What is Acid Reflux?

Acid reflux, also known as gastroesophageal reflux (GER), refers to the phenomenon where stomach acid or food flows back into the esophagus.

When the lower esophageal sphincter (LES) becomes relaxed or weakened, stomach acid or food can flow back into the esophagus, causing symptoms such as burning sensations in the throat or chest (heartburn), a bitter taste in the mouth, burping, nausea, and bloating. Many people experience acid reflux occasionally, especially after eating a large meal or lying down immediately after eating.

Almost everyone experiences acid reflux occasionally, but if it happens frequently, it may be a symptom of gastroesophageal reflux disease (GERD). In the United States, approximately 20% of the population suffers from GERD.

Treatment for acid reflux typically involves lifestyle changes and medication.

Types

Acid reflux is mainly classified into two types: gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD). The main difference between GER and GERD lies in the severity and frequency of symptoms.

Gastroesophageal Reflux (GER)

GER occurs when the lower esophageal sphincter (LES) relaxes, allowing stomach contents to flow back into the esophagus, causing symptoms such as burning sensations in the chest and throat, regurgitation, and burping. GER is common and is often triggered by consuming spicy or greasy foods, drinking carbonated beverages or juices, and certain medical conditions and medications. GER is also known as heartburn, regurgitation, acid reflux, and hyperacidity.

Gastroesophageal Reflux Disease (GERD)

GERD is a chronic condition of acid reflux that occurs when the symptoms of GER persist and cause damage to the esophagus. Besides the typical symptoms of GER, patients with GERD may also experience difficulties in swallowing, chest pain, chronic cough, and throat irritation. If not treated promptly, GERD can lead to complications.

Symptoms of Acid Reflux

Symptoms of acid reflux vary among individuals. Some people may experience no symptoms, while others may have common acid reflux symptoms, including:

• Burning sensations in the chest or throat, especially after eating, lying down, or bending over

• Regurgitation of stomach contents into the throat or mouth, causing a bitter or sour taste in the mouth

• Burping

• Bad breath

• Feeling of a lump in the throat

• Sore throat

• Bloating

• Nausea

• Dry cough

Causes of Acid Reflux

Acid reflux occurs when the lower esophageal sphincter (LES), a muscle at the bottom of the esophagus, relaxes or weakens at inappropriate times, allowing stomach contents (acid and food) to flow back into the esophagus. Various factors can cause or exacerbate the weakening of the LES and acid reflux, including:

• Obesity: Excess weight increases pressure on the stomach, forcing stomach acid to flow back into the esophagus.

• Hiatal hernia: A condition where part of the stomach protrudes through the diaphragmatic opening into the chest, causing weakening of the LES and leading to acid reflux.

• Pregnancy: Hormonal changes and increased pressure on the stomach from growing babies during pregnancy can cause acid reflux.

Risk Factors

Certain risk factors may increase the likelihood of acid reflux, including:

• Smoking

• Eating large meals

• Lying down or exercising immediately after eating

• Consuming certain trigger foods, such as spicy or acidic foods

• Certain medications, such as beta-blockers for heart disease or hypertension, sedatives for anxiety, antihistamines, and tricyclic antidepressants

• Stress

• Anxiety

• Poor sleep habits

Diagnosis

Acid reflux is usually diagnosed based on symptoms. If you experience acid reflux occasionally, you may be able to recognize the symptoms and use over-the-counter medications to relieve them.

Healthcare providers can diagnose acid reflux based on your symptoms, medical history, and physical examination. Occasional acid reflux usually does not require testing for diagnosis, but if it occurs more than a few times a week or if you have symptoms suggesting complications of GERD, healthcare providers may recommend testing. These tests can include:

• Upper endoscopy: A flexible tube with a camera is inserted through the throat into the esophagus and stomach to check for signs of tissue damage.

• Esophageal pH monitoring: A small capsule or catheter is inserted through the nose or mouth to measure acid reflux in the esophagus over a certain period (e.g., 24 hours).

• Barium swallow test: Also known as esophageal radiography, the examiner swallows a contrast agent containing barium sulfate. Barium sulfate can be visualized on X-rays, helping to identify any abnormalities or damage in the esophagus, throat, and stomach.

• Esophageal manometry: A thin, flexible tube is inserted through the nose or mouth into the esophagus to measure the strength and coordination of the muscles involved in swallowing.

