Acid reflux overview
Acid reflux is estimated to affect up to 20 percent of Americans. It is caused when stomach acid reaches the food pipe or esophagus through the lower esophageal sphincter (LES). The LES is a ring of muscle at the end of the esophagus and is normally closed. It opens to allow food into the stomach and then closes. If the LES muscle is weak or opens frequently it can cause stomach contents to back up into the esophagus.
Frequent acid reflux (greater than twice a week), for which you have to take daily antacids, acid reflux that affects your life or has damaged the lining of the esophagus can indicate gastroesophageal reflux disease (GERD). This should be treated to avoid complications so it is important to consult your doctor.
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Acid reflux symptoms
Symptoms will vary between individuals and depending on the frequency and extent of reflux. Symptoms can be mild or severe and include:
- Heartburn - This is the most common symptom. The esophagus becomes irritated after stomach contents reach it. Unlike the stomach the esophagus is not adapted to be in contact with gastric acid. This causes a burning sensation usually in the center of the chest under the breastbone but the pain can also radiate, to the chest, back or shoulders for example. The sensation can be unpleasant to painful but the severity of this feeling does not necessarily mean lasting injury to the esophagus.
- Sour taste in the mouth - This is caused by regurgitation when the stomach acid reaches the mouth. The taste can also be bitter and create a burning sensation. Long term dental problems such as erosion of the teeth and gum disease can arise with repeated exposure to stomach acid. Bad breath is also a symptom.
- Indigestion - This is a feeling of discomfort in the upper middle part of the stomach. You may feel bloated, full and nauseous. You may vomit or burp.
- Sore throat - Stomach acid irritates the throat making swallowing problematic, causing a hoarse voice or an uncomfortable sensation that there is a lump in the throat. This may cause a dry cough.
- Asthma symptoms - Reflux can make asthma worse in children and adults if the stomach acid is able to irritate the airways.
- Reflux is often made worse by having a large meal that is spicy or rich in fat, and by bending down or lying down soon after eating.
If GERD is not treated it can lead to serious complications through lasting damage to the esophagus:
- Esophagitis - This is when the lining of the esophagus is inflamed. Irritation, bleeding and ulceration can occur. Esophagitis increases cancer risk.
- Strictures - Scar tissues can lead to narrowing of the esophagus making it difficult to swallow food.
- Barrett’s esophagus - The lining of the esophagus can undergo pre-cancerous changes or metaplasia. This makes the risk of developing cancers higher.
Is it reflux or something else?
The symptoms of acid reflux and heart attacks are largely overlapping so can warrant a visit to the emergency department. You may suspect something more sinister than acid reflux if:
- The ‘heartburn’ is worse than usual or different in nature
- You have severe chest pain
- You have a squeezing, tightening or crushing feeling in the chest
Additional symptoms that may indicate a heart attack include:
- Shortness of breath
- Pain radiating to the left arm, shoulder, neck, jaw or back
Other conditions to be ruled out are pneumonia, chest wall pain or a pulmonary embolus. Another gastrointestinal cause may also be possible. Symptoms such as bloody or dark stools or black vomit may indicate that you have an ulcer that is bleeding. This is considered a medical emergency and requires immediate evaluation.
Acid reflux is a common condition and the most common symptom is heartburn. If acid reflux is frequent and affects your quality of life there is a chance that you may have GERD. You should consult your doctor and get treated to avoid complications. Emergency conditions such as a heart attack may mimic acid reflux so it is important to get medical help if you suspect an alternate diagnosis for your symptoms.