Acid Reflux Overview
Acid reflux is an extremely common health problem, affecting as many as 50 percent of Americans. Other terms used for this condition are gastroesophageal reflux disease (GERD) or peptic ulcer disease.
The hallmark symptom of acid reflux is “heartburn” a burning sensation behind your breastbone that sometimes travels up your throat. In some cases, this pain can be severe enough to be mistaken for a heart attack.
Conventionally, acid reflux is thought to be caused by excessive amounts of acid in your stomach, which is why acid-blocking drugs are typically prescribed or recommended.
This is a serious medical misconception that adversely affects hundreds of millions of people, as the problem usually results from having too little acid in your stomach.
What Causes Acid Reflux Disease?
One common cause of acid reflux disease is a stomach abnormality called a hiatal hernia. This occurs when the upper part of the stomach and LES move above the diaphragm, a muscle that separates your stomach from your chest. Normally, the diaphragm helps keep acid in our stomach. But if you have a hiatal hernia, acid can move up into your esophagus and cause symptoms of acid reflux disease.
These are other common risk factors for acid reflux disease:
- Eating large meals or lying down right after a meal
- Being overweight or obese
- Eating a heavy meal and lying on your back or bending over at the waist
- Snacking close to bedtime
- Eating certain foods, such as citrus, tomato, chocolate, mint, garlic, onions, or spicy or fatty foods
- Drinking certain beverages, such as alcohol, carbonated drinks, coffee, or tea
- Smoking
- Being pregnant
- Taking aspirin, ibuprofen, certain muscle relaxers, or blood pressure medications
Symptoms of Acid Reflux
Acid reflux is a fairly common condition that occurs when stomach acids and other stomach contents back up into the esophagus through the lower esophageal sphincter (LES). The LES is a muscular ring located in the digestive tract where the esophagus meets the stomach. The LES opens to allow food into the stomach when you swallow, and then closes to prevent stomach contents from rising up into the esophagus. When the LES is weak or damaged it may not close properly, allowing harmful stomach contents to back up into the esophagus, causing acid reflux symptoms.
According to the National Center for Biotechnology Information (NCBI), acid reflux affects more than 20 percent of Americans.
Symptoms can range from mild to severe. Reflux symptoms are more common:
- when lying down or bending over
- after a heavy meal
- after a fatty or spicy meal
Acid reflux can occur at any time of day. However, most people tend to experience symptoms at night. This is because lying down makes it easier for acid to move up into the chest.
See your doctor for testing if you:
- find yourself taking antacids on a daily basis
- experience acid reflux more than twice a week
- have symptoms that significantly affect your quality of life
Frequent acid reflux may indicate gastroesophageal reflux disease (GERD), a chronic, more severe form of acid reflux that can lead to serious health complications if it goes untreated.
Tests and Diagnosis of Gastroesophageal Reflux Disease
The first port of call for someone experiencing frequent acid reflux symptoms is the family doctor, who may refer on to a specialist in gut medicine, a gastroenterologist.
Gastroesophageal reflux disease is often diagnosed simply by finding no improvement in heartburn symptoms in response to lifestyle changes and acid reflux medication.
Gastroenterologists may also arrange the following investigations:
- Endoscopy (camera imaging)
- Biopsy (taking a tissue sample for laboratory analysis)
- Barium X-ray (imaging the esophagus, stomach and upper duodenum after swallowing the chalky liquid)
- Esophageal manometry (pressure measurement of the esophagus)
- Impedance monitoring (measuring rate of fluid movement along the esophagus)
- pH monitoring (acidity testing).
Are You Suffering a Drug Side Effect?
Besides these underlying conditions, please beware that certain prescription and over-the-counter (OTC) medications can also cause heartburn. Common culprits include anxiety medications and antidepressants, antibiotics, blood pressure medications, nitroglycerin, osteoporosis drugs, and pain relievers.
If your heartburn is caused by a medication you’re taking, the answer is, of course, to address what, when, and how you’re taking that drug. Please do not make the mistake of simply adding yet another drug to counteract this side effect. WebMD4 offers a number of helpful tips for how to address drug-induced heartburn, such as:
- Avoid taking more than the recommended or prescribed dose
- Some medications are best taken on an empty stomach, while others are less likely to cause side effects like heartburn when taken with a meal. Check the label for instructions, or ask your doctor or pharmacist for advise on when and how to take your medication
- Ask your doctor or pharmacist to review ALL the medications and supplements you’re taking to see if one or more of them cause heartburn.
- Changing the dose or switching to another medication may be advisable to ease your heartburn. Some drugs may be available in cream form rather than a pill, which would be far less likely to cause heartburn
- Avoid laying down right after taking your medication
- Drink some ginger tea
Treatment and prevention of Gastroesophageal Reflux Disease
The main treatment option for people who repeatedly experience acid reflux in gastroesophageal reflux disease is a class of drugs known as proton-pump inhibitors (PPIs for short).
The mode of action of proton-pump inhibitors is to reduce the damage caused by acid reflux by reducing the acidity of the stomach’s secretions – by blocking some of the acid production.12
Here is the full list of proton-pump inhibitors available on prescription in the US (brand names given followed by generic names, 2014):
- Aciphex (rabeprazole)
- Dexilant (dexlansoprazole)
- Nexium (esomeprazole)
- Prevacid (lansoprazole)
- Prilosec (omeprazole; also available in pharmacies without prescription)
- Protonix (pantoprazole)
- Zegerid (immediate-release omeprazole with sodium bicarbonate).
Proton-pump inhibitors are generally safe and effective, but like any prescription drug, they are not appropriate for all people with reflux disease and can cause side-effects.
They are blockbuster drugs – prescribed to millions and earning huge sums for pharmaceutical firms because of their common use.
Proton-pump inhibitors have superseded earlier drug therapies that were used for gastroesophageal reflux disease – H2 blockers (also known as H2-receptor antagonists). These were the first blockbuster drugs of modern medicine – Zantac (ranitidine), for example, was the drug that caused GlaxoSmithKline to soar into the top of the league of the pharmaceutical giants.
