Acid reflux: The Optum Store Guide

Almost anyone can experience acid reflux. Some people have it without symptoms, or they notice the symptoms only once in a while. Others have chronic acid reflux, or GERD, with symptoms that pop up on a regular basis. Reflux is a normal biological process, says Harvey H. Allen Jr., MD. He's a gastroenterologist at St. Luke’s and St. Elizabeth hospitals in Utica, New York.

Here’s how it happens. You have a small sphincter (a ring of muscle) that acts like a valve at the bottom of your esophagus (the tube that connects your throat to your stomach). Called your lower esophageal sphincter, it’s like a door between your stomach and your esophagus. It opens, or relaxes, when you eat. And it should close tightly once the food has entered your stomach. But sometimes it doesn’t. When that happens — either because the ring is too loose or it relaxes when it shouldn’t — abnormal reflux occurs.

That allows gastric acids — the fluids that help you break down and digest food — out of your stomach and up into your esophagus, throat and mouth. And when they’re in the wrong place, those acids can cause the symptoms of acid reflux.

Over time, chronic acid reflux (or GERD) can injure your esophagus, causing a condition called esophagitis (inflammation of the esophagus). It can even cause scars (called strictures) that can narrow your esophagus. That makes it tough for food and liquid to reach your stomach.

Those acids can also lead to changes in the cells of your esophagus. The condition, called Barrett’s esophagus, happens in about 1% of people with reflux. According to the Cleveland Clinic, it’s a precancerous condition. Staying on medications for GERD keeps the acid from making it worse.

(Find out other reasons your stomach might be upset here.)

Acid reflux can bring on lots of different symptoms. Some of them may be painful, says Atif Iqbal, MD. He’s the medical director at the Digestive Care Center at MemorialCare Orange Coast Medical Center in Fountain Valley, California. Here’s what you might notice:

• A dry, chronic cough, commonly at nighttime
• A feeling of food being trapped in your throat
• Burning sensation in your throat and/or chest after eating
• Chest pain
• Clearing your throat often
• Difficulty or discomfort swallowing
• Nausea
• Reflux laryngitis
• Regurgitation (a feeling of fluid or food coming back up)
• Vomiting
• Wheezing

Lots of factors can play a part in acid reflux. You may have only one risk factor, or many, says Omid B. Mehdizadeh, MD. He’s an otolaryngologist (ear, nose and throat doctor) at Pacific Eye, Ear and Skull Base Center in Santa Monica, California.

Here are the potential causes of acid reflux and some things that make it worse, plus ways to prevent it:

• Anatomical issues. These can include a hiatal hernia, which is when the upper part of your stomach bulges through your diaphragm (the muscle that separates your abdomen from your chest) into your chest cavity. A hiatal hernia can obstruct food.

• Weight. Being overweight can be a risk factor for acid reflux. Losing weight can reduce symptoms.

• Certain medications. Some medications can contribute to acid reflux. Examples include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), including pain relievers such as ibuprofen (Advil^®)
  • Medications used to treat hypertension (high blood pressure)
  • Allergy relief medications
  • Steroids
  • Sedatives
  • Antidepressants
• Foods. Certain foods and beverages can cause acid reflux. But the specific ones that trigger reflux are different for everyone. So figuring out which ones tend to cause issues for you can be helpful. Potential culprits include foods that are:
  • Fatty
  • Fried
  • Sour
  • Spicy
  • Acidic

  Some foods to avoid:

  • Chocolate
  • Dairy
  • Peppermint
  • Citrus
  • Caffeine
  • Carbonated drinks

  Tip: Try reducing full-fat foods (such as ice cream) and acidic foods (such as tomatoes), to help cut down on acid reflux symptoms.

• Strenuous exercise. Certain kinds of exercise such as jumping (think cardio) or bending (think yoga) can put pressure on your esophageal sphincter and lead to reflux. That’s according to Loyola University Medical Center in Maywood, Illinois. And avoid exercising right after meals. Wait until a couple of hours after eating so that your food has time to digest.

• Eating too close to bedtime. Getting in bed right after eating can cause reflux symptoms. The solution: Don’t hit the sack until at least 3 hours after your last meal, according to the Cleveland Clinic.

• Overeating. Eating too much during a meal can contribute to acid reflux problems.

• Pregnancy. Especially during the last trimester, abdominal pressure can compress your stomach and cause acid reflux, says Dr. Iqbal.

• Smoking. Nicotine can weaken your esophageal sphincter and may even play a part in esophageal cancer. But studies show that quitting improves GERD symptoms, according to the Cleveland Clinic.

• Sex and race. About 60% of GERD patients are women. Race is a factor, too. Whites make up more than 80% of GERD patients, according to a 2018 study. African Americans make up less than 12%.

• Tight clothing. If your pants are too tight, it can push stomach acids up into your esophagus, causing reflux. Your best bet: Wear clothing that fits comfortably.

If you have symptoms such as heartburn only occasionally, it’s acid reflux. But if you get symptoms over and over, it’s GERD (the chronic form of the condition). Your doctor may tell you that you’ve got GERD when your symptoms act up more than twice a week for a few weeks. Or you may be diagnosed with GERD if medications such as antacids don’t help.

