Acid Reflux

Also known as gastroesophageal reflux disease (GERD) or heartburn, acid reflux is the occurrence of frequent flowing of stomach acid back into the tube connecting your mouth and stomach.

The entrance of your stomach has a ‘valve’; this ‘valve’ is a ring of muscle called the lower esophageal sphincter (LES). Under normal conditions, the LES will close as soon as the food passes through it. If the LES does not close all the way, or if the frequency at which it opens is high then the acid that is produced and secreted into the stomach can make its way up to your oesophagus. This will lead to symptoms such as a burning sensation in the chest and discomfort, this is what is commonly referred to as heartburn.

If the acid reflux symptoms occur more than two times a week, you are likely to have acid reflux disease.

Acid reflux is a common condition that can affect people throughout their life. GERD is a mild version of acid reflux that can occur at least twice a week, with both moderate to severe symptoms.

The discomfort of GERD can be managed through simple lifestyle changes and over-the-counter medication. However, some people who suffer from symptoms may require surgery to ease them.

The primary symptoms of acid reflux include:

• Heartburn: a burning pain or major discomfort that moves from the stomach to the abdomen or chest, sometimes even up to a person’s throat
• Regurgitation: the backing up of a sour or bitter-tasting acid in the throat and mouth

Other lesser symptoms that can still cause discomfort and other conditions include:

• Bloating
• Burping
• Fluctuation 
• Nausea
• Consistent hiccups
• Weight loss
• Wheezing, dry cough, chronic sore throat
• Dysphagia — the sensation of food being stuck in your throat and struggling to swallow

These symptoms can vary from person to person. Acid reflux symptoms tend to be worse after eating, or when lying down or bending over.

If you are struggling with acid reflux symptoms, speak to your GP or pharmacist.

Many people suffer from acid reflux and associated conditions such as heartburn every day. There is often no recognisable reason why.

Some of the most common causes of acid reflux include:

• Being overweight
• Smoking
• Drinking alcohol and caffeine products
• Certain foods
• Pregnancy
• Stress and anxiety
• Some medicines, such as anti-inflammatory painkillers (including ibuprofen)
• A hiatus hernia (this occurs when part of your stomach moves up into your chest)

Hiatus hernia happens when the upper part of the stomach and LES move above the diaphragm. The diaphragm is a large muscle that separates your stomach from the thoracic cavity, which contains the lungs, heart, oesophagus and trachea.

The diaphragm helps to keep the acid in your stomach because it contains muscles that stop the food/acid from coming up your oesophagus. If you have a hiatal hernia, acid can move freely up into your oesophagus and cause symptoms associated with acid reflux.

Food is one of the most common causes of acid reflux and heartburn, triggering the oesophagal sphincter to relax and delay the digestive process, which causes food to sit in the stomach for longer.

Large and heavy meals are obviously implicated in causing acid reflux as well as eating 3-4 hours before you go to bed, this is because this food does not have enough time to be processed in the stomach and therefore when you lie down, you are likely to begin to feel the burning sensation in the chest.

Foods that are known to cause acid reflux include:

• Foods with high fat, salt and spice quantities
• Fried food
• Fast food
• Processed snacks
• Chilli powder and peppers
• Matty meats
• Daisy products
• Tomatoes and tomato-based sauces
• Citrus fruits
• Chocolate
• Peppermint
• Carbonated beverages

A diet that reduces or moderates the intake of these foods can help to reduce the impact and prevalence of acid reflux. Avoiding eating these foods before bedtime so they’re not sitting in your stomach and rising through your oesophagus while you lay down can help limit the impact.

Foods that can help reduce or avoid the onset of acid reflux include:

• Baked, broiled or grilled chicken breast (with the fatty skin removed)
• Lettuce, celery and sweet peppers
• Brown rice (boiled, not fried)
• Melons (including watermelon, cantaloupe and honeydew)
• Oatmeal
• Fennel
• Ginger (including ginger tea)

Eating smaller, more frequent meals rather than heavier meals and bedtime snacks can also help.

Although acid reflux itself isn’t a life-threatening condition, it can lead to more serious health issues and complications if left untreated.

