Alleviating Acid Reflux

It’s Friday night after a long week of work. You decide tonight’s dinner will be a gorgefest with a cheeseburger as the star of the show. Paired with a soda it’s a food paradise. About an hour later, the paradise turns into a nightmare. You are hit with the worst case of heartburn. You could be experiencing acid reflux.

Acid reflux or gastroesophageal reflux disease (GERD)  is when stomach acid spurts into the esophagus, the food tube, because of a weak mechanism for keeping it in the stomach. Essentially what happens is as food slides south, a valve, a muscular sphincter at the bottom of the esophagus, relaxes allowing passage into the stomach. But if the sphincter doesn’t close completely after food passes through, or if the sphincter relaxes at the wrong time, stomach acid refluxes back into the esophagus, causing a painful burning near the heart.

In people with significant GERD, that muscle is weak all the time or at least on a temporary basis so acid can come up and stay longer than it should. It’s the duration of acid in the esophagus that distinguishes GERD patients from other heartburn sufferers.

Periods of relaxation (in which gastric content occasionally may wash back into the esophagus) are normal. But in patients with acid reflux, a greater number of these [relaxation] episodes are associated with the contents washing up into the esophagus and we don’t know why that occurs.

But persistent acid reflux isn’t just annoying. If it occurs too often and persists for too long, it can erode the lining of the esophagus and increase the risk of developing a deadly cancer called esophageal adenocarcinoma.

It is estimated that about 20 percent of people in the United States have GERD. In the United States alone, overall spending on all GI diseases is estimated to be $142 billion per year. GERD accounts for approximately $15-20 billion of these direct and indirect costs. Some symptoms include a burning sensation in your chest (heartburn) usually after eating, might be worse at night; chest pain; difficulty swallowing; regurgitation of food or sour liquid; and a sensation of a lump in throat. Some troubling symptoms that can affect you at night are a chronic cough; laryngitis; new or worsening asthma; and disrupted sleep.

Heartburn or acid indigestion is the most common symptom of GERD and usually feels like a burning chest pain beginning behind the breastbone and moving upward to the neck and throat. The burning pain of heartburn can last as long as two hours and is often worse after eating.

Conditions that increase your risk of GERD include obesity, pregnancy, bulging of the top of the stomach up into the diaphragm (hiatal hernia), connective tissue disorders such as scleroderma, and delayed stomach emptying.

Lifestyle tips to help prevent indigestion include avoiding certain foods and beverages such as chocolate, peppermint, fatty foods, coffee, alcohol, citrus fruits and juices, tomato products and pepper. Big meals should be avoided. Tight-fitting clothing and lying down within two to three hours after eating contribute to the problem.

In fact, some complications of GERD include narrowing of the esophagus (esophageal stricture), an open sore in the esophagus (esophageal ulcer), and precancerous changes to the esophagus (Barrett’s esophagus).

To diagnose GERD, your doctor may depend on a physical exam and a history of signs and symptoms. But your doctor may also suggest an upper endoscopy where a thin tube equipped with a light and camera is inserted down your throat to view the inside of your esophagus and stomach.

 An ambulatory acid probe test may also be run where a monitor is placed in your esophagus to identify when and how long stomach acid regurgitates there. An esophageal manometry measures the muscle contractions in your esophagus when you swallow. An X-ray of your upper digestive system after drinking a chalky liquid that coats the inside lining of your digestive tract, which enables you to see a silhouette of your esophagus, stomach, and upper intestine.

To treat GERD, your doctor may suggest lifestyle changes and over-the-counter medications. If those things don’t offer relief, then prescribed medicine or surgery may be recommended. Over-the-counter medication like antacids (Mylanta, Rolaids, Tums) may neutralize stomach acid effectively. H-2 receptor blockers (Tagamat HB, Pepcid AC, Axid AR) reduce acid production. Proton pump inhibitors (Prevacid 24HR, Prilosec OTC, Zegerid OTC) block acid production and heal the esophagus.

There are also prescription strength H-2 receptor blockers, proton pump inhibitors, and medication to strengthen the lower esophageal sphincter. While GERD is usually controlled with medication, there are other alternatives to long-term drug treatments like surgery and other procedures. In fundoplication, the surgeon wraps the top of the stomach around the lower esophageal sphincter, to tighten the muscle and prevent reflux.

For the procedure regarding the LINX device, tiny magnetic beads are wrapped around the junction of the stomach and esophagus. The magnetic attraction between the beads is strong enough to keep the junction closed to refluxing acid, but still allow food to pass through. With the transoral incisionless fundoplication, this procedure involves tightening the lower esophageal sphincter by creating a partial wrap around the lower esophagus using polypropylene fasteners.

Some tips to ward off acid reflux are to maintain a healthy weight, stop smoking, elevate the head of your bed (place wood or cement blocks under the feet of the bed), don’t lie down after a meal, and eat slowly and chew thoroughly.

Most of all, lower your stress. The more stressed out you are, the more it will affect your digestion. Practice a state of mindfulness where you slow things down and appreciate small changes and hopefully that will affect your reflux.