What Triggers an Acid Reflux?

Acid reflux can be relieved by simple lifestyle changes, such as avoiding certain foods and drinks, eating small meals, and not eating too close to bedtime.

Acid reflux refers to the condition in which the stomach contents move up into the food pipe (esophagus).

When the acidic stomach contents leak frequently, more than twice a week over several weeks, into the esophagus, the condition is called gastroesophageal reflux disease (GERD). 

The site where the food pipe joins the stomach is guarded by a valve (the lower esophageal sphincter). The valve prevents the backflow of the stomach contents into the food pipe. When the lower esophageal sphincter does not close properly when the food enters the stomach, acid reflux occurs. Because the stomach contents are acidic, the backwash then flows back up through the food pipe into the throat and mouth, which gives a strong sour taste. 

GERD needs medical attention, not just to relieve the symptoms, but because it may lead to more serious problems (such as narrowing of the esophagus and difficulty in swallowing) if left untreated.

The common symptoms of acid reflux are as follows:

• Heartburn: An uncomfortable sensation in the middle of the chest usually after eating food, this condition may worsen on lying down, which may disturb the person during sleep. It is caused by irritation to the inside of the food pipe because of stomach acid.
• Chest pain
• Sour taste in the mouth
• Dysphagia (difficulty in swallowing)
• Bloating
• Burping
• Feeling of food caught in the throat
• Hiccups
• Nausea
• Vomiting
• Weight loss
• Long-term cough
• Sore throat
• Hoarse voice
• Difficulty in breathing

If you have chronic acid reflux, you may experience additional symptoms, such as:

1. Frequent heartburn (most common symptom)
2. Taste of eaten food or stomach acid in your throat or mouth
3. Pain or discomfort in your chest or the upper part of your abdomen
4. Nausea
5. Vomiting
6. Dysphagia (difficulty swallowing)
7. Halitosis (bad breath)
8. Throat irritation
9. Hoarse voice
10. Recurrent cough

Not everyone suffers from acid reflux frequently, but it is not uncommon. At least 40 percent of Americans suffer from acid reflux once a month.

If you have been suffering from acid reflux at least two times a week, you may have gastroesophageal reflux disease (GERD) or chronic acid reflux disease, a structural chronic digestive disorder in which mild acid reflux occurs at least two times a week or moderate to severe acid reflux that occurs at least one time a weak.

Chronic acid reflux disease results from the weakening or relaxation of the lower esophageal sphincter (LES). LES is a valve that is present between the lower part of the esophagus and the upper part of the stomach. It prevents the food and acid in the stomach from flowing backward or up (refluxing) into the esophagus.

Factors that can weaken the LES and cause chronic acid reflux disease include:

• Increased pressure on the abdomen due to obesity or pregnancy
• Hiatus hernia (a condition in which the upper part of the stomach moves up into the chest due to the weakening of the diaphragm)

Acid reflux can affect anyone. Some risk factors, however, may increase the chances of acid reflux:

• Eating heavy or large meals 
• Lying down right after a meal
• Being obese or overweight 
• Eating or snacking right before bedtime
• Having certain foods, such as spicy or oily foods, citrus, tomato, mint, garlic, onions, and chocolate
• Consuming certain drinks, such as alcohol, carbonated drinks, coffee, or tea
• Smoking or being frequently exposed to second-hand smoke
• Being pregnant 
• Taking medications, such as aspirin, ibuprofen, and some muscle relaxants 
• Hiatal hernia (a condition in which the upper part of the stomach bulges into the diaphragm—a muscle that separates the stomach from the chest)

Chronic acid reflux is not a serious condition. Only in the long term, if not treated well, it can cause complications, such as:

• Esophagitis: Esophagitis refers to the irritation and inflammation caused by the acid reflux in the lining of the esophagus. Esophagitis can cause ulcers in the esophagus. These ulcers can bleed and cause blood loss.
• Barrett's esophagus: Barrett's esophagus is a condition that develops in about 10 percent of people with long-term gastroesophageal reflux disease. The condition increases the chances of developing cancer of the esophagus.
• Esophageal cancer: This may result due to Barret’s esophagus (adenocarcinoma) or from squamous cells (squamous cell carcinoma).
• Strictures: Narrowing of the esophagus due to scarring of the damaged lining of the esophagus.

Before asking you to undergo tests for acid reflux, your doctor will take your medical history and look for factors that may be causing or triggering your acid reflux.

For example, if you have a lot of caffeinated drinks frequently or take medication, your doctor would like to see if limiting consumption or changing medication helps control acid reflux.

If dietary modifications and simple medications do not help relieve the condition your doctor may ask you to get tested for chronic acid reflux disease with the following tests:

• Upper gastrointestinal (GI) endoscopy and biopsy: A small tube-like camera is inserted into the mouth and moved toward the throat. This helps visualize the internal structure of the esophagus and stomach and look for any GERD-suggestive changes. The doctor may cut a small piece from the esophagus or stomach (biopsy) and send it to the laboratory for examination.
• Upper GI series: You will be told to swallow a liquid. X-rays of the esophagus and stomach will be taken as the liquid passes through these organs.
• Esophageal pH-impedance monitoring: This is a 24-hour monitoring test that measures the amount of food and acid reflux in the esophagus and checks whether the symptoms are correlated with the reflux.
• Bravo wireless esophageal pH monitoring: This is a 48-hour test that measures how much acid and food is refluxed in 48 hours.
• Esophageal manometry: A small flexible tube with sensors is inserted into the nose to enter the esophagus. The sensors present in the tube measure the strength of the muscles in different parts of the esophagus.

The treatment of acid reflux includes the following:

• Lifestyle and home remedies:
  • Eat small meals 
  • Eat your food slowly
  • Avoid certain foods and beverages, such as spicy and oily foods, citrus, tomato, mint, garlic, chocolate, tea, coffee, carbonated drinks, and alcohol
  • Do not lie down right after eating
  • Do not snack before bedtime
  • Maintain a healthy weight
  • Do not smoke
• Medications:
  • Antacids to neutralize stomach acid
  • H2 blockers to reduce acid production
    • Foaming agents to coat the stomach to prevent reflux
  • Proton pump inhibitors to reduce the amount of acid the stomach makes
  • Prokinetics to help strengthen the lower esophageal sphincter, empty the stomach faster, and reduce acid reflux
• Surgery: If the medications do not provide lasting relief and the symptoms are severely interfering with everyday activities, your doctor may recommend the following surgery options:
  • LINX device placement: The procedure involves surgically placing a ring (LINX device) around the outside of the lower end of the esophagus.
  • Fundoplication: The procedure creates an artificial valve using the upper part of the stomach.

For acid reflux, you may find relief from any over-the-counter (OTC) medications that include:

• Antacids: These medications neutralize the stomach acids and provide relief.
• H-2 receptor blockers: These medications decrease acid production and include
  • Ranitidine
  • Famotidine
  • Cimetidine
• Proton pump inhibitors: These reduce stomach acid but are stronger acid blockers. They help heal damaged esophagus tissue.

If you do not get relief from these drugs, your doctor may prescribe you a larger dose. They may put you on another drug, baclofen, a prescription drug that works on the lower esophageal sphincter to reduce acid reflux.

If you do not want to take medications for long, your doctor may recommend surgeries that include:

• Nissen fundoplication: This is the name given for laparoscopic antireflux surgery. It is a minimally invasive procedure that involves creating a new valve mechanism at the lower part of the esophagus.
• LINX device implantation: Another minimally invasive surgery, LINX device implantation involves putting a ring of tiny magnets between the stomach and esophagus.