Acid Reflux & GERD

Acid reflux is when stomach acid flows upward into your esophagus and, sometimes, your throat. Normally, these acids flow one way: down. So, your esophagus and throat aren’t built to withstand them. Stomach acid can irritate the tissues there. This can lead to uncomfortable sensations, like heartburn. But most people have occasional reflux. It’s nothing to worry about.

GERD (gastroesophageal reflux disease) is when acid reflux becomes chronic. This means you have reflux episodes twice a week for several weeks straight.

While acid reflux can be annoying but temporary, GERD (also spelled GORD for gastro-oesophageal reflux disease) is a constant, mechanical problem. The systems in place to keep acid moving down aren’t working right.

Acid reflux and GERD are common. GERD affects 1 in 5 people in the United States.

Acid reflux in babies is also normal, especially in their first year of life. They can have GERD, too. But it looks a little different for them.

Symptoms of acid reflux and GERD

Symptoms of acid reflux and GERD can include:

• A burning feeling: Stomach acid burns the lining in your esophagus and throat. When the pain is in your chest, it’s heartburn. When it’s closer to your stomach, it’s indigestion.
• Chronic coughing, wheezing and shortness of breath: If particles of stomach acid enter your airways, it can make them contract. This causes symptoms like those of asthma.
• Noncardiac chest pain: This is when the pain in your chest feels like a heavy pressure or tightness. Pain in your esophagus triggers the same nerves as pain related to your heart.
• Nausea: Acid overflow and regurgitation can make you feel sick to your stomach or lose your appetite. You may also feel like there’s still food in your stomach even if you haven’t eaten in a while.
• Regurgitation: You might notice acid, food or liquids coming back up into your throat. There may also be a sour taste along with the backwash.
• Sore throat: Your throat may get sore after acid rises into it and inflames the tissues. It may feel like there’s a lump in your throat, or like swallowing is hard. Reflux in your throat often happens at night.

GERD symptoms can be worse at night or while lying down. They can also worsen after you:

• Have a large or fatty meal
• Bend over
• Drink alcohol or smoke

What causes acid reflux and GERD?

A weakened or relaxed lower esophageal sphincter (LES) causes acid reflux and GERD. For acid to get into your esophagus and throat, it needs to get past the LES, a special valve at the bottom of your esophagus. Its job is to prevent stomach contents from moving upward.

Some things can temporarily relax your LES, like lying down after a large meal. But if you have GERD, your LES is doing this more often than it should.

Sometimes, occasional acid reflux turns into GERD when its triggers persist or overlap.

Risk factors

Common risk factors for acid reflux and GERD include:

• Hiatal hernia: A hiatal hernia can squeeze your esophagus, trapping stomach acid. It can also move your LES and weaken the muscles that support it.
• Pregnancy: Increased abdominal pressure and volume during pregnancy can strain the muscles that prop up your LES. Hormones can also relax the LES.
• Obesity: Like in pregnancy, obesity increases the pressure and volume inside your abdomen and can weaken your LES. Fat tissue also makes hormones that relax the valve.
• Smoking: Tobacco smoke — even secondhand exposure — relaxes your LES. Smoking also triggers coughing, which opens your LES. Together, smoking and coughing can weaken muscles in your diaphragm and slow your digestion (this can produce more stomach acid).

Less common risk factors are:

• Certain conditions: Disorders you have from birth that affect your digestive system can affect your LES. Connective tissue diseases can impact your esophagus muscles.
• Medications: Some medications may relax your LES. These include NSAIDs, calcium channel blockers, antidepressants and theophylline.
• Surgery in your chest and abdomen: Procedures in these parts of your body can injure your esophagus.

How to lower your risk

Many risk factors of acid reflux and GERD are beyond your control. But certain changes to your daily habits can help lower your risk, like not smoking or removing yourself from smoky environments. So can maintaining a weight that’s healthy for you.

Can foods cause acid reflux?

Not on their own. But they can contribute to it. In higher doses, chocolate, coffee, alcohol, mint, garlic and onions can relax your LES.

Heavy meals and fatty foods need more stomach acid to break down, and they take longer. They might not have enough time to digest before you go to bed.

Complications of GERD

Having acid reflux here and there won’t affect your long-term health. But GERD can damage digestive organs above your stomach. This is because your stomach has built-in protection against acid. But your esophagus and throat don’t. Over time, stomach acid can burn and hurt them.

