Acid reflux is commonly called Gastroesophageal Reflux Disease. It is the spilling of the stomach contents, (food, acid, pepsin, bile acids, and pancreatic enzymes) into the esophagus. A small amount of spilling of stomach contents happens in all individuals, especially after meals. Only when symptoms and complications occur is it considered a problem.
When the esophagus is exposed to the acidic stomach content repeatedly and for long periods of time inflammation of the esophagus occurs (reflux esophagitis) and this can progress to erosion of the esophagus (erosive esophagitis). Interestingly, acid reflux is not generally caused by too much acid in the stomach but by the acid remaining too long in the esophagus.
Acid Reflux Symptoms
In many cases acid reflux is due to a defective lower esophageal sphincter pressure. The esophageal sphincter is a group of muscles at the bottom of the esophagus which relaxes and opens to allow food into the stomach after swallowing and then increased pressure in the muscles closes the sphincter to prevent the stomach contents from going back up into the esophagus. Problems arise when the sphincter spontaneously relaxes and opens at times that it shouldn’t, when increased pressure from the stomach overpowers the pressure in the sphincter forcing stomach content up into the esophagus, or when the sphincter has a naturally low pressure.
Spontaneous relaxation of the sphincter and lowered sphincter pressure can be caused by high fat content in food, smoking, certain medications and too large a meal causing distension of the stomach. Foods that can lower sphincter pressure are peppermint, spearmint, chocolate, fat, coffee, cola, tea, citrus juices, onions and garlic.1
Other causes of acid reflux symptoms may come from poor protection of the esophagus by the mucosal lining in the esophagus, slow esophageal emptying, slow stomach emptying or a hiatal hernia.
Because there are a large number of factors which can cause acid reflux and these factors can be worsened by acid reflux itself, it is difficult to know which came first the acid reflux or the events which contribute to it. Because it is a cyclic process it is important to treat the condition when it occurs frequently to prevent worsening of the disease.
Acid Reflux Causes
• Non-allergic asthma symptoms such as wheezing
• Chronic cough
• Chest pain (may feel like angina)
• Dysphagia (discomfort in swallowing)
Acid Reflux Medication
Treatment of Acid Reflux is aimed at:
• Getting rid of symptoms
• Decreasing the frequency of acid reflux
• Promote healing of the damaged esophageal mucosa
• Prevent long term damage1
Therapy is directed at:
• Increasing the pressure in the esophageal sphincter
• Enhance esophageal acid clearance
• Increase speed of gastric emptying
• Protect esophageal mucosa
• Decrease acidity of the refluxed content
• Decrease gastric volume available to be refluxed1
Many patients are able to successfully self-medicate acid reflux. In other situations where symptoms are severe and frequent or complications have arisen such as erosive esophagitis, strictures or Barrett’s esophagus more intensive treatment is required.
Phase 1 – Lifestyle changes
• Smaller, more frequent meals
• Quit smoking
• Reduce caffeine intake
• Stress reduction
• Avoid foods that cause heartburn by (delaying gastric emptying or increasing acid exposure) i.e. chocolate, onions, spearmint, peppermint, fat, coffee, garlic, citrus juices
• Reduce alcohol intake
• Reduce fat intake
• Obtain ideal body weight
• Avoid lying down after meals
• Elevate the head of the bed approximately 10 cm (4 inches)2
• Avoid exercising on a full stomach
• Avoid tight fitting clothes around the waist
Over the counter antacids such as:
• Aluminum hydroxide
• Magnesium hydroxide
• Calcium hydroxide
• Sodium bicarbonate
Over the counter foaming agents:
• Alginic acid (Gaviscon)
• Sodium alginate (Gaviscon)
Over the counter H2 receptor antagonist:
Phase 2 – Lifestyle changes
Higher more frequent doses of an H2 receptor antagonist ranitidine, famotidine, cimetidine, nizatidine.
Proton Pump Inhibitors (Lansoprazole, Omeprazole, Pantoprazole, Rabeprazole)
Phase 3 – Surgery