Heartburn, one of the most common symptoms of acid reflux, is a burning pain in your chest that usually happens after eating. It often happens at night, according to the Mayo Clinic. Heartburn tends to feel worse when you’re lying down or bending over. And it can leave a bitter taste in your mouth.

But heartburn can also be caused by bile from your duodenum (the first part of your small intestine), not just by acid, Dr. Iqbal explains. “Bile also refluxes back and gives the same symptoms,” he says.

Even though heartburn is a common symptom of acid reflux and GERD, you can have either condition without heartburn.

The process is the same for both. But when you lie down, acid can more easily travel up into your throat and mouth. That causes coughing and other symptoms. To prevent it, try waiting at least 3 hours after eating before going to sleep.

You can also try using blocks to raise the head of your bed 6 to 8 inches. This can be helpful because when you’re sitting up, the acid can’t travel as easily from your stomach, explains Dr. Allen.

If your reflux just isn’t going away, make an appointment with your doctor. A diagnosis can get you started on treatment, and it can rule out other issues or conditions. “You should go see your provider if you’re having uncontrolled symptoms even though you’re taking medications,” Dr. Mehdizadeh advises. If you notice any of the following, give your provider a call:

• Your over-the-counter antacid isn’t working.
• You’re having difficulty swallowing.
• You notice blood in your saliva or stool.
• You have an ongoing feeling of a lump in your throat.
• You experience unintentional weight loss.

To make a diagnosis of acid reflux or GERD, your doctor will need to take a history of your symptoms and do a full diagnostic workup, including:

• Upper gastrointestinal (GI) endoscopy and biopsy. This involves placing a lighted tube called an endoscope in your mouth and into your throat. That helps doctors see the lining of your esophagus, stomach and duodenum. During the procedure, your doctor may also take samples to examine for damage or irregularities.

• Upper GI series. This is a series of x-rays of your upper GI tract. First, you’ll drink a liquid called barium, which illuminates your GI tract as the x-rays are taken.

• Bravo wireless esophageal pH monitoring. For this test, your doctor places a small capsule in your esophagus, where it stays for 2 days. It transmits readings to a small receiver that you wear on your belt. The receiver measures the acid levels in your esophagus.

• Esophageal pH and impedance monitoring. This test measures your acid levels over 24 hours. The doctor places a thin tube through your nose and into your esophagus to evaluate the flow of liquids from your stomach into your esophagus.

• Esophageal manometry. For this test, a small flexible tube with sensors goes into your nose. It measures how strong your esophageal sphincter, muscles and contractions are during swallowing.

You can treat many symptoms of acid reflux at home. Simple changes to your habits should be the first things you try. These include:

• Lose weight if you’re overweight or obese.
• Improve your diet and sleep routines.
• Reduce alcohol consumption.
• Avoid trigger foods and beverages that make your reflux worse.
• Sit upright or stand after meals.
• Elevate the bed if you go to sleep right after eating.

There are many medications that can treat GERD, according to the American College of Gastroenterology. Some effective prescription and over-the-counter (OTC) medications include:

Antacids: You’ve likely heard of some of these popular OTC medications. They include Tums^®, Rolaids^®, some forms of Mylanta^®, Gaviscon^® and Maalox^®. Antacids neutralize stomach acids, giving you fast relief from common symptoms.

H2 receptor blockers: These popular medications decrease acid production. Some are available over the counter, while others require a prescription. Examples include:

• Tagamet^® (cimetidine)
• Pepcid^® and Pepcid AC^® (famotidine)
• Axid AR^® (nizatidine)
• Zantac^® (ranitidine)

Proton pump inhibitors: These acid blockers focus on healing the irritated esophageal tissue. For some of these medications, you’ll need a prescription. Others are sold over the counter. Examples include:

• Prevacid^® (lansoprazole)
• Prilosec^® and Zegerid^® (omeprazole)
• Nexium^® (esomeprazole)
• Protonix^® (pantoprazole)
• AcipHex^® (rabeprazole)
• Dexilant^® (dexlansoprazole)

Talk to your doctor or pharmacist about side effects to look out for. Some possibilities:

• Bone loss
• Vitamin B12 deficiency
• Risk of C. diff bacterial infection

Harvey H. Allen Jr., MD, gastroenterologist and medical director at Mohawk Valley Endoscopy Center in Utica, New York

Atif Iqbal, MD, general surgeon specializing in minimally invasive bariatric procedures and digestive disorder surgery; medical director of the Digestive Care Center at MemorialCare Orange Coast Medical Center in Fountain Valley, California

Omid B. Mehdizadeh, MD, otolaryngologist and laryngologist at Pacific Eye, Ear and Skull Base Center at Pacific Neuroscience Institute in Santa Monica, California

Acid reflux stats: National Institutes of Health
Symptoms and triggers of GERD: Loyola Medicine
Other risk factors: Journal of Neurogastroenterology and Motility (2018). “The Changing Epidemiology of Gastroesophageal Reflux Disease: Are Patients Getting Younger?”
Relieving acid reflux: Cleveland Clinic
GERD medications: American College of Gastroenterology