Acid Reflux Disease Relief

Whether we know them as "heartburn" or "acid indigestion," the symptoms of gastro-esophageal reflux are familiar. In fact, an estimated 10% of Americans have symptoms of acid reflux, caused by stomach acids that have splashed back into the esophagus, on a daily basis. More than one-third of healthy people may experience such symptoms at least once a month. Women are affected more frequently than men. Fortunatley, there are cures for acid reflux.

What causes acid reflux disease

Acid reflux is, to some extent, a natural part of the digestive process. When we eat, food mixes with saliva in the mouth. Swallowing sends a bolus of food and saliva into the esophagus -- a 10-inch tube formed by longitudinal and circular muscle fibers that connects the throat with the stomach. These fibers contract several times in a process called peristalsis to propel the bolus toward the stomach. The change in pressure as the bolus is pulsed through the esophagus causes the lower esophageal sphincter -- a thick ring of muscle fibers at the entrance of the stomach -- to relax, allowing food to pass through. Once the food is in the stomach, the sphincter closes. However, before it is fully closed, reflux can occur. Usually, so little of the stomach's contents spill back into the esophagus that we don't notice the effect.

However, when acid reflux is more severe -- a condition called gastroesophageal reflux disease -- we are more likely to feel its effects. More of the esophagus is bathed in caustic fluid from the stomach. This fluid contains pepsin -- an enzyme to dissolve proteins --and hydrochloric acid. Sometimes it also contains bile salts and pancreatic enzymes.

Unlike the esophagus, the stomach can survive a constant bath in this mix of gastric juices, because its lining has ample protection against these digestive agents. The cells of the topmost layer, or epithelium, secrete a protective coat of mucus, and the tightly connected configuration of these cells prevents acid from penetrating deeper. Moreover, rapid cell turnover restores the epithelium continuously.

Acid reflux becomes a problem when the lower esophageal sphincter relaxes too often or too long or does not close properly. It is more likely to occur when pressure on the stomach is greater than pressure in the upper esophagus, for example when wearing a tight belt or control-top pantyhose. In some people simply bending over or lying down after a large meal increases the pressure in the abdomen enough to cause reflux. Carrying excess weight, which can create increased abdominal pressure, often contributes to reflux as well. During the last months of pregnancy reflux is extremely common, not only because of increased abdominal pressure, but also because levels of progesterone, which relaxes the sphincter, are high. As many as 25% of pregnant women suffer from severe acid reflux.

Certain drugs and foods may contribute to acid reflux. Several widely used acid reflux medications, including proges-tins, calcium-channel blockers, tricyclic antidepres-sants, and asthma medications, can relax the esophageal sphincter. Cigarette smoking and alcohol consumption have been implicated. Foods to avoid with acid reflux include high-fat foods, onions, garlic, peppermint, chocolate, and coffee are common dietary culprits.

In some people, acid reflux not only causes heartburn, but may also inflame the lining of the esophagus -- a condition called reflux esophagitis. A few people who have esophagitis eventually develop scarring or stricture -- a narrowing of the esophagus that impedes swallowing. Some may develop Barrett's esophagus, which occurs when the normal cells lining the esophagus become abnormal and may occasionally progress to cancer.

Acid reflux Symptoms

The symptoms of acid reflux disease can be exacerbated by infection, acidic foods, or nonsteroidal anti-inflammatory drugs (NSAIDs). People who have reflux esophagitis may experience one or more of the following, either singly or in combinations:

* Heartburn is the most common symptom. A burning sensation that arises behind the breastbone and sometimes
  radiates to the neck and arms, it usually begins 1-2 hours after one has eaten and may be brief or last for several hours.

* Regurgitation. Sometimes gastric juices and small amounts of food are brought all the way back to the mouth or respiratory tract. This is particularly troublesome if it occurs during sleeping because the re-fluxate can be sucked into the lungs, and may result in pneumonia.

* Chest pain. Often confused with angina, chest pain may be due to a spasm of the acid-bathed esophagus.

* Other symptoms. When acid reflux is severe, a small percentage of people with gastroesophageal reflux disease will develop unexplained coughing, hoarse-ness, sore throat, gingivitis, or asthma -- all caused by acid damage to the larynx, throat, mouth, or lungs.

