What causes acid reflux?

Understanding acid reflux

Acid reflux is when stomach acid reaches the esophagus. Acid escapes from the stomach and passes through a ring of muscle at the end of your food pipe called the lower esophageal sphincter (LES). Normally the LES is shut and only opens to allow food through, but a lack of tone or frequent opening can cause acid to leak into the esophagus. There are three main contributing factors to acid reflux symptoms. These are:

• Poor clearance of food/ leaked acid in the esophagus
• Too much gastric acid production
• Delayed stomach emptying

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Symptoms of acid reflux

The symptoms of acid reflux include:

• Heartburn - A burning feeling typically in the center of the chest that can spread to neighboring parts of the body e,g, the neck and also be in the upper abdomen. 
• Regurgitation - A sour taste in the mouth caused by stomach acid reaching the mouth.
• Coughs/hiccups/belches - These frequently recur.
• Hoarse voice - This is when the stomach acid irritates the larynx.
• Bad breath and dental problems - This is from the gastric acid reaching the mouth.
• Bloating/ feeling sick/ vomiting - Again as the stomach acid is an irritant.
• Issues swallowing - This can also lead to weight loss.

Causes and factors that make acid reflux worse

• A common cause is eating a big meal and lying down soon afterward - Not only has the big meal increased the production of acid but lying down means that gravity is not your friend. It is easy to avoid this problem. Have fewer, more frequent meals and wait a couple of hours before you lie down. It is best to lie down with the chest raised, ideally with a foam wedge on your bed under your chest.
• Being overweight is a risk factor for acid reflux -  Extra weight, particularly around the abdomen, puts pressure on the stomach making acid reflux more likely. Plus overweight individuals may consume large amounts of food in one sitting increasing acid production. Obese individuals also have an increased likelihood of suffering from GERD. This condition is gastroesophageal reflux disease, where acid reflux occurs frequently (greater than twice a week). The risk of suffering from GERD complications is also increased such as Barett’s esophagus (precancerous changes to the cells lining the esophagus). Hormones may also be altered and contribute to the disease. Lifestyle changes such as diet and exercise are recommended.
• Certain foods and drinks may play a part - Other than increased consumption, foods and drinks such as coffee, alcohol, carbonated drinks, chocolate, fatty and spicy foods may either increase acid production, alter LES tone or emptying and pressure in the stomach. Another class of foods to watch out for is citrus fruits as they are already acidic. It is easy to make changes to your diet and avoid these triggers.
• Other underlying conditions may also be problematic - Some important examples are hiatus hernia and connective tissue problems. Hiatus hernia is when your stomach shifts up to rest in your chest cavity preventing the LES from closing normally. Over-the-counter medication may help but surgery may be required.  Connective tissue disorders are a problem because they interfere with sphincter tone and contractions to move food down the digestive system may be weaker. Another condition that can cause acid reflux is scleroderma. This is an autoimmune disease that attacks the body's connective tissue.
• Avoid stress and anxiety - Stress may worsen heartburn symptoms. Anxious people may produce more stomach acid during the time of anxiety your perception of the discomfort from acid reflux is greater. Stress can lead to harmful behaviors such as drug use and overeating further contributing to acid reflux. Reflux can also cause stress if chronic, leading to a vicious circle.
• Smoking and Alcohol can make it worse. - Smoking including second-hand smoking and drinking can lower LES tone and reduce the clearance of acid. Smokers also tend to cough increasing pressure on the stomach and promoting reflux. It is never too late to quit smoking.
• Pregnant women are also more susceptible - Hormones relax the sphincter and the expanding uterus creates pressure on the stomach. An important point to address for pregnancy is that you should talk to your doctor before trying certain medications.
• Acid reflux is a side effect of some medications. - These include certain NSAIDs such as ibuprofen and aspirin, blood pressure medications,  antihistamines,  some antidepressants, some antibiotics, and bone-strengthening medications amongst others. Talk to your doctor with regards to your medicines as it may be possible to find a suitable alternative.
• Moving too fast after eating is problematic - Strenuous exercise and bending over may cause acid to reach your esophagus. During exercise blood flow is diverted from the digestive system to skeletal muscles so your digestive system function will not be optimal. 
• Tight clothes are also a no-go - This can put pressure on your belly and contribute to reflux. Wear comfortable, loose clothing instead. 

Summary

Acid reflux can have many causes. It can be avoided through changing lifestyle habits including how often, how much and what foods and beverages you consume. Exercising to lose weight and avoiding drugs such as alcohol and cigarettes will also help. Medications (over the counter medications and those prescribed by a doctor) and then surgery if necessary are solutions to persistent acid reflux. Remember to consult your doctor particularly if your symptoms are persistent, troublesome or you have additional symptoms indicating you may have a condition other than acid reflux.

Sources

https://www.health.harvard.edu/digestive-health/9-ways-to-relieve-acid-reflux-without-medication

https://www.medicalnewstoday.com/articles/146619#causes

https://www.nhs.uk/conditions/heartburn-and-acid-reflux/

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