Acid Reflux

About Acid Reflux

Acid reflux, also known as gastroesophageal reflux disease (GERD), occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach (oesophagus). This backwash (reflux) can irritate the lining of your oesophagus, causing symptoms and sometimes damage.

Acid reflux is commonly triggered by the relaxation or weakening of the lower oesophageal sphincter (LES), a ring of muscle at the end of your oesophagus that acts like a valve between the oesophagus and stomach. When functioning properly, the LES closes as soon as food passes through it. If the LES doesn’t close all the way or if it opens too often, acid produced by your stomach can move up into your oesophagus, leading to symptoms like heartburn.

Several factors can contribute to acid reflux, including obesity, the layout of your stomach and oesophagus, certain eating habits, and lifestyle choices. Common triggers include large meals, lying down after eating, spicy or fatty foods, caffeine, alcohol, smoking, and certain medications. Persistent reflux can lead to complications such as esophagitis (inflammation of the oesophagus), oesophageal strictures, and Barrett’s oesophagus, which is a precursor to oesophageal cancer.

Symptoms

Symptoms of acid reflux, typically include:

● A burning sensation in the chest, commonly referred to as heartburn, which is usually worse after eating, lying down, or at night.
● Regurgitation of food or sour liquid.
● Difficulty swallowing.
● A feeling of a lump in the throat.
● Chronic cough or sore throat.
● Disrupted sleep or new or worsening asthma.
● Chest pain that may intensify when lying down or bending over.

These symptoms occur when stomach acid flows back into the tube connecting the mouth and stomach, irritating the lining of the oesophagus.

Diagnosis

To diagnose acid reflux, medical experts employ a variety of tests and procedures, guided by the patient’s symptoms and medical history.

● Upper Endoscopy: Often recommended when GERD is suspected, this procedure involves inserting a thin, flexible tube with a camera into the oesophagus to examine for signs of inflammation or damage. It’s particularly useful for assessing ongoing pain or discomfort and for checking complications such as oesophageal stricture or Barrett’s oesophagus.
● Oesophageal pH Monitoring: This test measures the acid level within the oesophagus over a 24-hour period. A small sensor is placed in the oesophagus, either through a catheter or as a wireless capsule, to record acid exposure and correlate it with symptoms experienced during the monitoring period.
● Oesophageal Manometry: This test evaluates the function of the oesophageal muscles and the lower oesophageal sphincter (LES) by measuring the muscle contractions that occur when you swallow. It helps determine if there is a motility disorder contributing to the symptoms.
● Esophagram (Barium Swallow X-ray): This involves drinking a barium-containing liquid that coats the lining of the oesophagus, stomach, and upper part of the small intestine. X-rays are then taken to identify abnormalities such as a hiatal hernia, strictures, or abnormal muscle contractions.

These tests are essential for confirming the presence of GERD and for determining the best course of treatment. Each test provides valuable information about the condition of the oesophagus and the effectiveness of the lower oesophageal sphincter, helping to tailor treatment to the individual’s specific needs.

Treatment

Proton pump inhibitors (PPIs) are all effective in managing symptoms of acid reflux, these medications work by blocking an enzyme in the stomach that produces acid, significantly reducing the acid output. This reduction helps alleviate the painful symptoms associated with acid reflux, such as heartburn and indigestion, and protects the oesophagus from the damage that excessive stomach acid can cause.

Esomeprazole and Omeprazole function by blocking the enzyme in the wall of the stomach that produces acid. This reduction in acid limits the reflux and the irritation of the oesophagus that acid can cause. Esomeprazole, in particular, is noted for its high effectiveness in healing rates of reflux esophagitis, especially in severe cases.

Lansoprazole works similarly by inhibiting the amount of acid produced in the stomach, effectively treating the symptoms of GERD as well as conditions that cause excessive stomach acid like Zollinger-Ellison syndrome.

Pantoprazole is used primarily for the prevention of acid reflux and is effective at reducing the amount of stomach acid produced, thereby minimising damage from acid reflux back into the oesophagus.

These medications generally provide relief from symptoms within a few days of starting treatment, but it’s crucial to follow the prescribed dosage and consult with healthcare providers for optimal results and to avoid potential side effects such as abdominal pain, constipation, or more serious conditions like kidney disease or nutritional deficiencies from long-term use.

Prevention Strategies

Here are some practical steps to help prevent acid reflux:

● Maintain a Healthy Weight: Excess weight can put pressure on the abdomen, pushing stomach contents into the oesophagus.
● Identify and Avoid Trigger Foods: Common triggers include spicy foods, fatty foods, chocolate, caffeine, and acidic foods like tomatoes and citrus fruits.
● Eat Smaller, More Frequent Meals: Large meals can exacerbate acid reflux.
● Quit Smoking: Nicotine weakens the lower oesophageal sphincter, which can allow stomach acid to escape into the oesophagus.
● Elevate the Head of Your Bed: Sleeping on a slight incline helps prevent stomach acid from travelling back into the oesophagus.
● Wait Before Lying Down: Avoid lying down immediately after eating to give your body time to digest.
● Avoid Tight Clothing: Tight clothing can squeeze the stomach, pushing contents into the oesophagus.

Related Reading

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