A brief overview of acid reflux
Acid reflux is when stomach acid reaches the feeding tube or esophagus. Normally this is prevented by a band of muscle in the esophagus called the lower esophageal sphincter (LES). The LES is closed unless food needs to pass down from the gullet to the stomach. However, if the LES is too relaxed or opens frequently there can be an escape of stomach acid into your feeding tube. When this happens people can have unpleasant symptoms such as:
- Heartburn - Burning pain in the middle of the chest
- Regurgitation - A sour taste in the mouth due to stomach acid reaching the mouth
- Recurrent coughs/hiccups/belches
- Hoarse voice
- Halitosis or bad breath
- Feeling bloated
- Feeling or being sick
- Problems swallowing - this can lead to weight loss
Typically this is made worse by eating, bending over or lying down.
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Avoiding acid reflux
We can class treatments into 3 categories. These are lifestyle modifications, medications and surgery. This is also the order that usually we follow i.e. if lifestyle changes fail to work, think about medications and if medications fail then consider surgery.
- Change your lifestyle - There are lots of practical ways to make a difference.
- Avoid overeating - Having big meals increases gastric acid production. Try to have smaller, more frequent meals instead. Chronic overeating will lead to obesity which puts you at an increased risk of acid reflux.
- Exercise - Obesity is a major risk factor for acid reflux as extra weight around the abdomen puts pressure on the stomach. Losing weight can show real benefits in terms of health in general. Diet and exercise combined are effective to lose weight. However, armed with this information do not go straight into vigorous exercise especially soon after eating as this can actually trigger reflux.
- Avoid trigger food and drink - Triggers include caffeine-rich items (coffee, chocolate), fatty foods, onions, citrus fruits, tomatoes, peppermint, carbonated drinks and spicy foods. These foods are harder to digest and increase the production of stomach acid.
- Avoid recreational drugs - Smoking (first and secondhand smoke) and alcohol have multiple effects. They lower LES tone and increase gastric acid production. It is never too late to quit smoking or limit drinking.
- Wait before you lie down after eating - This will avoid acid sloshing into your esophagus. Normally when standing or sitting upright gravity is your friend, but when lying down it is not.
- Lie with the chest raised - If you are going to lie down try to lie on a foam wedge raising your chest 4/6 inches above your abdomen. This is better than using pillows as pillows provide a nonuniform raise.
- Avoid stress and anxiety - Mental stress is not helpful with regard to acid reflux. It may increase gastric acid production and make you feel that symptoms e.g. heartburn are worse than they actually are. Chronic heartburn can also trigger stress so it's a vicious cycle that needs to be broken. Try to listen to your body, take breaks and meditate. Consult a doctor if you feel like anxiety is affecting your life.
- Wear looser clothes - Tight clothes can put too much pressure on your belly and trigger heartburn.
- Consider medication - This may involve taking over-the-counter heartburn relief or consulting your doctor with regards to other medications and changing existing medications.
- Over the counter medications (OTC) include:
- Antacids - Antacids work quickly within a few seconds to neutralize stomach acid. They last up to 3 hours.
- H2 blockers - These lower the amount of acid the stomach makes. They get to work in around half an hour and are effective up to 12 hours
- Proton-pump inhibitors (PPIs) - These also lower acid production. They take up to 4 days to get to work and last for up to 24 hours.
- Alginate drugs - Drugs like Gaviscon contain alginic acid that floats on top of stomach acid. Any reflux is then alginic acid which is much weaker and does not irritate the esophagus as much.
- Other drugs are not sold over the counter and will need a prescription - These include prokinetics which speed up gastric emptying leaving less residual acid. Remember that these and OTC drugs may cause unwanted side effects. Consult a doctor in case you take any medications that may interact with these or if you are pregnant.
- Changing existing medications - Consult your doctor if your existing medications are causing problematic acid reflux. There may be a suitable alternative. Different classes of medicines such as certain painkillers, blood pressure medications, antidepressants, muscle relaxants and antibiotics list reflux as a side effect to be aware of. Avoid quitting cold turkey without support.
- A final option may be surgery - Different operations such as laparoscopic fundoplication or insertion of a LINX device, for example, are possible. These include folding a part of the stomach over the esophagus to create a stronger valve and having a device around the outside of the LES to increase pressure respectively.
Treating acid reflux has a variety of options. Lifestyle modifications are the easiest to follow and are least likely to have detrimental effects. Limit the size of your meals and watch what you eat. Exercise appropriately. If you still need relief, consider medications. Most OTC medications are effective for many people but you may need to consult your doctor. In more severe cases surgery may be helpful.