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 made by 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).
What Causes Acid Reflux Disease?
One common cause of acid reflux disease is a stomach abnormality called a hiatal hernia. This occurs 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 our 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
- Being pregnant
- Taking aspirin, ibuprofen, certain muscle relaxers, or blood pressure medications
What Are the Symptoms of Acid Reflux Disease?
Common symptoms of acid reflux are:
- Heartburn: a burning pain or discomfort that may move from your stomach to your abdomen 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:
- Bloody or black stools or bloody vomiting
- Dysphagia – the sensation of food being stuck in your throat
- Hiccups that don't let up
- Weight loss for no known reason
- Wheezing, dry cough, hoarseness, or chronic sore throat
- Bad breath and/or a bad taste in the mouth
- Chest pain
How Is Acid Reflux Disease Diagnosed?
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 if 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:
Diagnosing Acid Reflux With a Barium Swallow Radiograph
Your doctor may decide to use a special X-ray procedure – the barium swallow radiograph – to rule out any structural problems in your esophagus. In this painless acid reflux test, you will be asked to swallow a solution of barium. The barium enables doctors to take X-rays of your esophagus. Barium swallow isn't a surefire method of diagnosing GERD. Only one out of every three people with GERD has esophageal changes that are visible on X-rays.
Diagnosing Acid Reflux With 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 enables the doctor to 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 spray to make the procedure more comfortable for you. 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.
Diagnosing Acid Reflux With a 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. The tissue sample will then be sent to a pathology lab for analysis. There it will be assessed to see if there is a disease such as esophageal cancer.
Diagnosing Acid Reflux With Esophageal Manometry
Your doctor may perform an esophageal manometry to help diagnose acid reflux. This is a test to see how well your esophagus is working. It also 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 a narrow, flexible tube will be passed through your nose, through your 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 being exerted at various places inside your esophagus and stomach. To further see how well your esophagus is working, you may be asked to take a few sips of water. The sensors on the tube will record the muscle contractions in your esophagus as the water passes down into your stomach.
The test typically takes 20 to 30 minutes.
Diagnosing Acid Reflux With Esophageal Impedance Monitoring
To obtain an even more detailed picture of how well your esophagus is working, the gastroenterologist may recommend esophageal impedance monitoring. If so, this can be done along with manometry. This test 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 these results are compared with your manometry findings, your doctor will be able to assess how effectively your esophageal contractions are moving substances through your esophagus into your stomach.
Diagnosing Acid Reflux With pH Monitoring
This test uses a pH monitor to record the acidity in your esophagus over a 24-hour period. 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 is left in place for 24 hours, with the portion exiting your nose affixed to the side of your face. It will be connected to a small recording device that you can wear or carry.
During the course of this acid reflux test, you will record in a diary when you are eating or drinking. You will also push a specific button on the recording device to indicate when you are having acid reflux symptoms. This detailed information will allow the doctor to analyze and interpret your test results.
A newer, wireless version of this test is now being used. In this version, a small pH sensor is affixed to your lower esophagus using suction. The small capsule is able to communicate wirelessly with a recording device outside your body for 48 hours. The capsule ultimately falls off and passes through the remainder of the digestive tract. Many patients have found the wireless pH monitoring exam to be far more pleasant than the traditional version. Both techniques yield similar information.
Can Acid Reflux Disease Be Treated With Diet and Lifestyle Changes?
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 frequently 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 inches 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.
Can Acid Reflux Disease Be Treated With Medications?
In many cases, lifestyle changes combined with over-the-counter medications are all you need to control the symptoms of acid reflux disease.
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 that contain both 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 medications such as these:
- Foaming agents (Gaviscon) coat your stomach to prevent reflux.
- H2 blockers (Pepcid, Tagamet) decrease acid production.
- Proton pump inhibitors (Aciphex, Nexium, Prilosec, Prevacid, Protonix) also reduce 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 more than one type of antacid or other medications without your doctor's guidance.
Is Acid Reflux Disease Ever Treated With Surgery?
If medications don't completely resolve your symptoms of acid reflux disease and the symptoms are severely interfering with your life, your doctor could recommend surgery. There are two types of surgical treatment used to relieve symptoms of GERD if daily use of medication isn't effective.
The most recently approved procedure involves surgically placing 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 were able to 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 surgical procedure 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.
These procedures are done only as a last resort for treating acid reflux disease after medical treatment hasn't helped.