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Acid Reflux

Last updated date: 13-Aug-2022

CloudHospital

12 mins read

Acid Reflux

Acid reflux, more commonly described as heartburn, looks like a burning feeling in the chest caused by stomach acid that travels up towards the throat, through the esophagus. If this keeps happening and becomes chronic, it is called gastro-esophageal reflux disease (GERD). Researchers estimate that about 20% of people in the United States have GERD.

 

Symptoms of acid reflux

The main symptoms of heartburn include:

  • A burning sensation in the middle of the chest;
  • An unpleasant taste in the mouth which is caused by stomach acid;
  • Hiccups;
  • A hoarse voice;
  • Bad breath;
  • Nausea and vomiting;
  • Dental erosion;
  • Difficulty or pain with swallowing;
  • Wheezing;
  • Dry, persistent cough;
  • Bloating and feeling sick.

These symptoms may worsen after eating, when laying down or bending over.

 

Acid reflux in infants and children

Regurgitation and spitting up are normal in babies younger than 1 year old, therefore GER and regurgitation are common in infants. About 70 to 85 percent of infants have daily regurgitation by the age of 2 months and most will no longer have any GER (gastro-esophageal reflux) symptoms by the time they are 12 to 14 months old. Although any infant can have GERD, it is more common in premature infants, or infants with certain conditions that affect the nervous system, lungs or the esophagus. If you suspect your child has GERD, you should talk to a pediatrician.

Generally, specialists analyze gastroesophageal reflux disease (GERD) by looking into a youngster's clinical history. On the off chance that indications propose GERD, specialists may suggest treatment with lifestyle changes or medications, rather than doing tests. Specialists may suggest other clinical  examinations if indications recommend that the child may have a medical issue other than GERD or a complication of GERD. they may likewise suggest tests if symptoms don't improve after lifestyle changes and medications. The child may be referred to a gastroenterologist to diagnose and treat GERD.

The tests that help diagnose GERD in children are very similar to the ones used for adults and mostly involve:

  • Upper gastrointestinal endoscopy;
  • Esophageal pH monitoring;
  • Upper GI CT series.

Once the diagnosis is confirmed, the gastroenterologist adopts a treatment regimen for GERD in the child in whom medication and lifestyle changes have not improved symptoms or if investigations show true complications. of GERD. It should be noted that children are at higher risk of complications from GERD surgery than adults.

Fundoplication is the most widely recognized medical procedure for GERD. Generally, it prompts long term improvement of GERD symptoms. Specialists regularly perform fundoplication on laparoscopic surgery, which is performed by making little cuts in the abdomen and inserting surgical tools to perform the operation. Laparoscopic fundoplication leaves a few small scars where the instruments were inserted into the abdomen. During the technique, surgeons sew the higher part of the stomach, called the fundus, around the end of the esophagus, which adds pressure to the lower esophageal sphincter and lessens reflux.

 

Acid reflux in pregnancy

In the United States alone, 30 to 50 percent of women experience heartburn during their pregnancy even if they do not have a history of acid reflux. Lifestyle changes are recommended with pregnancy, such as not eating too late at night and consuming small meals. If you are pregnant and experience acid reflux talk to your doctor about treatment options. Consider drinking plenty of water as it dilutes the stomach acid therefore alleviating your symptoms, avoid excessive snacking as it gives the stomach the order to digest therefore increasing the risk of getting heartburn symptoms. Propping yourself at night is also important as sleeping positions can impact the severity of heartburn symptoms; try to sleep with your head slightly lifted as gravity alone can sort out night time heartburn. If you are pregnant, quit smoking and drinking both for the health of your baby and yours as cigarettes and alcohol both put you at risk for acid reflux. For support with quitting ask your doctor or midwife. Although a lot of pregnant women experience heartburn symptoms it is important to note that you do not have to suffer alone, always ask for advice and possible treatments from your doctor.

 

What causes acid reflux?

