Acid Reflux Disease

Medically Reviewed by Zilpah Sheikh, MD on April 11, 2024
Written by Annie Stuart
10 min read

Acid reflux is when acid from inside your stomach flows up into your esophagus and throat. At the entrance to your stomach is a valve, a ring of muscle called the lower esophageal sphincter (LES). Normally, the LES closes as soon as food passes through it. But if it doesn't close all the way or it opens too often, acid from your stomach can move up into your esophagus. This can cause symptoms such as a burning chest discomfort called heartburn. If acid reflux symptoms happen more than twice a week, you may have acid reflux disease, also known as gastroesophageal reflux disease (GERD).

 

One common cause of acid reflux disease is a stomach abnormality called a hiatal hernia. This happens when the upper part of the stomach and LES move above the diaphragm, a muscle that separates your stomach from your chest. Normally, the diaphragm helps keep acid in your stomach. But if you have a hiatal hernia, acid can move up into your esophagus and cause symptoms of acid reflux disease.

These are other common risk factors for acid reflux disease:

  • Eating large meals or lying down right after a meal
  • Being overweight or obese
  • Eating a heavy meal, and lying on your back or bending over at the waist
  • Snacking close to bedtime
  • Eating certain foods, such as citrus, tomato, chocolate, mint, garlic, onions, or spicy or fatty foods
  • Drinking certain beverages, such as alcohol, carbonated drinks, coffee, or tea
  • Smoking
  • Being pregnant
  • Taking aspirin, ibuprofen, certain muscle relaxers, or blood pressure medications

Common symptoms of acid reflux are:

  • Heartburn. A burning pain or discomfort that may move from your stomach to your belly or chest or even up into your throat
  • Regurgitation. A sour or bitter-tasting acid backing up into your throat or mouth

Other symptoms of acid reflux disease include:

  • Bloating
  • Bloody or black stools or bloody vomiting
  • Burping
  • Dysphagia – the sensation of food being stuck in your throat
  • Hiccups that don't let up
  • Nausea
  • Weight loss for no known reason
  • Wheezing, dry cough, hoarseness, or a chronic sore throat
  • Bad breath and/or a bad taste in the mouth
  • Chest pain
  • Asthma

Acid reflux cough

A cough is a common symptom of acid reflux and GERD. Stomach acid that backs up into your throat can trigger irritation and inflammation, causing you to cough. You may only have a cough every once in a while, or it could be a long-term condition. Along with a cough, you may have wheezing, hoarseness, chest congestion, and phlegm.

What to do during an acid reflux attack

When you have an acid reflux attack, try the following:

  • Stand up.
  • Take small sips of water to wash away stomach acid.
  • Put on looser pants or remove your belt.
  • Take an antacid.

How long does acid reflux last?

The symptoms of acid reflux can stay with you for a few minutes up to a few hours. You'll probably feel better once your last meal leaves your stomach.

Acid reflux in babies

Babies often spit up, and there could be some stomach acid in it, though not enough to cause problems. It's normal for babies to spit up a bit; even if there's some stomach acid in it, it usually doesn't bother them much. But babies can have GERD, which makes feeding hard or causes other problems.

Babies born too early or with issues in their esophagus are more likely to have GERD. If your baby seems to be having a tough time, the doctor might check for the condition.

Signs of GERD in babies and small kids include: 

  • Being very fussy
  • Trouble sleeping
  • Not wanting to eat
  • Throwing up a little bit
  • Making wheezing or hoarse sounds
  • Bad breath

It's time to see your doctor if you have acid reflux symptoms two or more times a week or if medications don't bring lasting relief. Symptoms such as heartburn are the key to the diagnosis of acid reflux disease, especially if lifestyle changes, antacids, or acid-blocking medications help reduce these symptoms.

If these steps don't help or you have frequent or severe symptoms, your doctor may order tests to confirm a diagnosis and check for other problems. You may need one or more tests such as these:

Barium swallow radiograph

Your doctor may use this special X-ray procedure to rule out any structural problems in your esophagus. In this painless acid reflux test, they'll ask you to swallow a solution of barium. The barium lets doctors take X-rays of your esophagus. But barium swallow isn't a surefire method of diagnosing GERD. Only 1 in every 3 people with GERD have esophageal changes visible on X-rays.

