Acid Reflux; What You Should Know

The symptom of GERD that everyone knows is persistent heartburn.

Heartburn is a burning pain felt in the center of the chest, just behind the breastbone. This burning pain often starts in the upper abdomen and spreads up into the neck or throat. It can last as long as 2 hours. Also, it is usually worse after eating.

Lying down or bending over could make it worse. The pain, sometimes, does not start or get worse with physical activity. Heartburn is sometimes called acid indigestion. Not everyone with Gastroesophageal Reflux Disease has heartburn.

Other symptoms of GERD include:

1. Regurgitation of acid up into the throat while bending over or sleeping
2. Persistent dry cough
3. Post-meal pain in the abdomen
4. The feeling of tightness in the throat
5. Trouble swallowing
6. Sore throat
7. Wheezing
8. Bitter taste in the mouth
9. Nausea
10. Hoarseness (mostly in the morning)

In children and infants, the most common symptoms are repeated, coughing, vomiting, and other respiratory problems.

There are many factors that influence the symptoms of GERD or cause GERD. Here are some contributing factors  that weaken or relax the lower esophageal sphincter, making gastric reflux worse:

Eating habits: Eating large meals, eating quickly or just before bedtime

Lifestyle: Frequent use of alcohol or cigarettes, poor posture (slouching), obesity

Medications: Calcium channel blockers, nitrates, antihistamines, theophylline (Tedral, Hydrophed, Marax, Bronchial, Quibron)

Diet: Fatty and fried foods, drinks with caffeine, acidic foods such as citrus fruits and tomatoes, spicy foods, mint flavorings, chocolate, garlic and onions

Other medical conditions: Hiatal hernia, diabetes, rapid weight gain, pregnancy

Hiatal hernia is a condition where the upper part of the stomach protrudes through the opening in the diaphragm. This happens where the esophagus passes through to its connection with the stomach.

In this case, the upper part of the stomach is up above the diaphragm (the firm muscle that keeps off the organs of the chest from those of the abdomen).

• The cause of Hiatal hernias is certain yet. However, it is possible that it can occur because of persistent vomiting, coughing, straining, or sudden physical exertion. Obesity and pregnancy often make this condition worse.
• A hiatal hernia makes it easier for the acid to reflux.
• This condition is very common in people that are older than 50 years of age. Often, it is not associated with GERD.
• Hiatal hernia usually does not require any treatment. In rare cases when the hernia is very large or becomes really twisted, surgery may be needed.

Acid reflux usually feels like a hurting or burning sensation in your stomach, upper abdomen behind the breastbone, esophagus, and even up into your throat. There’s a feeling of a hot, acidic, or sour tasting fluid at the back of the throat or a sore throat.

It may feel like it’s difficult to swallow or feel a tightness in the throat when you have heartburn, and it may feel as if food is stuck in your throat or esophagus.

You’re likely to feel chest pain when lying down, bending over, or after eating. (See your doctor for any undiagnosed chest pain – do not assume you are experiencing heartburn until a doctor diagnoses it)

Notwithstanding the fact that many people can relieve their reflux disease symptoms by changes in their habits, diet, and lifestyle, others need to consult their health-care professional.

You can start with your family or general practitioner (primary care provider). You may be referred to a gastroenterologist, a specialist in disorders of the gastrointestinal (GI) tract. If the symptoms you experience are severe and require surgery, you will be referred to a general surgeon. Most of the diagnostic tests for GERD are done by a radiologist.

• Call your health-care professional when symptoms of GERD occur frequently, disrupt your sleep, interfere with work or other activities, are associated with respiratory problems, or are not relieved by self-care measures alone.
• Make your health-care professional aware that you are using self-care measures or over-the-counter medications so that they can monitor how well they work and how often you need to use them.

If you have any of the following, go immediately to the emergency department where you will be seen by an emergency medical specialist:

• Acute chest pain or pressure, especially if it radiates to your arm, neck, or back
• Vomiting followed by severe chest pain
• Vomiting blood
• Dark, tarry stools
• Difficulty swallowing
• Shortness of breath

Doctors have a way of diagnosing reflux disease from the symptoms you report.

• Lifestyle changes may be recommended first (which includes diet), and maybe an over-the-counter antacid.
• If symptoms continue more than 4 weeks despite this therapy the person may be referred to a gastroenterologist, which is a doctor who specializes in the gastrointestinal (GI) tract.

The gastroenterologist may perform an upper GI series.

• This is a series of X-rays of the esophagus, stomach, and upper part of the intestine.
• You will have to take a contrast liquid (before the x-ray) that makes certain features show up better on the X-rays.
• This series is sometimes called a barium swallow for one type of contrast liquid that is used and when the examination is limited to the esophagus.
• This test gives less information than an upper GI endoscopy but is ordered to rule out other conditions such as ulcers or blockage of the esophagus. The upper GI series is sometimes skipped altogether.

The gastroenterologist may perform an upper GI endoscopy, also called esophagogastroduodenoscopy or EGD, a procedure that can be done as an outpatient.

• You receive sedation then a flexible probe with a tiny camera on the end is passed down your throat. The camera allows the doctor to see damage to the esophagus, how severe the GERD is, and to rule out serious complications of GERD or unexpected diseases.
• If you have mild GERD, your esophagus may appear normal.
• the specialist to make diagnoses, assess damage, take biopsies if necessary, and even treat certain conditions on the spot from this procedure.

Esophageal manometry is a test that measures the functionality of the lower esophageal sphincter and the motor function of the esophagus. There is a passing of a tube until it reaches the esophagus. Usually, it is performed along with 24-hour pH probe study.

In a 24-hour pH probe study, a thin tube is placed down into your esophagus for 24 hours. The tube observes and records episodes of acid reflux over the day and while you sleep.

For certain people, acid reflux symptoms may be relieved by changing diets, habits, and lifestyle. The following steps may help reduce reflux.

• Don’t eat within 3 hours of bedtime. During this time your stomach empties and acid production decreases.
• Avoid lying down right after eating at any time of day.
• Raise the head of your bed 6 inches with blocks. This is because gravity helps prevent reflux.
• Don’t eat large meals. When you eat a lot of food at one time, the amount of acid needed to digest it increases. Rather, have smaller, more periodic meals throughout the day.
• Keep away from fatty or greasy foods, chocolate, caffeine, mints or mint-flavored foods, spicy foods, citrus, and tomato-based foods. The competence of the lower esophageal sphincter is decreased by these foods.
• Avoid drinking alcohol. The likelihood that acid from your stomach will back up increases when you take alcohol.
• Stop smoking. The lower esophageal sphincter and increases reflux when you smoke.
• Lose excess weight. When you’re of a healthy weight, you stand a better chance than obese and overweight individuals.
• Stand upright, sit up straight, and maintain good posture. This aids food and acid pass through the stomach instead of returning up into the esophagus.
• Talk to your health-care professional about taking over-the-counter pain relievers like aspirin, ibuprofen (Advil, Motrin), or medicines for osteoporosis. These can aggravate reflux in some people.