Acid reflux is fairly common and not always a sign of an underlying condition. In infants under 6 months old it is fairly common and usually not a reason to worry.

Heartburn surrounds when a portion of the stomach acid streams up into the throat, into the esophagus : the gullet, which drops food down from the mouth. Notwithstanding the name, heartburn has nothing to do with the heart.

The stomach contains hydrochloric acid, a solid acid that assists with breaking down food and protecting against microorganisms like pathogens. The lining of the stomach is commonly adjusted to shield it from the power of this acid, however the esophagus is not.

A ring of muscle, the gastroesophageal sphincter, regularly acts like a valve that gives food access to the stomach but not back into the throat. At the point when this valve comes up short, stomach substances are regurgitated into the throat and the symptoms of acid reflux are felt like a heartburn.

Acid reflux can be a symptom of:

  • Hiatal hernia, a condition where the top of the stomach lifts into the chest through an opening in the diaphragm. This lowers the pressure in the esophageal stricture and raises the risk of GERD. Some of the most common symptoms of hiatal hernia are:
  1. Chest pain;
  2. Bloating;
  3. Burping;
  4. Difficulty swallowing;
  5. Bad taste in mouth;
  6. Upset stomach, nausea;
  7. Backflow of liquids from stomach into the mouth;
  8. Shortness of breath.

But in case you have any of the following symptoms medical care is urgent:

  1. Severe pain in your chest or abdomen;
  2. Upset stomach;
  3. Uncontrollable vomiting;
  4. Cannot poop or pass gas. 

These could be a sign of a strangulated hernia or an obstruction, both of them are surgical emergencies.

 

What worsens acid reflux and foods to avoid

 

reflux and foods to avoid

Sometimes acid reflux is caused or worsened by:

  • Certain foods and drinks, such as coffee, tomatoes or any other citrus or acidic foods, chocolate, onions, peppermint, carbonated beverages, alcohol, mint, fatty or very spicy foods;
  • Being overweight;
  • Smoking;
  • Staying up after eating or moving too fast;
  • Stress and anxiety;
  • Pregnancy;
  • Certain medicines, such as anti-inflammatory painkillers like ibuprofen;
  • A hiatus hernia, when a part of the stomach moves into the  chest.

 

Acid reflux friendly foods

  • High fiber foods: High fiber foods make you feel full therefore you are less likely to overeat, which may contribute to heartburn. Foods that are rich in fibers are whole grains (oatmeal, couscous, brown rice), root vegetables, such as carrots, beets, sweet potatoes and green vegetables, like asparagus, broccoli and green beans;
  • Alkaline foods:  Alkaline foods help offset strong stomach acid. foods that have a low pH are more likely to cause acid reflux. Alkaline foods include bananas, melons, nuts, fennel, cauliflower.
  • Watery foods: Eating watery foods can help dilute the stomach acid therefore reducing the risk of heartburn. Some examples of foods that contain a lot of water include celery, cucumber, watermelon, herbal tea, broth-based soups, and lettuce.
  • Lean proteins: Eggs and lean meat are high in protein. High fat meals and friend foods tend to decrease the lower esophageal sphincter pressure and delay stomach emptying, which essentially increases the risk of reflux. Choose lean meats that are grilled, poached, baked or boiled.
  • Healthier fats: Generally you should avoid or reduce saturated fats (found in meat and dairy) and trans fats (found in processed foods like margarines and shortenings). Try replacing these with unsaturated fats from fish or plants like monounsaturated fats (found in olive oil, sesame oil, sunflower oil, avocados, peanuts, peanut butter, seeds and many nuts) and polyunsaturated fats (found in oils such as safflower, soybean, corn, flaxseed and walnut, soybeans, tofu, fatty fish like salmon and trout)

 

Acid reflux home remedies

A few  home remedies for acid reflux include:

  • Eating smaller but more frequent meals;
  • Raising your head and chest above your waist level when sleeping or laying down so stomach acid does not travel towards your throat;
  • Losing weight if the cause for acid reflux is being overweight;
  • Trying to find ways to relax;
  • Avoiding foods and drinks that trigger your symptoms;
  • Quitting smoking, as nicotine may relax your lower esophagus sphincter;
  • Not drinking much alcohol;
  • Not wearing too tight fitting clothes around your waist;
  • Not eating 3 to 4 hours before going to bed;
  • Avoiding coffee;
  • Chewing gum (not spearmint or peppermint) can relax the lower esophagus sphincter, increase saliva production and reduce the amount of acid that is found in the esophagus.

