Acid reflux is a condition where stomach acid flows back into the esophagus, causing a burning sensation or discomfort in the chest area.
The feeling of acid reflux is heartburn: a mild burning sensation in the mid-chest, often occurring after meals or when lying down.
The causes of acid reflux can be varied and as follows :
- Weak Lower Esophageal Sphincter (LES): The LES is a muscular valve that separates the esophagus from the stomach. When it weakens or relaxes inappropriately, stomach acid can flow back into the esophagus, leading to reflux.
- Hiatal Hernia: A hiatal hernia occurs when a portion of the stomach protrudes through the diaphragm into the chest cavity. This can disrupt the function of the LES, contributing to acid reflux symptoms.
- Dietary Triggers: Certain foods and beverages can trigger or exacerbate acid reflux symptoms. These may include fatty or fried foods, spicy foods, citrus fruits, tomatoes, onions, garlic, chocolate, caffeine, carbonated beverages, and alcohol.
- Obesity: Excess weight can put pressure on the abdomen, which may cause the stomach contents to be pushed up into the esophagus, leading to acid reflux.
- Smoking: Smoking can weaken the LES and increase acid production in the stomach, making reflux more likely to occur.
- Pregnancy: Hormonal changes and increased pressure on the abdomen during pregnancy can contribute to acid reflux symptoms in some women.
- Medications: Some medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), calcium channel blockers, antihistamines, sedatives, and certain asthma medications, can relax the LES or irritate the esophagus, leading to reflux symptoms.
- Delayed Stomach Emptying (Gastroparesis): When the stomach takes longer than usual to empty its contents, there is a higher likelihood of reflux occurring.
- Connective Tissue Disorders: Conditions such as scleroderma and systemic sclerosis can affect the connective tissues in the body, including those in the LES, potentially leading to acid reflux.
- Eating Habits: Eating large meals, lying down immediately after eating, or eating close to bedtime can increase the risk of acid reflux by putting pressure on the LES or allowing stomach contents to flow back into the esophagus more easily.
The prevalence of acid reflux varies across different populations and regions, but it’s estimated that approximately 10-20% of people in the Western world experience symptoms of gastroesophageal reflux disease (GERD) at least once a week. Globally, millions of individuals are affected by acid reflux, making it one of the most common gastrointestinal disorders worldwide.
Acid reflux is categorized into different conditions based on the underlying causes, these include;
Gastroesophageal reflux disease (GERD)
A more serious form of chronic acid reflux is called gastroesophageal reflux disease (GERD). It’s a chronic condition where stomach acid frequently flows back into the esophagus, leading to symptoms such as heartburn, regurgitation, and chest pain. It can result from a weakened lower esophageal sphincter (LES) or other factors, causing discomfort and potential complications if left untreated.
Laryngopharyngeal reflux (LPR)
Silent reflux, also known as laryngopharyngeal reflux (LPR), is a type of reflux where stomach acid flows back into the larynx (voice box) and pharynx (throat) without causing typical heartburn symptoms. It causes symptoms like hoarseness, chronic cough, throat clearing, and throat irritation. Unlike typical acid reflux, LPR often does not cause heartburn, making it challenging to diagnose without specific evaluation.
Non-Erosive Reflux Disease (NERD)
NERD refers to acid reflux symptoms without evidence of esophageal mucosal damage, as seen in GERD. Patients with NERD may experience typical symptoms of GERD but without visible changes in the esophagus during endoscopy.
Reflux Esophagitis
Reflux esophagitis is a condition where the lining of the esophagus becomes inflamed due to repeated exposure to stomach acid, often resulting in symptoms like heartburn, chest pain, and difficulty swallowing.
Barrett’s Esophagus
Barrett’s esophagus is a complication of chronic GERD where the normal lining of the esophagus is replaced by tissue similar to that found in the intestine. It is considered a precancerous condition due to its association with an increased risk of esophageal adenocarcinoma.
Diagnosis
Diagnosis of acid reflux conditions typically involves a combination of patient history, symptom assessment, physical examination, and diagnostic tests such as endoscopy, pH monitoring, and esophageal manometry. Gastroenterologists are specialists who primarily deal with the diagnosis and management of acid reflux disorders, while otolaryngologists (ENT)(ear, nose, and throat specialists) may be involved in cases of laryngopharyngeal reflux (LPR).
Prognosis
The prognosis for each acid reflux conditions varies depending on the specific diagnosis, severity of symptoms, and effectiveness of treatment. With appropriate management, including lifestyle modifications, medication, and in some cases, surgical intervention, many individuals can achieve symptom relief and prevent complications, although long-term adherence to treatment plans is often necessary for optimal outcomes.
The three main medications used to treat acid reflux include:
- Proton pump inhibitors (PPIs), such as omeprazole, esomeprazole, and lansoprazole, which reduce stomach acid production and promote healing of the esophagus.
- Histamine H2-receptor antagonists (H2 blockers), like ranitidine, famotidine, and cimetidine, which also decrease stomach acid production and help alleviate symptoms.
- Antacids, such as calcium carbonate (Tums), magnesium hydroxide (Milk of Magnesia), and aluminium hydroxide (Maalox), which neutralize stomach acid and provide rapid but short-term relief from heartburn and indigestion.
Long-term acid reflux, if left untreated or poorly managed, can lead to various complications, including:
- Esophagitis: Inflammation or irritation of the esophagus due to repeated exposure to stomach acid, which can cause pain, difficulty swallowing, and potentially lead to ulcers or bleeding.
- Esophageal Cancer: Chronic acid reflux can cause changes in the lining of the esophagus, leading to Barrett’s esophagus, a precancerous condition characterized by abnormal cellular changes and an increased risk of developing esophageal cancer.
- Esophageal Stricture: Scar tissue formation in the esophagus due to chronic inflammation can lead to narrowing (stricture), causing difficulty swallowing and increasing the risk of food getting stuck (food impaction).
- Respiratory Complications: Acid reflux can lead to aspiration of stomach contents into the lungs, potentially causing respiratory issues such as asthma, chronic cough, or recurrent pneumonia.
- Dental Problems: The regurgitation of stomach acid into the mouth can erode tooth enamel, leading to dental decay, cavities, and gum disease.
- Erosive Tooth Wear: Chronic acid exposure from reflux can lead to erosion of tooth enamel, resulting in tooth sensitivity, discoloration, and increased susceptibility to cavities.
- Strictures and Obstructions: In severe cases, long-term acid reflux can cause narrowing or strictures in the esophagus, leading to difficulty swallowing solid foods and increasing the risk of food getting stuck.
Summary
Acid reflux is something many people will experience due to how common it is in the general population. It is considered chronic when these symptoms occur at least twice a week or cause complications over an extended period, typically lasting for months or years, and is sometimes difficult to diagnose. There are many over the counter remedies for acid reflux, but a visiting a specialist is the best way to get a proper diagnosis and treatment plan. It’s common for people to just put up with heartburn issues, because symptoms might flare up and down over time, but there are various complications of this illness that make it advisable to definitely consult a specialist.