Endoscopy or EGD

During an endoscopy, the doctor inserts a small tube with a camera on the end through the mouth into the esophagus. This lets the doctor see the lining of the esophagus and stomach. Before inserting the tube, your gastroenterologist may give you a mild sedative to help you relax. The doctor may also spray your throat with an analgesic to make the procedure more comfortable. This acid reflux test typically lasts about 20 minutes. It is not painful and will not interfere with your ability to breathe. While this test may detect some complications of GERD, including esophagitis and Barrett's esophagus, only about half the people with acid reflux disease have visible changes to the lining of their esophagus.

Biopsy

Depending on what the EGD shows, your doctor may decide to perform a biopsy during the procedure. If this is the case, your gastroenterologist will pass a tiny surgical instrument through the scope to remove a small piece of the lining in the esophagus. They'll send a tissue sample to a pathology lab for analysis. There, it will be assessed to see if there is a disease, such as esophageal cancer.

Esophageal manometry

Your doctor may perform this test to help diagnose acid reflux. It sees how well your esophagus is working and checks to see if the esophageal sphincter – a valve between the stomach and esophagus – is working as well as it should.

After applying a numbing agent to the inside of your nose, the doctor will ask you to remain seated. Then, they'll pass a narrow, flexible tube through your nose and esophagus and into your stomach.

When the tube is in the correct position, the doctor will have you lie on your left side. When you do, sensors on the tube will measure the pressure at various places inside your esophagus and stomach. To further see how well your esophagus is working, you may need to take a few sips of water. The sensors on the tube will record the muscle contractions in your esophagus as the water passes into your stomach.

The test typically takes 20 to 30 minutes.

Esophageal impedance monitoring

This test gets an even more detailed picture of how well your esophagus is working and can be done along with manometry. It uses a manometry tube with electrodes placed at various points along its length. It measures the rate at which liquids and gases pass through your esophagus. When your doctor compares these results with your manometry findings, they can judge how well your esophageal contractions move substances through your esophagus into your stomach.

pH monitoring

This test uses a pH monitor to record the acidity in your esophagus over 24 hours. In one version of this test, a small tube with a pH sensor on the end is passed through your nose into your lower esophagus. The tube will stay in place for 24 hours, with the portion exiting your nose attached to the side of your face. It will be connected to a small recording device you can wear or carry.

During this acid reflux test, you'll record in a diary when you eat or drink. You'll also push a specific button on the recording device to indicate when you have acid reflux symptoms. This detailed information will allow the doctor to analyze and interpret your test results.

Doctors are now using a newer, wireless version of this test. This version uses suction to attach a small pH sensor to your lower esophagus. The small capsule can communicate wirelessly with a recording device outside your body for 48 hours. The capsule ultimately falls off and passes through the rest of the digestive tract. Many patients have found the wireless pH monitoring exam far more pleasant than the traditional version. Both techniques yield similar information.

In many cases, lifestyle changes combined with over-the-counter medications are all you need to control the symptoms of acid reflux disease.

Acid reflux medications

Antacids, such as Alka-Seltzer, Maalox, Mylanta, Rolaids, or Riopan, can neutralize the acid from your stomach. But they may cause diarrhea or constipation, especially if you overuse them. It's best to use antacids containing magnesium hydroxide and aluminum hydroxide. When combined, they may help counteract these gastrointestinal side effects.

If antacids don't help, your doctor may try other medications. Some require a prescription. Your doctor may suggest more than one type or suggest you try a combination of drugs such as these:

  • Foaming agents (Gaviscon) coat your stomach to prevent reflux.
  • H2 blockers (Pepcid, Tagamet) lower acid production.
  • Proton pump inhibitors (AcipHex, Nexium, Prilosec, Prevacid, Protonix) also lower the amount of acid your stomach makes.
  • Prokinetics (Reglan, Urecholine) can help strengthen the LES, empty your stomach faster, and reduce acid reflux.

