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Acid Reflux

acid reflux antacid pills

What is acid reflux?
Also called acid regurgitation, acid reflux is a common condition in which stomach acid flows backward up the esophagus (the tube carries food from the mouth to the stomach), causing symptoms such as a burning feeling in the chest (heartburn) and a bitter or sour taste in the mouth. These symptoms usually last a few hours after a meal and then go away. Most people experience acid reflux from time to time, usually after eating certain foods. Acid reflux that occurs more than twice a week is called gastroesophageal reflux disease (GERD). This is a more serious condition that, left untreated, can lead to problems such as inflammation of the esophagus (esophagitis) and a precancerous condition called Barrett's esophagus. GERD can also worsen asthma, chronic cough, insomnia, and pulmonary fibrosis.

What are the symptoms of acid reflux?
Heartburn is the most common symptom of acid reflux. Other symptoms include:

  • Bitter or sour taste in the mouth
  • Chronic dry cough
  • Trouble swallowing
  • Wheezing
  • Hoarseness

What are the causes of acid reflux?
Acid reflux occurs when a ring of muscle at the bottom of esophagus called the lower esophageal sphincter (LES) doesn't function properly. Normally, the LES keeps stomach contents in the stomach and prevents the backflow of acid by tightening up after swallowing. But in people with acid reflux, the LES becomes weak and relaxes, allowing acid and stomach contents to flow back up the esophagus.

Although it's still unclear exactly what causes the LES to weaken, several factors have been shown to contribute to and worsen acid reflux. These include:

  • Obesity (extra pounds can put pressure on the LES)
  • Pregnancy
  • Hiatal hernia, a condition in which the top of your stomach protrudes above the diaphragm muscle in your chest
  • Smoking
  • Alcohol or caffeine consumption
  • Eating large meals
  • Eating before bedtime
  • Medications such as antihistamines, calcium channel blockers, theophylline, and nitrates
  • Fatty, fried, and spicy foods; tomato-based foods; citrus fruits; chocolate; mint; garlic; and onions

Who is likely to get acid reflux?
Acid reflux and GERD can occur in people of all ages, including children. It is most common in people who are overweight, smoke, and eat poor diets, as well as in pregnant women.

How is acid reflux diagnosed?
Acid reflux that occurs more than twice a week could be GERD and should be evaluated by a doctor, especially if you have been taking antacids or over-the-counter (OTC) reflux medications for more than two weeks.

To test for GERD, a doctor may perform a test called an upper GI series. In this exam, the patient drinks a type of contrast or dye called liquid barium, which highlights the upper digestive tract. As the barium flows down the esophagus and into the stomach, the doctor will take X-ray pictures of the process. The doctor may also recommend an endoscopic examination. In an endoscopy procedure, the doctor passes a small, flexible tube with a tiny camera at the tip into the mouth and esophagus while the patient is sedated. The camera allows the doctor to view any abnormalities in the esophagus.

What is the conventional treatment of acid reflux?
Conventional doctors usually recommend lifestyle changes and OTC medications as the first line of treatment for acid reflux. If symptoms aren't relieved, the patient may be prescribed medication. The doctor will also consider the medications the patient already takes and discuss alternatives to those that may trigger reflux.

Lifestyle Measures:

  • Stop smoking
  • Avoid foods and beverages that trigger or worsen symptoms
  • Eat small, frequent meals
  • Don't lie down within three hours after eating
  • Lose weight if necessary
  • Avoid wearing tight clothing, especially around your midsection

These OTC drugs (Alka-Seltzer, Maalox, Mylanta, Rolaids, Tums) use different combinations of either magnesium, calcium, or aluminum and hydroxide or bicarbonate ions to help neutralize stomach acid and temporarily relieve symptoms. Depending on their ingredients, they may also cause diarrhea or constipation.

H2 Blockers:
Available both OTC and by prescription, these drugs (Tagamet, Pepcid, Zantac, Axid) provide short-term relief of GERD by preventing production of stomach acid.

Proton Pump Inhibitors (PPIs):
Available by prescription, PPIs (Prilosec, Prevacid, Protonix, Nexium) block stomach acid production more effectively than H2 blockers. However, they can cause "rebound" reflux: If the patient uses them, then stops taking them, the stomach acid may return worse than before.

What therapies does Dr. Weil recommend for acid reflux?
In addition to the lifestyle measures listed above, Dr. Weil recommends:

  • Use solid supports such as bricks, blocks, or boards to tilt the head of your bed a few inches above your feet. Avoid raising your head by sleeping on two pillows, which can make reflux worse.
  • Practice a relaxation strategy. Stress and anxiety can worsen reflux symptoms.
  • Keep a food log to track the foods and beverages that make your symptoms worse.
  • Eat a diet rich in fiber - at least 40 grams a day - including whole grains, fruits and vegetables.
  • Stop drinking alcohol. Keep alcohol to a minimum if you do drink, and drink only with meals.
  • Get regular exercise.
  • Stay hydrated by drinking plenty of water.
  • Avoid stimulants. Caffeinated beverages, coffee (including decaffeinated coffee), tobacco and other stimulants can irritate the gastrointestinal tract.
  • Use DGL (deglycyrrhizinated licorice). Slowly chew two tablets or take a half-teaspoon of the powder before or between meals and at bedtime. Taper your dose down after your symptoms are under control.
  • Consider slippery elm. It can heal irritated digestive tract tissues.

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