Common complications that can arise from continued GERD/acid reflux include:

• Esophagitis
• Oesophageal ulcers
• Oesophagal stricture
• Aspiration pneumonia
• Barrett’s oesophagus
• Oesophagal cancer

Over time, chronic inflammation in your oesophagus can also lead to:

• The narrowing of the oesophagus: damage to the lower oesophagus from stomach acid can cause scar tissue to develop, narrowing the food pathway and causing swallowing problems
• Precancerous changes to the oesophagus (Barrett's oesophagus): the tissue lining of the lower oesophagus can be damaged by stomach acid

Acid reflux can cause discomfort and other symptoms for two hours or longer, depending on the cause.

Mild heartburn may occur immediately after consuming particular food or drink, such as a spicy or acidic meal until it has been digested.

Heartburn symptoms may also return several hours later if you have been bending over or lying down.

Acid reflux is most commonly treated with long-term lifestyle and diet changes.

Some of the things you can to do get rid of acid reflux or reduce symptoms include:

• Avoiding food and beverages that trigger acid reflux symptoms and heartburn
• Eating smaller meals throughout the day and modifying the types of foods intaken
• Quitting or reducing smoking
• Raising your head while you sleep to between 4 and 6 inches
• Eating no later than 2 to 3 hours before bed
• Sleeping upright during daytime naps
• Wearing lighter clothes
• Taking steps to lose weight through exercise or diet changes
• Consulting your doctor about medication that may be triggering symptoms

If you find that you keep getting heartburn, speak to a pharmacist for advice — they can recommend medicines that can ease symptoms.

Most of the time, acid reflux can be treated by adopting positive lifestyle changes such as eating light meals at appropriate times, losing weight, not smoking and avoiding sugary carbonated drinks as well as other triggers that you may have experienced in the past that caused you to experience acid reflux.

If the lifestyle changes have not had any positive impact then there are some over the counter preparations available, such as antacids like Rennie or preparations that act as rafting agents by coating aggravated tissues in the stomach and oesophagus to help protect them from the stomach acid.

There are a number of acid reflux treatment options available. In many cases, over-the-counter medications can help to control the symptoms and effects of acid reflux.

These include:

• Omeprazole and Lansoprazole: these work by decreasing the amount of acid your stomach produces. It does this by blocking a system in the cells of your stomach called the proton pump
• Antacids: these can neutralise the acid from your stomach. However, they may cause diarrhoea or constipation, especially in overuse. For best results, ensure you’re using antacids that contain both magnesium hydroxide and aluminium hydroxide. When combined, these can help to counteract common gastrointestinal side effects

In the event these don’t work, your doctor may prescribe the following:

• Foaming agents: Coat your stomach to prevent reflux
• H2 blockers: Decrease acid production in your stomach
• Proton pump inhibitors: Reduce the volume of acid your stomach makes
• Prokinetics: These can help empty your stomach faster and reduce acid reflux

Ensure you aren’t combining more than one type of antacid medication with another form of prescription medication without your doctor’s guidance.

In most cases, a combination of lifestyle changes and these medications is all an individual needs to control and reduce the impact of acid reflux symptoms.

In the event medication and dietary changes don’t resolve your acid reflux symptoms and they continue to adversely affect your life, your doctor may recommend surgical solutions.

There are two types of surgery used to relieve the symptoms of acid reflux/GERD if you aren’t seeing solutions through the daily use of medication.

One procedure involves the surgical placing of a ring (known as a LINX device) around the outside of the lower end of a person’s oesophagus.

The ring consists of magnetic titanium beads held together by titanium wires that wrap around the tube connecting the mouth to the stomach. This device prevents stomach contents from backing up into the oesophagus, limiting the impact of acid reflux. This procedure should be avoided by anyone allergic to certain metals and patients should not take any type of MRI test afterwards.

Another surgical procedure called fundoplication can help prevent further acid reflux.

The process creates an artificial valve using the top of the patient’s stomach. The procedure involves wrapping the upper part of the stomach around the LES to strengthen it, prevent acid reflux, and repair a hiatal hernia. The procedure is performed through one of two options, either an open incision in the abdomen or chest or with a lighted tube inserted through a tiny incision in the abdomen.

Typically, these procedures are an absolute last resort for treating acid reflux. Dietary, lifestyle and medical solutions should be followed first.