffeinated drinks (coffee, tea)

• Carbonated beverages

• Alcohol

• Peppermint

Symptoms of Acid Reflux / GERD:

• Heartburn – burning pain in the chest, especially after eating or lying down

• Regurgitation – sour or bitter-tasting acid backing up into your throat or mouth

• Difficulty swallowing (dysphagia)

• Chest pain – can mimic heart problems

• Chronic cough or sore throat

• Hoarseness or voice changes

• Sensation of a lump in the throat

• Bloating, nausea

Diagnosis:

1. Medical History & Symptom Review

2. Endoscopy (EGD) – to view and biopsy the esophagus

3. 24-hour pH monitoring – measures acid levels in the esophagus

4. Esophageal manometry – checks muscle function of the esophagus

5. Barium swallow X-ray

Treatment Options:

Lifestyle & Dietary Changes (First Line of Defense)

• Eat smaller, more frequent meals

• Avoid trigger foods

• Don’t lie down for 2–3 hours after eating

• Elevate the head of your bed by 6–8 inches

• Lose weight if overweight

• Quit smoking

• Avoid tight clothing around the abdomen

 Medications:

1. Antacids (short-term relief)

   • E.g., Tums, Rolaids, Maalox

2. H2 Blockers

   • Reduce acid production

   • E.g., Ranitidine (withdrawn in many countries), Famotidine (Pepcid)

3. Proton Pump Inhibitors (PPIs) – Most effective

   • Strongly reduce stomach acid

   • E.g., Omeprazole (Prilosec), Esomeprazole (Nexium), Pantoprazole (Protonix)

   • Long-term use should be monitored by a doctor

4. Prokinetics – Help empty the stomach faster

   • E.g., Metoclopramide (Reglan)

Surgical Options (for severe cases):

If medications and lifestyle changes fail:

• Fundoplication:

  • Most common surgery.

  • The top of the stomach is wrapped around the LES to strengthen it.

  • Can be done laparoscopically.

• LINX device:

  • A ring of magnetic beads is placed around the LES to reinforce it.

 Complications If Untreated:

• Esophagitis – inflammation of the esophagus

• Esophageal stricture – narrowing of the esophagus due to scarring

• Barrett’s esophagus – changes in esophageal lining, a precancerous condition

• Esophageal cancer (rare, but a serious risk with chronic GERD)

• Chronic cough, asthma, or dental erosion

Natural Remedies (Supportive, Not Primary Treatment):

• Aloe vera juice (low-acid, natural anti-inflammatory)

• Chewing gum (stimulates saliva to neutralize acid)

• Licorice root (DGL) – may soothe esophageal lining

• Ginger tea – may help with digestion and inflammation