What Is Acid Reflux?

Acid reflux is a condition where the tube between the mouth and the stomach (the esophagus) is irritated by stomach acid or bile (a fluid used for digestion). It might also be called gastroesophageal reflux (GER).

It is a common problem that causes symptoms that include pain in the chest after eating which may get worse when lying down, regurgitation, problems swallowing, and the feeling of a “lump” in the throat.

Treatment for acid reflux might include making changes to lifestyle and using medications. When acid reflux occurs more than a few times a week, it may be a chronic condition called gastroesophageal reflux disease (GERD).

The Esophagus

When food and drink are swallowed, they go down the esophagus, which is a hollow tube that runs from the mouth to the stomach. The smooth muscle in the esophagus moves food down to the stomach by contracting, which is called peristalsis.

There are special muscles in the esophagus that allow food and liquid to pass through and down to the stomach and also prevent food from coming back up from the stomach into the mouth. These muscles are called sphincters.

The upper esophageal sphincter (UES) is at the top of the esophagus. This muscle can be voluntarily controlled during swallowing. It also helps prevent food and liquid from going down the windpipe or from coming back up from the esophagus. 

The lower esophageal sphincter (LES) is at the bottom of the esophagus and at the opening to the stomach. This muscle can not be controlled voluntarily. It closes up to prevent food from coming up out of the stomach and back into the esophagus. When the LES becomes weakened, it might lead to acid reflux.

Acid Reflux Symptoms

The signs and symptoms of acid reflux can include:

• Abdominal bloating
• Bad breath
• Dry cough
• Gas (burping)
• Heartburn (pain or burning in the chest)
• Feeling like something is in the throat (dysphagia)
• Hiccups
• Nausea
• Regurgitation (tasting food or stomach acid in the throat)
• Sore throat
• Vomiting

Causes

There are several different factors that may cause or contribute to the weakening of the LES and acid reflux. One potential cause is a hiatal hernia. There is a muscle that is between the chest and the abdomen, which is called the diaphragm. The esophagus passes through the diaphragm via a small opening that’s called the hiatus.

The upper part of the stomach and the LES can push up into that small opening and into the chest. This is called a hiatal hernia. The hiatal hernia weakens the LES, allowing the stomach contents to move back up into the esophagus.

Other causes and contributing conditions to acid reflux include:

• Being overweight
• Obesity
• Pregnancy
• Medications (including antidepressants, antihistamines, asthma medications, calcium channel blockers, painkillers, and sedatives)
• Smoking (including secondhand smoke)

Diagnosis

Some people will be able to self-diagnose acid reflux based on the symptoms. Making some changes to lifestyle or using over-the-counter medications may be helpful in treating symptoms. A healthcare provider may also help in making the diagnosis, usually based on a medical history and a physical exam. 

Acid reflux usually doesn't require any tests. However, if it is happening more than a few times a week, making it a chronic condition, there might be a need for testing. There are some tests that might be done if acid reflux does become bothersome and may actually be GERD. These can include:

• Bravo wireless esophageal pH monitoring: During an upper endoscopy, a capsule that can measure acid levels is attached inside the esophagus
• Esophageal manometry: A tube is passed into the esophagus in order to measure muscle contractions
• Esophageal pH and impedance monitoring: This test uses a tube inserted in the esophagus to measure acid levels in the esophagus
• Upper GI series: In this test, a series of X-rays is taken after the patient drinks a specialized liquid that contains barium (this test is also sometimes called a barium swallow)

Treatment

Treatment begins with changes in lifestyle and diet, but may also include medications.

Lifestyle and Diet

In many cases, acid reflux can be treated with changes to lifestyle and diet. Some people may find it helpful to keep a food log or diary and include any signs or symptoms that occur after meals and at night. This can show if there are certain times of day when acid reflux is more likely to occur or if there are foods that seem to make the condition worse.

Other changes that may help in preventing acid reflux include:

• Avoid carbonated beverages
• Avoid eating within two or three hours of bedtime or naps
• Avoid foods that may cause symptoms (such as fatty, spicy, or greasy foods; chocolate; coffee; peppermint; tomatoes and tomato products; and alcohol)
• Avoid strenuous exercise after eating
• Eat slowly
• Eat smaller meals
• Lose weight, if needed
• Quit smoking or avoid secondhand smoke
• Sleep with the upper body on an incline

Medications

Over-the-counter medications may also be used to treat occasional acid reflux. It's important to take only one type of medication to treat acid reflux at a time. It's a good idea to consult a physician on which type of acid reflux treatment to take. Some of the medications that might be used include:

• Antacids: These drugs work by neutralizing the acids in the stomach. Some name brands include Tums, Maalox, Rolaids, or Mylanta.
• Bismuth subsalicylate: This medication limits the flow of fluids and electrolytes into the intestines. It is sold as Pepto-Bismol.
• H2-receptor blockers: These reduce the amount of acid created in the stomach lining. They work quickly, often in 15 to 30 minutes, and the effects may last for about 12 hours. Examples are Axid AR (nizatidine), Zantac 360 or Pepcid AC (famotidine), Tagamet (cimetidine).
• Proton pump inhibitors: These also affect the stomach lining and reduce the amount of acid produced. It takes approximately an hour for them to work but they may last for 24 hours. The effect is increased when they’re taken for several days in a row. They include Nexium (esomeprazole), Prevacid (lansoprazole), and Prilosec (omeprazole).

When to See a Doctor

Occasional heartburn and acid reflux should be discussed with a physician at a regular appointment. However, if reflux is happening more than a few times a week, that should prompt a visit to see a healthcare professional for diagnosis and treatment.

Acid reflux is common and can often be treated at home with some changes to diet and lifestyle. In some cases, over-the-counter medications may also be needed to help get symptoms under control. It’s important to note, however, that acid reflux is something that occurs on occasion. 

If reflux is happening approximately two times a week, it is considered chronic. When that is the case, there may be a need for further testing and treatment for GERD. This is because GERD is associated with long-term effects that can be harmful.

Some of the medications that are used to treat acid reflux should only be used for short periods of time, so it’s important to get guidance from a physician if there’s a need to take these medications more than occasionally.

What’s more, chronic reflux can limit one’s quality of life and make basic activities like socializing and sleeping more difficult. There are now many potential treatments for acid reflux and for GERD that can help.