Causes and Treatment for Acid Reflux

Acid reflux is a common digestive condition in which stomach contents flow back into the oesophagus, a tube approximately 1 inch wide and 10 inches long that connects the mouth to the stomach.

Located at the bottom of the oesophagus, the lower oesophageal sphincter (LES), a circular ring of muscles connects the oesophagus to the stomach. When you swallow, the LES relaxes and opens to allow food to enter the stomach, where it mixes with stomach acid to aid in digestion. Afterwards, the LES closes to prevent stomach acid and food from flowing back into the oesophagus.

Occasional reflux is quite common after a large meal and most of the time the condition is brief. Despite not usually causing significant issues or complications, it could still damage the oesophagus and induce a number of bothersome symptoms.

Symptoms of acid reflux

Common acid reflux symptoms include:

Heartburn (a burning sensation in the chest)
Regurgitation (the feeling of stomach contents being forced back up your oesophagus)
Difficulty swallowing or pain when swallowing
Sour taste in the mouth
Nausea or vomiting
Bad breath
Voice hoarseness
Chest pain

There is a much more severe form of acid reflux known as GERD (Gastroesophageal Reflux Disease). It is defined as a chronic digestive condition and is characterised by persistent symptoms that can significantly impact one’s quality of life.

Risk factors

The risk of developing acid reflux may by increased by factors such as obesity, pregnancy, having pre-existing medical conditions such as hiatal hernia - a condition in which the upper part of your stomach bulges up into your chest, and on certain medications.

Lifestyle factors such as caffeine and alcohol consumption and smoking, caffeine also increases the risk of acid reflux. Lying down immediately or shortly after eating can cause stomach acid to flow back into the oesophagus, leading to heartburn and discomfort.

Diagnosis of acid reflux

Based on your reported symptoms, your doctor may perform an upper gastrointestinal (GI) endoscopy. This involves using an endoscope, a thin, flexible tube with a camera to inspect the oesophagus and lining of the stomach. During the procedure, biopsy samples may be taken to check for damage or signs of infection.

Prolonged oesophageal pH test can also be done to determine how severe the acid reflux is. This involves the insertion of a small tube with a sensor through the nose into the oesophagus or placing a wireless sensor during an upper endoscopy. The sensor remains in place for 24 hours.

Treatment of acid reflux

A common treatment option for mild acid reflux is antacids such as Gaviscon for short-term relief due to its ability to neutralise stomach acid. For longer-lasting effects, histamine receptor antagonists such as cimetidine and famotidine can be used to decrease the stomach’s acid production.

Proton pump inhibitors (PPIs) are the most effective option to treat moderate to severe acid reflux symptoms by reducing stomach acid. While higher doses might require prescriptions, some PPIs can be bought over-the-counter. Omeprazole and pantoprazole are two examples of PPIs.

Potential complications

Complications that come with acid reflux are usually not serious with most people, especially if they are receiving treatment. However, some individuals with severe acid reflux may sometimes experience potentially serious complications.

Dental problems	Repeated occurrences of acid reflux can gradually erode teeth enamel.
Lung and throat problems	When stomach acid flows back into the throat, it can cause vocal cords inflammation, throat pain, or hoarse voice. The acid can also potentially be inhaled into the lungs causing symptoms of pneumonia or asthma, as well as irreversible damage to the lungs if the condition persists.
Erosive oesophagitis	This is a condition where stomach acid erodes the lining of the oesophagus and results in potential bleeding that is caused by erosions or sores. Stool tests can help detect bleeding from an ulcer, even if the bleeding is not visibly apparent.
Oesophageal stricture	Damage from stomach acid can lead to scarring and narrowing of the oesophagus. Repeated ulceration of the oesophagus followed by the healing process forms scar tissues which creates a partial obstruction (stricture) that may cause food or pills to become stuck.
Barrett’s oesophagus	This happens when a different cell type known as intestinal cells replaces the squamous cells that usually line the lower oesophagus. This change is typically the result of repeated injury to the oesophageal lining due to chronic acid reflux. Over time, there is a small risk that these intestinal cells may develop into cancer cells. Individuals with Barrett’s oesophagus are advised to undergo regular upper endoscopies to check for early signs of cancer.

Prevention tips

Lifestyle and dietary modifications are recommended to lower the frequency and severity of acid reflux occurrences.

For many people, eating spicy food can be a common cause of acid reflux as spicy foods contain a compound called capsaicin. It relaxes the lower oesophageal sphincter and make it easier for the stomach acid to flow into the oesophagus. You should avoid eating too many spicy foods if you are prone to acid reflux.

Other food categories that should be restricted or avoided include:

Chocolate
Mint
Tomatoes and tomato-based products
Citrus fruits and juices
Fried and fatty foods
Carbonated drinks
Caffeine
Alcohol

To prevent overeating, remember to eat smaller sized meals throughout the day. To minimise the symptoms of acid reflux, avoid eating late at night and give yourself at least three hours between your last meal and bedtime.

Lifestyle modifications that can help reduce acid reflux symptoms include:

Losing excess weight and maintaining a healthy weight.
Sleeping on your left side to guide stomach juices away from the stomach’s upper right section where the oesophagus connects.
Stop smoking.
Practising stress-reduction techniques to reduces chronic stress that can potentially increase the risk of acid reflux.

Schedule an appointment at Gleneagles Hospitals

For any questions or concerns regarding acid reflux, contact us to schedule an appointment today for a consultation, or visit our team of Gastroenterologists at your nearest Gleneagles Hospital.

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