Don't combine multiple types of antacid or other medications without your doctor's guidance.

Acid reflux surgery

If medications don't stop your acid reflux disease symptoms, and the symptoms are severely interfering with your life, your doctor could suggest surgery. Two types of surgery are used to relieve symptoms of GERD if daily use of medication isn't working.

One surgery places a ring known as a LINX device around the outside of the lower end of the esophagus, the tube that connects the mouth to the stomach. The ring consists of magnetic titanium beads held together by titanium wires. The device helps ease reflux by preventing stomach contents from backing up into the esophagus. In one study, patients could stop taking medicine or cut down the amount they took. You shouldn't get the LINX device if you're allergic to certain metals. And once you have a LINX device, you shouldn't get any type of MRI test.

Another surgery, called a fundoplication, can help prevent further acid reflux. It creates an artificial valve using the top of your stomach. The procedure involves wrapping the upper part of the stomach around the LES to strengthen it, prevent acid reflux, and repair a hiatal hernia. Surgeons perform this procedure through either an open cut in the belly or chest or with a lighted tube inserted through a tiny cut in the belly.

Transoral incisionless fundoplication (TIF) is a new procedure that tightens the lower esophageal sphincter by wrapping part of the lower esophagus with polypropylene fasteners. Doctors do the procedure through the mouth with an endoscope, avoiding any surgical cuts. It offers fast recovery without serious side effects.

If you have a large hiatal hernia, TIF alone isn't suitable. But combining it with laparoscopic hiatal hernia repair might be an option.

Doctors only do these procedures as a last resort for treating acid reflux disease after medical treatment hasn't helped.

One of the most effective ways to treat acid reflux disease is to avoid the foods and beverages that trigger symptoms. Here are other steps you can take:

  • Eat smaller meals more often throughout the day, and modify the types of foods you are eating.
  • Quit smoking.
  • Put blocks under the head of your bed to raise it at least 4 to 6 inches.
  • Eat at least 2 to 3 hours before lying down.
  • Try sleeping in a chair for daytime naps.
  • Don't wear tight clothes or tight belts.
  • If you're overweight or obese, take steps to lose weight with exercise and diet changes.
  • Also, ask your doctor whether any medication could be triggering your heartburn or other symptoms of acid reflux disease.

Does milk help with acid reflux?

The fat in milk can make acid reflux worse. Instead, try nonfat milk. It can temporarily shield the stomach lining from acidic contents, offering quick relief from heartburn symptoms.

Mint for acid reflux

Mint is a heartburn trigger. It relaxes the esophageal sphincter and postpones digestion, letting food stay in the stomach longer.

During pregnancy, temporary acid reflux is common. Added pressure and volume in your belly can strain and weaken the muscles supporting your lower esophageal sphincter (LES). Plus, pregnancy hormones like relaxin, estrogen, and progesterone can relax the LES, worsening reflux symptoms.

Stomach acid is designed to break down food for digestion, and a tough inner lining inside of your stomach shields it from this acid. But your other organs lack this protection.

While acid reflux mostly affects your esophagus, it can sometimes reach your windpipe or airways. Over the long term, acid reflux can lead to other health problems such as:

  • Esophagitis, or inflammation of the esophageal lining
  • Barrett’s esophagus, or a change in esophageal tissue, which raises your chances of esophageal cancer
  • Esophageal stricture, which is when scar tissue forms, narrowing the esophagus
  • Laryngopharyngeal reflux (LPR), or when reflux reaches your throat
  • Worsened asthma or asthma-like symptoms

Acid reflux happens when stomach acid moves up into your esophagus, causing symptoms like heartburn or regurgitation. It's usually due to a problem with a valve called the lower esophageal sphincter (LES) not closing properly. Causes include eating large meals, being overweight, certain foods and drinks, smoking, and pregnancy. If lifestyle changes and over-the-counter medications don't help, your doctor might order tests to confirm a diagnosis and suggest treatments, such as prescription medications or surgery, only as a last resort.