Acid reflux disease is a condition in which stomach acid flow back into the esophagus.
Acid reflux disease, also known as gastroesophageal reflux disease (GERD), is a condition in which stomach acid persistently refluxes, or flows back, into the esophagus. Most people experience the burning pressure of heartburn every now and then, but persistent acid reflux requires a doctors care. A frequent burning pain in the chest is the most common symptom of acid reflux disease. Patients may also experience a sore throat and have difficulty swallowing.
Although the lower esophageal sphincter, which is a muscle around the lower part of the esophagus, normally closes after food and liquid flows into the stomach, this muscle weakens over time in some people. According to the Mayo Clinic, excess weight can contribute to acid reflux. Being overweight puts more pressure on the stomach and diaphragm. This forces the esophageal sphincter to open, allowing acid to easily flow back into the esophagus. Acid reflux can also be a temporary condition during pregnancy when there is extra pressure on the stomach combined with the increased levels of progesterone, which can cause the lower esophageal sphincter muscle to relax.
A hiatal hernia, caused by the upper part of the stomach bulging into the chest through the esophagus, may also lead to the development of acid reflux disease. This common hernia is often seen in people who are fairly healthy, and many of them have no acid reflux symptoms. But according to the National Institutes of Health, in some people, the hernia weakens the esophageal sphincter muscle and allows acid to reflux back into the esophagus. This can cause severe chest pain similar to heart attack pains. It is still wise to get checked for possible heart problems even if chest pain is suspected to be a hiatal hernia or GERD.
A doctor can usually diagnose acid reflux disease by taking a clinical history and documenting symptoms. Some physicians will also order a barium x-ray, in which the patient drinks a liquid that coats the digestive tract. By looking at x-rays while this liquid is present, the doctor can see the condition of the esophagus, stomach and upper intestine. The doctor can also check for a hiatal hernia at that time.
Endoscopy is another test doctors sometimes use to diagnose acid reflux disease. By inserting a thin tube that has a camera down the patients throat, the doctor can see if the esophagus or stomach is inflamed.
Doctors frequently recommend positional therapy as a partial treatment for acid reflux disease. Patients may find that simply elevating their head while lying in bed effectively uses gravity to keep the acid from coming back up into the esophagus. To achieve an incline of 6 to 9 inches, place wood blocks under the bedposts at the head of the bed, put foam wedges between the mattress and box spring or lie on special pillows designed for people with acid reflux.
According to the National Digestive Diseases Information Clearinghouse (NDDIC), fatty and fried foods, spicy food, chocolate, citrus fruits and tomato-based foods may contribute to acid reflux symptoms. Patients should also avoid alcohol, coffee and other drinks that contain caffeine.
Health care providers recommend these other lifestyle changes to reduce heartburn:
Over-the-counter antacids can give symptom relief, but doctors may recommend prescription medications like cimetidine (Tagamet) or famotidine (Pepcid AC). These H2 blockers decrease the production of stomach acid. Proton pump inhibitors such as omeprazole (Prilosec) and esomeprazole (Nexium) actually stop acid production and give significant relief, as well as heal the inflamed lining of the esophagus. Prescription medication works for about 80 percent of acid reflux patients. GERD is a chronic illness and usually requires lifelong treatment.
If acid reflux symptoms don't improve with lifestyle changes or medications, or if a patient does not wish to take medication on a long-term basis, surgery may be the answer. Fundoplication strengthens the lower esophageal sphincter muscle by wrapping part of the stomach around the end of the esophagus. If the patient has a hiatal hernia, the surgeon first repairs it and then goes on to perform the fundoplication. In laparoscopic fundoplication, the surgeon makes small incisions and works through a telescope. Open fundoplication is a more traditional surgery, requiring a large incision. Health care providers consider fundoplication to be a safe and effective surgical treatment.