Some people find that drinking milk alleviates their heartburn symptoms but it is important to note that milk comes in different varieties. Fat milk can aggravate acid reflux whereas nonfat milk can act as a temporary buffer between the stomach lining and the acidic stomach contents and can provide immediate relief of symptoms.

 

Diagnosis of GER 

Your doctor may arrange at least one of the accompanying tests to assist with diagnosing GERD and check for GERD inconveniences or other medical conditions, if:

  • Your symptoms suggest that you might have a GERD complication;
  • Your symptoms suggest other health problems that are similar to GERD symptoms;
  • Your symptoms do not improve after treatment and lifestyle changes.

Some ways of diagnosing GERD include:

  • Esophageal manometry:  which is a test that measures the muscle contractions in the esophagus while swallowing and can measure an esophagus stricture.
  • Upper GI endoscopy: Upper GI endoscopy is a method consisting of introducing a camera through the mouth to visualize the inside of the esophagus; stomach and duodenum. It also allows biopsies to be taken which will be submitted to the pathologist for examination of the tissue under a microscope. Endoscopy also looks for complications of GERD or problems other than GERD that could cause the same symptoms.

Diagnosis of GER

  • Esophageal pH monitoring:  Esophageal pH observing is the most exact approach to identify stomach acid in the throat. Two sorts of esophageal pH observing are :
  1. Catheter monitoring, in which a doctor passes one end of a catheter—a slim, adaptable cylinder—through the nose and into the throat to quantify acid and nonacid reflux;
  2. Capsule monitoring, in which a doctor uses an endoscope to put a little, remote capsule on the lining of the esophagus to measure acid reflux; 

During esophageal pH observing, the patient wears a recorder that gets data from the catheter or capsule and tracks data about eating routine, sleep, and symptoms. the doctor will utilize this data to perceive how eating routine, sleep, and symptoms pertain to heartburn in the throat. Specialists may arrange this test to confirm the diagnosis of GERD or to see whether GERD medicines are working.

 

  • Barium X-ray. This testing involves an imaging of the esophagus, stomach and upper duodenum after swallowing a chalk-like liquid that helps improve contrast on the images.

 

Usual treatment for acid reflux 

It may be prescribed a proton pump inhibitor (PPI) that reduces how much acid the stomach makes, such as omeprazole and lansoprazole. Usually people need to take this medicine for 4 to 8 weeks, depending on the severity of the acid reflux.

Always talk to your doctor if the symptoms come back after stopping your medicine, as you may need a long term prescription.

You can purchase numerous GERD meds over the counter. Nonetheless, on the off chance that you have manifestations that won't disappear with over-the-counter drugs, you should converse with your primary care physician. Your doctor may recommend at least one med to treat GERD.