Possible complications include:

• Asthma and breathing problems: Stomach acid in your airways can irritate asthma that already exists. But it can also cause symptoms similar to asthma if you don’t have the condition.
• Barrett’s esophagus: This is when the cells in your esophagus’s lining change to look like those in your intestines. It happens after long-term exposure to acid and inflammation. Barrett’s esophagus is a risk factor for esophageal cancer.
• Esophageal stricture: To protect itself from damage, your esophagus may form scar tissue. This can narrow your esophagus and make it hard to swallow.
• Esophagitis: The lining of your esophagus becomes irritated and inflamed. Chronic esophagitis can cause pain and lead to ulcers, scarring and a precancerous condition called intestinal metaplasia.
• Laryngopharyngeal reflux (LPR): Reflux that travels all the way to your throat can cause swelling, hoarseness and growths on your vocal cords. Acid can also get into your breathing tubes. LPR may happen while you sleep.

How doctors diagnose GERD

A specialist called a gastroenterologist will take a closer look at your situation. They’ll ask about your symptoms and go over your medical history. If that isn’t enough to diagnose GERD, or they want to check for complications, your provider may use:

• Esophagram: This test takes moving X-rays (fluoroscopy) of your esophagus while you swallow a chalky liquid called barium.
• Upper endoscopy: A thin tube with a light and camera at the end lets your provider look inside your esophagus while you’re sedated.
• Esophageal pH test: A small, wireless receiver measures how much stomach acid is inside your esophagus.
• Esophageal manometry: Pressure sensors in a tube that goes through your nose and into your stomach measure muscle activity in your esophagus.

How is acid reflux treated?

If you have acid reflux, you may be able to ease your symptoms by adopting some new habits. These can include:

• Quitting smoking
• Drinking less alcohol or none at all
• Maintaining a weight that’s healthy for you
• Elevating your head at night by 6 to 8 inches using extra pillows or a foam wedge
• Avoiding foods and drinks that make acid reflux worse
• Eating smaller meals
• Eating two to three hours before you lie down
• Avoiding tight clothing (this puts pressure on your abdomen)

Medications

If you need a little extra help in the short term, over-the-counter (OTC) medications for acid reflux include:

• Antacids: These medicines (like Tums® and Rolaids®) weaken stomach acid.
• Alginates: These are sugars that seaweed naturally produces. They create a physical barrier between stomach acid and the esophagus.

Some medications have both antacids and alginates.

How is GERD treated?

Incorporating these habits can help if you have GERD. But your provider may also prescribe medications to reduce your stomach acid. They’re safer to take long term than OTC medications.

Medications

Medications for GERD include:

• H2 blockers: They’re also called histamine receptor antagonists. They reduce stomach acid by preventing your body from making histamine. But sometimes, your body gets used to them and they don’t work as well.
• Proton pump inhibitors (PPIs): If your GERD is severe or your esophagus is damaged, a provider will probably recommend PPIs first. They’re very effective at lowering reflux.
• Baclofen: This medication helps keep your LES from relaxing too much and letting acid flow upward. It’s not a first-line treatment, but it can be helpful in some cases.

Surgery

While daily habits and medication can ease the symptoms and effects of GERD, they can’t stop it from happening entirely. A severe case of GERD can still cause problems on medication, even if you can’t feel it.

When this happens, surgery may be the best option. Procedures to treat GERD are minor and have excellent outcomes. You can typically go home the same day. They include:

• Nissen fundoplication: This is the most common surgery for GERD. A surgeon wraps the top of your stomach around your lower esophagus and secures it with stitches to tighten your LES. It only needs small incisions, and recovery is relatively quick.
• LINX device: A ring of tiny magnets helps keep your LES closed. A surgeon implants a LINX device using small cuts in your abdomen.

When should I seek care?

Reach out to a provider if symptoms are still bothering you after treatment, or if they get worse. If you have acid reflux, this may mean that it’s become chronic. If you have GERD, it could mean that your treatment plan needs an update.

What can I expect if I have acid reflux or GERD?

So many things contribute to acid reflux that it can be hard to tell what’s triggering yours. Sometimes, simple tactics like new habits and over-the-counter medications can make symptoms disappear. Other times, acid reflux can get worse.

Talk with a healthcare provider if acid reflux is getting in the way of life. They can see whether it’s causing problems you aren’t aware of.

You may need surgery if you have severe GERD or complications that medications can’t help. Surgery is usually minimally invasive and effective. It might be worth doing to prevent complications or keep them from making things worse.

How can I stop an acid reflux attack?

If it’s happening right now, try:

• Standing up
• Taking small sips of water
• Loosening your waistband or belt
• Taking an antacid