Causes, Symptoms, Diagnostic and Treatment

Acid reflux or heartburn occurs when the stomach’s acidic contents go back into the oesophagus. Typically, this happens after eating and results in burning pain in the lower chest. The point at which food enters the stomach in the human body is marked by a ring-like structure of muscle called the Lower Esophageal Sphincter (LES). After all the food has passed into the stomach, the LES closes up the opening through which this passage happens. Its function is to prevent the hydrochloric acid present in the stomach from moving up into the esophagus. This acid helps to break down food and protects the stomach from pathogens such as bacteria.

The hydrochloric acid of the stomach may flow upwards if the LES does not close properly or opens up too often. This causes an ‘Acid Reflux’. If the symptoms of acid reflux occur more than twice a week, it may develop into a disease called Gastro Esophageal Reflux Disease (GERD). Thus, recurrent acid reflux must not be ignored.
It is extremely important for GERD to not go untreated to inhibit serious complications. One of them is esophagitis, which is inflammation of the esophagus, and is characterised by a major narrowing of the esophagus. Another complication is Barrett’s Esophagus (BE). In this, the stomach acid that flows into the esophagus causes cells in its lining to resemble cells in the lining of the stomach. This may ultimately lead to cancer in the esophagus called esophageal adenocarcinoma.  

What Causes Acid Reflux?

There are several conditions that increase one's predisposition to developing acid reflux:

•    Stomach abnormalities: A common cause of acid reflux is a condition called hiatal hernia wherein the upper portion of the stomach and the LES move above the diaphragm. A hiatal hernia makes the flow of stomach acid into the oesophagus more convenient
•    Pregnancy: An increase in hormonal levels and pressure from the growing foetus may increase the possibility of acid reflux
•    Scleroderma: This is a disease that scars the connective tissue of the body. It causes food to move more slowly through the digestive tract. It also prevents the LES from closing properly
•    Smoking: It develops a number of risk factors such as impairing muscle reflexivity in the throat, increasing stomach acid secretion and affecting the functioning of the LES
•    Acidic food: Excessive consumption of food that increases the risk of acid reflux such as carbonated and caffeinated beverages, fatty and spicy food, chocolate, citrus fruits, and alcohol
•    Overeating: Eating large quantities of food in one go or lying down right after a meal may also trigger certain symptoms of acid reflux, such as heartburn. It is ideal to eat several small meals throughout the day rather than a few large ones. One must rest only after two or three hours of having meals or elevate the head with pillows when lying down. It follows from this that snacking right before bed should be avoided
•    Medication: Being on certain kinds of medication may lead to side-effects in the form of acid reflux. Some of these are pain relievers like the common ibuprofen or aspirin, antihistamines for allergies, anti-depressants, antibiotics, blood pressure drugs, and sedatives
•    Obesity: Being overweight or obese may also trigger acid reflux. Extra abdominal fat puts pressure on the stomach, causing acid to move upwards. Obese people also have more circulating estrogens, which is linked to GERD symptoms.

Symptoms of Acid Reflux

•    One of the most common symptoms of acid reflux, heartburn is a burning sensation most often felt in the chest. This may make its way up from the abdomen via the stomach and can even be felt in the throat
•    The taste of a sour or bitter acid moving up into the back of the mouth from the throat. This is called regurgitation
•    The feeling that food is stuck in the throat. This is caused by a narrowing of the oesophagus called dysphasia
•    Bloody or black stools and/or vomiting
•    Excessive bloating, burping, hiccups and/or nausea
•    Discomfort in the throat; such as a chronic sore throat, wheezing, dry cough and/or hoarseness

How does one differentiate between manifestations of everyday heartburn and bloating, and the more serious symptoms of GERD? It has been observed that some people are more sensitive to changes in their digestive behavior.