  • Antacids. Specialists may prescribe acid neutralizers to diminish indigestion and other gentle GER manifestations. Antacid agents are accessible over the counter. Acid neutralizers can assist with easing gentle symptoms. Be that as it may, you shouldn't utilize these meds consistently or for severe symptoms, except after a thorough discussion with your primary care physician. These drugs can have side effects, like diarrhea and constipation. 
  • Sucralfate acid suppressants.
  • Potassium-competitive acid blockers.
  • GABA(B) receptor antagonists.
  • Selective serotonin reuptake inhibitors (SSRIs).
  • Theophylline, a serotonin-norepinephrine reuptake inhibitor.
  • Prokinetics: These help empty the stomach faster. Side effects of these medications include diarrhea, anxiety, nausea.
  • Erythromycin. This is a type of antibiotic that also helps with emptying the stomach faster.
  • H2 blockers. H2 blockers bring down the measure of stomach acid. H2 blockers can assist with recuperating the throat, however not just as proton pump inhibitors (PPIs) can. You can purchase H2 blockers over the counter, or your doctor can recommend one. 
  • Proton pump inhibitors (PPIs). PPIs bring down the measure of corrosive your stomach makes. PPIs are greater at treating GERD symptoms than H2 blockers, and they can recuperate the esophageal lining in the vast majority of people with GERD. You can purchase PPIs over the counter, or your primary care physician can recommend one. Specialists may recommend PPIs for long term GERD treatment. 

PPIs are for the most part protected and compelling. Side effects are minimal and may include migraines, diarrhea, and an upset stomach. Exploration likewise proposes that taking PPIs may build the risk of Clostridium difficile (C. diff) infection. Specialists are as yet contemplating the impacts of taking PPIs for a while or in high dosages. Talk with your primary care physician about the dangers and advantages of taking PPIs.

If PPI do not alleviate your symptoms, your doctor may refer you to a specialist for:

  • Tests to find out the reason for your symptoms; these tests may include a gastroscopy;
  • An operation on the stomach that stops the acid reflux, called a laparoscopic fundoplication.

Surgical options are generally the last resort to GERD and are recommended by a gastroenterologist. Surgical treatments include:

  • Fundoplication. Fundoplication is a surgery in which the surgeon sews the top of the stomach around the esophagus to add pressure to the lower end of the esophagus therefore reducing reflux. 
  • Endoscopic procedures. This is a range of procedures involving an endoscopic sewing, which uses stitches to tighten the esophagus sphincter muscle;  radiofrequency that uses heat to produce small burns that tighten the sphincter.

 

Complications of GERD

Without treatment, GERD can sometimes lead to serious complications, such as esophagitis, esophageal stricture and Barrett’s esophagus; other complications may be outside of the esophagus.

  • Esophagitis is an inflammation of the esophagus that can cause ulcers and bleeding in its lining. Chronic esophagitis increases the chance of developing esophageal stricture and Barrett’s esophagus.
  • Esophageal stricture happens when a narrowing develops in the esophagus and can lead to difficulties in swallowing.
  • Barrett’s esophagus is when the esophageal mucosa is replaced by an intestinal-type mucosa. Barrett's esophagus is considered to be a risk factor for cancer of the lower esophagus called adenocarcinoma of the esophagus. 

Complications outside of the esophagus involve:

  • Asthma;
  • Chronic cough;
  • Hoarseness;
  • Laryngitis;
  • Wearing away tooth enamel due to stomach acid.

 

Esophagitis 

This is a complication most commonly caused by GERD that affects 2 to 5 percent of people aged 55 and older with a normally good prognosis. Depending on the cause of esophagitis, there are various possible treatments available. Common symptoms of esophagitis include:

  • Abdominal pain;
  • Pain and difficulty swallowing;
  • Food becoming stuck in the esophagus;
  • Loss of appetite;
  • Nausea and even vomiting;
  • Cough;
  • Pain in the chest when eating;
  • Difficulty gaining adequate weight;
  • Mouth ulcers or sores.

 

Preventive measures

Some preventive measures include behavior and lifestyle changes such as:

  • Eating moderate amounts of food so as to not overeat;
  • Not eating for at least 2 hours before sleeping;
  • Quitting or avoiding smoking;
  • Improving posture;
  • Wearing loose clothing;
  • Sleeping at a slight angle so your head is slightly elevated.

 

When to see a doctor

You should consider going for a consult if:

  • Lifestyle changes and medicines are not helping;
  • Heartburns become frequent for 3 weeks or more;
  • You have other symptoms, like being frequently sick, losing weight unintentionally or when food gets stuck in your throat.

Always check with your doctor or GP if you suspect you might need medical assistance.

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