Treatment for Acid Reflux

Treatment for acid reflux typically involves lifestyle changes and medications to control symptoms and prevent complications. If you experience acid reflux occasionally, healthy lifestyle changes and over-the-counter medications may be sufficient to control symptoms. For more frequent or severe acid reflux, your healthcare provider may recommend prescription medications.

Lifestyle Changes

Acid reflux can often be controlled through lifestyle changes, including:

• Avoiding trigger foods that cause symptoms, including spicy, acidic, and greasy foods (e.g., citrus fruits, mint, tomatoes or tomato sauce, fried foods, coffee)

• Eating smaller meals and avoiding large meals

• Losing weight if overweight

• Avoiding lying down or exercising within 2-3 hours after eating

• Elevating the upper body and head by 6-8 inches when sleeping (e.g., by placing blocks under the head of the bed)

• Quitting smoking and avoiding secondhand smoke

Medications

Many over-the-counter (OTC) medications may help relieve acid reflux symptoms, including antacids, H2-blockers, and proton pump inhibitors (PPIs). These medications may have side effects and can interact with other medications, so consult your healthcare provider before starting any new acid reflux medications.

• Antacids: These medications neutralize stomach acid and provide rapid relief from mild to moderate acid reflux symptoms. Over-the-counter antacids include calcium carbonate, magnesium hydroxide, etc.

• H2-blockers: These medications reduce the amount of stomach acid produced, helping to relieve acid reflux symptoms. H2-blockers may take longer to start working than antacids but have a longer duration of effect. Examples include cimetidine and famotidine.

• Proton Pump Inhibitors (PPIs): These medications block the enzyme that produces acid in the stomach, helping to reduce acid reflux symptoms. PPIs are usually taken once a day and are often more effective than H2-blockers in controlling acid reflux symptoms. Examples include omeprazole, esomeprazole, and lansoprazole.

If these medications do not effectively control your symptoms, your healthcare provider may prescribe other medications to help manage acid reflux.

Prevention

Lifestyle changes can help prevent or reduce the frequency of acid reflux:

• Maintain a healthy weight

• Avoid trigger foods (e.g., spicy, greasy, or acidic foods)

• Eat small meals throughout the day

• Wait 2-3 hours after eating before lying down

• Elevate the head of the bed by 6-8 inches

• Quit smoking or avoid secondhand smoke

• Limit alcohol and caffeine intake

Complications

Occasional acid reflux is normal and does not lead to complications. However, untreated long-term acid reflux (GERD) can damage the esophagus and lead to serious complications, such as:

• Esophagitis: Inflammation of the esophagus occurs when stomach acid frequently flows back into the esophagus, causing ulcers and bleeding in the esophageal lining.

• Barrett's esophagus: A condition where the esophageal tissue is replaced by tissue similar to the lining of the intestine, increasing the risk of esophageal cancer.

• Esophageal stricture: Narrowing of the esophagus due to damage and scarring from repeated exposure to stomach acid, leading to difficulty in swallowing.

Some people with GERD may experience complications in other parts of the body, such as:

• Respiratory problems, including chronic cough and asthma

• Erosion of tooth enamel

• Laryngitis (hoarseness) or loss of voice

Acid Reflux and Life

Occasional acid reflux is normal, and most people can control symptoms with over-the-counter medications such as antacids. Eating smaller meals, maintaining a healthy weight, and avoiding trigger foods (e.g., acidic or greasy foods) can help prevent acid reflux.

Frequent acid reflux is a symptom of gastroesophageal reflux disease (GERD), a more severe condition that requires medical diagnosis, treatment planning, and monitoring for potential complications. Most patients with GERD can control symptoms and prevent complications with appropriate treatment.

FAQs

What causes acid reflux?

Acidic or greasy foods, such as citrus fruits, tomatoes, chocolate, and fried foods, commonly cause acid reflux. Carbonated beverages, coffee, and alcohol can also trigger acid reflux. Lying down after eating a large meal or exercising vigorously can also induce acid reflux.

Learn more: Foods that may cause acid reflux

Will acid reflux go away?

Occasional acid reflux is normal and usually resolves spontaneously or with the use of over-the-counter medications such as antacids. Frequent or chronic acid reflux can be controlled with lifestyle changes and medication but usually does not disappear completely. Most patients with acid reflux can manage symptoms and prevent complications with appropriate treatment.

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