A new study conducted at the Federal University of Sao Paolo, Brazil, has revealed that there are more intimate relations between mental and digestive health than one may imagine. Patients of anxiety, depression and other mental health issues are overly sensitive to feelings of pain. When it comes to GERD, which is a frequent digestive health issue; an interesting relationship between the degree of anxiety and level of hydrochloric acid in the esophagus was discovered.  The more anxious a patient was, the lesser was the actual damage to the esophageal lining.

Diagnosing Acid Reflux

Acid Reflux is relatively easy to diagnose. The usual impediment to its diagnosis is that it is confused with other chest complaints such as heart attack, pneumonia, the pain of the chest wall and pulmonary embolus.  Acid reflux is diagnosed as GERD if the symptoms do not subside even after certain lifestyle changes and medication.
Acid reflux is usually diagnosed by a primary care doctor, or gastroenterologist, by simply evaluating the frequency and severity of symptoms. But how does one know when to see a doctor? Usually, self-medication such as antacids does work for heartburn, which is the most common symptom of acid reflux. If they fail and symptoms persist for two or three times a week, one must seek medical advice.

If needed, a doctor will order tests, some of which are:

•    Barium Swallow or Esophagram: This procedure requires the patient to swallow a solution that makes it easy to detect changes in the esophagus on an X-Ray image. These changes could be the growth of an ulcer or a narrowing of the esophagus
•    Esophageal Manometry: This procedure is conducted to check the strength and coordination of the muscles of the esophagus involved in the act of swallowing
•    pH Monitoring: This test checks the level of acidity in the esophagus. The doctor installs a device in the esophagus for one to two days to measure the amount of acid in the oesophagus
•    Impedance Monitoring: This test measures the rate at which fluid flows along the oesophagus
•    Endoscopy: This procedure involves the insertion of a long, flexible and lighted tube that carries a camera. This camera moves down the throat for a detailed view of the esophagus. This allows identifying how frequently acid reflux occurs. To make this process easier for the patient, the doctor sprays the back of the throat with anesthetic and administers a sedative
•    Biopsy: A biopsy is taken as part of endoscopy to check tissue samples extracted from the esophagus. These are then examined under a microscope for infections and abnormalities

Treatment of Acid Reflux

The easiest and most effective way to treat acid reflux involves certain changes in lifestyle and diet. Some of them are avoiding foods and beverages that trigger symptoms, eating smaller meals and more frequently, quitting smoking, sleeping with the head at an elevation, avoiding tight clothes, and taking steps to lose weight if one is overweight.
Over-the-counter medicines also help relieve acid reflux to a great extent, especially when combined with these lifestyle changes. These include antacids such as GasoFast that effectively neutralizes the hydrochloric acid. This prevents it from moving up from the stomach to the esophagus. The most effective antacids are those that contain both magnesium hydroxide and aluminium hydroxide.  

In the case where these over-the-counter antacids do not work, medicines prescribed by the doctor may be required. Some of them are:

•    Foaming agents such as Gaviscon which coat the stomach, thus preventing reflux
•    H2 blockers such as Zantac that decrease the production of hydrochloric acid in the stomach. Proton-pump inhibitors such as Prevacid also do the same thing
•    Prokinetics such as Reglan that strengthen the LES, empty the stomach faster and reduce acid reflux
In some rare cases when the symptoms of acid reflux are too acute, surgery has proved to be of help.  Surgical treatments for acid reflux are of broadly two types:
•    A ring called LINX device is surgically placed at the lower end of the esophagus. It acts as a barrier for the acid to move up into the oesophagus
•    Fundoplication is a procedure that wraps the upper part of the stomach around the LES to strengthen it. This not only prevents acid reflux but also repairs a hiatal hernia

For instant relief from the symptoms of acid reflux, a number of home remedies are available. But you may not have the time to prepare a concoction when discomfort takes over you. For such times, choose Gas-O-Fast for fighting the condition quickly and naturally. Combining the goodness of natural ingredients with Ayurveda, Gas-O-Fast loses no time in neutralizing acidity in the stomach.