Gastroesophageal reflux disease (GERD) is diagnosed when acid reflux occurs more than twice a week.
Exact figures vary, but diseases resulting from acid reflux are the most common gut complaint seen by hospital departments in the United States.
GERD is most common in Western countries, affecting an estimated 20 to 30 percent of the population.
Chronic heartburn can lead to serious complications.
Here are some key points about acid reflux. More detail is in the main article.
- Acid reflux is also known as heartburn, acid indigestion, or pyrosis.
- It happens when some of the acidic stomach contents go back up into the esophagus.
- Acid reflux creates a burning pain in the lower chest area, often after eating.
- Lifestyle risk factors include obesity and smoking.
- Drug treatments are the most common therapy and are available on prescription and over the counter (OTC).
Acid reflux is when some of the acid content of the stomach flows up into the esophagus, into the gullet, which moves food down from the mouth. Despite the name, heartburn has nothing to do with the heart.
The stomach contains hydrochloric acid, a strong acid that helps break down food and protect against pathogens such as bacteria.
The lining of the stomach is specially adapted to protect it from the powerful acid, but the esophagus is not protected.
A ring of muscle, the gastroesophageal sphincter, normally acts as a valve that lets food into the stomach but not back up into the esophagus. When this valve fails, and stomach contents are regurgitated into the esophagus, the symptoms of acid reflux are felt, such as heartburn.
GERD affects people of all ages, sometimes for unknown reasons. Often, it is due to a lifestyle factor, but it can also be due to causes that cannot always be prevented.
One cause that is not preventable is a hiatal (or hiatus) hernia. A hole in the diaphragm allows the upper part of the stomach to enter the chest cavity, sometimes leading to GERD.
Other risk factors are more easily controlled:
- smoking (active or passive)
- low levels of physical exercise
- medications, including drugs for asthma, calcium-channel blockers, antihistamines, painkillers, sedatives, and antidepressants
Pregnancy can also cause acid reflux due to extra pressure being placed on the internal organs.
Food and dietary habits that have been linked to acid reflux include:
- a high intake of table salt
- a diet low in dietary fiber
- eating large meals
- lying down within 2 to 3 hours of eating a meal
- consuming chocolate, carbonated drinks, and acidic juices
A recent study suggests that dietary choices may be as effective as using proton pump inhibitors (PPIs) in treating acid reflux.
Zantac is one medication for heartburn relief.
The main treatment options for acid reflux are:
- PPIs, including omeprazole, rabeprazole, and esomeprazole
- H2 blockers, including cimetidine, ranitidine, and famotidine
- Over-the-counter treatments, such as antacids
- Alginate drugs, including Gaviscon
The main treatment options for people who repeatedly experience acid reflux in GERD are either PPIs or H2 blockers, both of which are medications.
PPIs and H2 blockers decrease acid production and reduce the potential for damage caused by acid reflux.
These medications are generally safe and effective, but like any prescription drug, they are not appropriate for all people with reflux disease and can cause side effects.
For instance, they can cause problems absorbing nutrients. This can lead to malnutrition.
OTC remedies for acid reflux
For people who experience heartburn or indigestion infrequently, perhaps in association with occasional food and drink triggers, OTC treatments to reduce the acidity of the stomach contents are available.
These liquid and tablet formulations are called antacids, and there are dozens of brands available, all with similar effectiveness. They may not work for everyone, and any need for regular use should be discussed with a doctor.
Antacids provide rapid but short-term relief by reducing the acidity of the stomach contents.
Alginate drugs such as Gaviscon
Gaviscon is a well-known over-the-counter heartburn medication.
Gaviscon is probably the best-known heartburn therapy. It has a different mode of action than antacid drugs. Alginate drugs such as Gaviscon vary slightly in composition, but they usually contain an antacid.
The alginic acid works by creating a mechanical barrier against the stomach acid, forming a foamy gel that sits at the top of the gastric pool itself.
Any reflux is then relatively harmless as it consists of alginic acid and not damaging stomach acid.
The active ingredient—alginate—is found naturally in brown algae.
Other possible treatment methods include:
- Sucralfate acid suppressants
- Potassium-competitive acid blockers
- Transient lower esophageal sphincter relaxation (TLESR) reducers
- GABA(B) receptor agonist
- mGluR5 antagonist
- Prokinetic agents
- Pain modulators
- Tricyclic antidepressants
- Selective serotonin reuptake inhibitors (SSRIs)
- Theophylline, a serotonin-norepinephrine reuptake inhibitor
If GERD is severe and unresponsive to medical treatment, a surgical intervention known as fundoplication may be needed.
Losing weight and stopping smoking will remove two lifestyle risk factors associated with acid reflux.
Lifestyle measures that may help include:
- improving posture, for instance, sitting up straighter
- wearing loose clothing
- losing weight if overweight or obese
- avoiding increased pressure on your abdomen, such as from tight belts or doing sit-up exercises
- stopping smoking
Acid reflux usually produces heartburn, whether it is due to a single episode of overeating or persistent GERD.
Heartburn is an uncomfortable burning sensation that occurs in the esophagus and is felt behind the breastbone area. It tends to get worse when lying down or bending over. It can last for several hours and often worsens after eating food.
The pain of heartburn may move up toward the neck and throat. Stomach fluid can reach the back of the throat in some cases, producing a bitter or sour taste.
If heartburn occurs two or more times a week, it is known as GERD for short.
Other symptoms of GERD include:
- dry, persistent cough
- asthma and recurrent pneumonia
- throat problems, such as soreness, hoarseness, or laryngitis (voice box inflammation)
- difficulty or pain when swallowing
- chest or upper abdominal pain
- dental erosion
- bad breath
Risks and complications
Without treatment, GERD can lead to serious complications in the long term, including an increased risk of cancer.
Persistent exposure to stomach acid can damage the esophagus, leading to:
- Esophagitis: the lining of the esophagus is inflamed, causing irritation, bleeding, and ulceration in some cases
- Strictures: damage caused by stomach acid leads to scar development and difficulties swallowing, with food getting stuck as it travels down the esophagus
- Barrett's esophagus: a serious complication where repeated exposure to stomach acid causes changes in the cells and tissues lining the esophagus with potential to develop into cancer cells
Both esophagitis and Barrett's esophagus are associated with a higher risk of cancer.
In the U.S., 30 to 50 percent of women experience heartburn during pregnancy, even if they did not have it before.
Lifestyle modifications are recommended during pregnancy, such as not eating too late at night and consuming small meals.
Any woman who is experiencing severe reflux during pregnancy should speak to her doctor about treatment options.
Acid reflux and heartburn are common and relatively easy to diagnose, however, they can be confused with other chest complaints such as:
- heart attack
- chest wall pain
- pulmonary embolus
GERD is often diagnosed simply by finding no improvement in heartburn symptoms in response to lifestyle changes and acid reflux medication.
Gastroenterologists may also arrange the following investigations:
- endoscopy: camera imaging
- biopsy: taking a tissue sample for laboratory analysis
- barium X-ray: imaging the esophagus, stomach, and upper duodenum after swallowing a chalky liquid that helps provide contrast on images
- esophageal manometry: pressure measurement of the esophagus
- impedance monitoring: measuring rate of fluid movement along the esophagus
- pH monitoring: acidity testing