Acid reflux cures

In most cases, the symptoms alone are enough to identify acid reflux disease, so diagnostic testing isn't necessary. Doctors who suspect the condition usually suggest the following acid reflux treatments:

* Lifestyle changes. Often, it is enough to avoid large meals or to eliminate foods and drugs that decrease lower esophageal sphincter pressure or irritate the lining of the esophagus. Weight loss can reduce acid reflux symptoms by decreasing the abdominal pressure. Smokers may also reduce the severity of acid reflux by giving up the habit. 

* Eating and sleeping habits. Refraining from eating for at least 3 hours before retiring at night or prior to daytime naps often helps get rid of acid reflux. Doing so allows ample time for food to pass through the stomach. Elevating the head of the bed on 6- to 8-inch blocks should reduce nighttime acid reflux symptoms.

* Antacids. Over-the-counter products (like Tums, Maalox, and Mylanta) neutralize acids in the stomach. When taken four times a day (1 hour after each meal and at bedtime), they are effective for transient symptoms. Another nonprescription product, Gaviscon, contains an acid derived from algae in addition to other antacids. These substances form a foam barrier in the stomach that blocks the gastroesophageal junction, to prevent acid from refluxing back through.

* The H2-receptor antagonists. Cimeti- dine (Tagamet), famotidine (Pepcid), nizatidine (Axid), and ranitidine (Zantac) prevent the secretion of gastric acid in the stomach. They are often prescribed for patients with stubborn symptoms. When taken for 4-6 weeks, they cure many cases of mild to moderate esophagitis, but are often ineffective when esophagitis is severe.

* Prokinetic agents, such as cisapride (Propulsid) and metoclopramide, increase pressure on the lower esophageal sphincter and speed gastric emptying. These drugs are often used in combination with an H2-receptor antagonist. Cisapride is the prokinetic agent of choice for curing acid reflux, because it has the fewest side effects.

* Proton-pump inhibitors. Lansoprazole (Prevacid) and omeprazole (Prilosec) constitute a relatively new class of drugs that block acid secretion in the stomach nearly completely, and are the most effective medical therapies for reflux esophagitis.

* Surgery. When acid reflux medication and lifestyle changes fail to relieve symptoms of esophagitis, and diagnostic procedures do not reveal any specific abnormalities that may be responsible, surgery may be recommended. Most of the procedures create a valve by wrapping a pouch of tissue around the lower esophagus, and, in some patients, can be performed laparoscopically. However, with the advent of proton-pump inhibitors, surgery is less often needed to control severe acid reflux disease.

Additional acid reflux testing

Most cases of acid reflux can be relieved by lifestyle changes and medication. However, when people have unusual, severe, or stubborn symptoms that aren't substantially alleviated by medication, doctors may use the following diagnostic procedures to assess the severity of acid reflux or to rule out heart disease or other conditions:

* Upper gastrointestinal x-rays, taken after swallowing a barium-containing drink, show the esophagus and stomach. These give limited information about reflux, but may indicate if the symptoms are due to ulcers or scarring of the lower esophagus.

* Upper gastrointestinal endoscopy involves inserting a lighted scope through the mouth into the esophagus, and looking at the tissue lining the esophagus for inflammation. A tissue sample may be taken.

* Esophageal pH monitoring. This test involves inserting a thin probe through the nose to about 2 inches above the lower esophageal sphincter and allowing it to remain in place for 24 hours. The probe monitors the pH level -- an indicator of acidity -- in the esophagus continuously during that period. A pH level lower than 4 for more than 4% of the testing period is an indication of stomach acid in the esophagus. The procedure is useful in documenting reflux as a possible cause of chest pain, cough, or asthma in patients with relatively mild heartburn.

* Bernstein test, which entails dripping a mild acid through a tube in the esophagus, is used to reproduce chest pain in patients suspected of having esophageal spasm. If the pain caused by the test is different from the patient's usual symptoms, the symptoms are not likely to be due to acid reflux.

If you have acid reflux disease

Acid reflux is usually a chronic problem. Although it may progress to produce disabling chest pain, inflammation, or permanent damage to the esophagus, such complications are unusual. In most cases, lifestyle changes and over-the-counter drugs are enough to control the symptoms of acid reflux. The newer prescription drugs omeprazole and lansoprazole can be very effective for severe esophagitis. However, long-term acid reflux treatment is almost always needed to prevent esophagitis from recurring.

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Last updated Jan 4/07