Overview – What is Acid Reflux?

Acid reflux can be described as a commonly occurring condition where the contents of the stomach (food/liquid) rise up from the stomach and flows back up into the food pipe or oesophagus. The reason behind this occurrence is because the opening to your stomach (the lower oesophageal sphincter (LES)) tends to stay open for longer than usual or doesn't close all the way after food passes through it. The primary role of the LES is to function as a valve between the oesophagus and stomach thus helping prevent any food contents from flowing back into the oesophagus. Acid Reflux can affect people of all ages—from infants to older adults.

One of the main symptoms experienced during an acid reflux attack is the feeling of a burning sensation around the heart region – especially after eating. It also needs to be highlighted that acid reflux and heartburn are not the same things. As a matter of fact, heartburn is actually considered to be the primary symptom of acid reflux – characterized by a stinging and burning pain which is usually felt in the lower part of the mid-chest, behind the breast bone.

Furthermore, Acid reflux should not be mistaken for Gastroesophageal Reflux Disease (GERD) either. Although it can be said that they are closely linked, they don't necessarily mean the same thing. GERD can be described as a more severe form of acid reflux and can occur frequently – once or twice a week and can vary in severity from moderate to severe.

As per a study conducted by The American College of Gastroenterology, it was revealed that over 60 million Americans experience some form of heartburn at least once a month, and nearly 15 million experience it on a daily basis. Although acid reflux has always been perceived as a western phenomenon, cases of acid reflux have been on a rise in India as well. As per a recent study conducted by the Indian Society of Gastroenterology, the prevalence of acid reflux has risen to 7.6 percent in the six Indian cities covered in their study.

Causes

There are several factors that can lead to acid reflux. While risk factors include obesity or overweight, connective tissue disorders – such as scleroderma, being pregnant, a condition called hiatal hernia characterized by a distinct bulge appearing at the top of the stomach extending into the diaphragm, etc. Besides the risk factors, there are some common triggers which can cause discomfort including:

• Excessive consumption of alcohol
• Smoking
• Consuming foods such as citrus fruits, chocolate, caffeinated beverages, fatty and fried foods, foods containing garlic and onions, carbonated beverages, tomato-based foods, including spaghetti sauce, chilli, and pizza, mint flavourings, spicy foods, etc.
• Taking certain medications, such as aspirin, ibuprofen, blood pressure medications, certain types of muscle relaxers
•  Lying down within 2 to 3 hours of consuming a meal
• Snacking close to bedtime
• Eating large meals
• A high intake of table salt

Symptoms

Here are symptoms associated with Acid Reflux.

• A burning pain felt in the lower chest which worsens when lying down or bending over. This sensation can last for several hours and often tends to get worse after consuming food.
• An icky, sour, bitter taste in the mouth which can lead to choking – in extreme cases
• Issues with the throat including hoarseness in the voice, soreness in the throat and/or laryngitis (voice box inflammation)
• Respiratory symptoms – including dry, chronic cough and wheezing
• Bad Breath emanating from the mouth
• Sudden production of excessive saliva
• Nausea and vomiting
• Unintentional weight loss
• Difficulties or pain while swallowing
• Asthma and recurrent pneumonia
• Dental issues such as Inflammation of the gums, cavities, dental erosion
• Pain in the chest or upper abdominal region

It needs to be mentioned that if the above-mentioned symptoms have started to cause any interference with your daily life, it is time to see your health care professional at the earliest.

Diagnosis

Although acid reflux is a common complaint, there are instances where it can be confused with other chest-related illnesses, including:

• Heart attack
• A pulmonary embolus or lung embolism – when a blood clot gets stuck in an artery in the lung leading to a blood flow getting blocked to part of the lung
• Pneumonia
• Pain in the chest wall.

In order to diagnose acid reflux accurately, there are several tests which include:

• X-rays and a barium swallow radiograph which makes use of x-rays to help detect the presence of any abnormalities including hiatal hernia and severe inflammation of the oesophagus.
• Endoscopy (examines the inside of the oesophagus, stomach, and portions of the intestine with the help of a thin flexible lighted tube.
• Ambulatory pH monitoring examination which monitors the amount of acid in the oesophagus with the help of a tiny tube
• Oesophagal impedance study which is similar to the pH test as it measures the movement of substances in the oesophagus using two probes and helps in detecting both acidic and alkaline reflux.

Risks and complications

If left untreated, Acid Reflux can lead to serious complications in the long term –

Esophageal stricture or narrowing of the esophagus owing to the damage caused by the acid of the stomach thus causing scar tissue to form. This, in turn, can lead to difficulties in swallowing as the scar tissue narrows the food pathway.

Barrett's oesophagus: a serious complication where repeated damage from acid can lead to changes in the cells and tissues lining the lower oesophagus. These changes have the potential to develop into cancerous cells and are associated with an increased risk of developing esophageal cancer.

Esophagitis: Continuous exposure to stomach acid can damage the lining of the oesophagus causing it to become inflamed leading to irritation while eating, bleeding, and oesophagal ulcer to form in some cases. Even esophagitis is linked with a higher risk of cancer and people suffering from acid reflux are likely to be predisposed to carcinoma of the esophagus.

Treatment

If you are suffering from acid reflux, taking preventive action can help fix it before it escalates into something serious like GERD. In that regard, making a few tweaks to your lifestyle is the first step towards fixing acid reflux. Some recommended measures include:

• Losing excess weight especially if obese
• Avoiding eating large meals at one time and instead of dividing meals into smaller proportions.
• Decreasing the intake of alcohol and quitting smoking
• Avoiding lying down immediately (2-3 hours) after eating
• Elevating the head of the bed by five to seven inches.
• Decreasing caffeine intake
• Avoiding known triggers – spicy food, chocolates, fried food, etc.
• Certain medications such as over-the-counter antacids, Proton pump inhibitors (PPI), and H2 blockers can be helpful in treating reflux and/or controlling symptoms

In the case of severe problems, surgery may be recommended.