acid reflux overview for patients

Overview

Acid reflux happens when stomach acid flows back up into the esophagus, the tube that carries food from your mouth to your stomach. This can cause a burning feeling in your chest, known as heartburn, along with a sour taste in your mouth. When acid reflux happens often, it may be called GERD (gastroesophageal reflux disease).

Yes, acid reflux is one of the most common digestive issues worldwide. Many people experience it occasionally, especially after a large meal or lying down too soon after eating.

Acid reflux can affect anyone, from babies to older adults. You may be more likely to have it if you are overweight, pregnant, smoke, or take certain medicines. It also becomes more common with age.

Symptoms

Common symptoms

• Heartburn: a burning pain or discomfort in the middle of the chest
• An unpleasant sour or bitter taste in the mouth
• Difficulty swallowing or a feeling that food gets stuck
• Regurgitation: food or liquid coming back up into your throat
• A persistent cough, especially at night
• Hoarseness or a sore throat
• Feeling like you have a lump in your throat

Symptoms in children

• A burning feeling in the chest or upper belly
• Frequent vomiting or spitting up
• A chronic cough or wheezing
• Refusing to eat or having trouble feeding
• Poor weight gain or being unusually fussy after meals

Symptoms in older adults

• Less typical heartburn; instead, symptoms may include a cough, trouble swallowing, hoarseness, or chest pain
• Repeated pneumonia or bronchitis from breathing in small amounts of acid
• Anemia from irritation or bleeding in the esophagus
• Unexplained weight loss or decreased appetite

Causes

Main causes

• A weak or relaxed lower esophageal sphincter (the ring of muscle at the bottom of the esophagus)
• A hiatal hernia, where part of the stomach pushes through the diaphragm into the chest
• Increased pressure on the stomach from being overweight, pregnant, or straining
• Certain foods and drinks that relax the sphincter or make your stomach produce more acid

Risk factors

• Being overweight or having obesity
• Pregnancy
• Smoking or breathing secondhand smoke
• Eating large meals or eating late at night
• Eating fatty, spicy, or acidic foods, or having carbonated drinks, caffeine, alcohol, or chocolate
• Lying down or bending over shortly after eating
• Having conditions that delay stomach emptying, like diabetes

When to see a doctor

See a doctor urgently if:

• If you have trouble swallowing or pain when swallowing
• If you are losing weight without trying
• If you have severe or ongoing chest pain
• If you are vomiting blood or see black stools

Book a routine appointment if:

• If you have heartburn more than twice a week
• If your symptoms last for several weeks or get worse
• If over-the-counter acid reducers or lifestyle changes are not helping
• If you have a persistent cough, hoarseness, or sore throat that does not go away

Diagnosis

To diagnose acid reflux, your doctor will start by asking about your symptoms, medical history, and lifestyle. They may also do a physical exam. Often, that is enough to recommend treatment. If your symptoms are severe or do not improve, your doctor may suggest tests to look at your esophagus and confirm the diagnosis.

Tests that may be done

• Endoscopy: a thin, flexible tube with a camera is passed into your mouth to examine your esophagus and stomach
• Ambulatory acid (pH) test: a small monitor measures how much acid is in your esophagus during 24 hours
• Esophageal manometry: a test that measures the muscle contractions in your esophagus when you swallow
• Barium swallow: an X-ray test where you drink a liquid that coats your esophagus and stomach to show their shape

What to expect at your appointment

Before an endoscopy, you may be given a sedative to help you relax, and your throat will be numbed. For a pH test, a thin tube passes through your nose into your esophagus, or a small wireless capsule is placed during an endoscopy. These tests may cause mild discomfort, but they are generally well tolerated and done as outpatient procedures.

Treatment

Treatment for acid reflux aims to relieve symptoms, heal any damage to the esophagus, and prevent complications. It usually starts with lifestyle changes and may include medicines that reduce stomach acid. If these are not effective, or if you have complications, surgery can be considered.

Self-care at home

• Eat smaller meals and avoid eating within 2–3 hours before bedtime
• Elevate the head of your bed about 6–8 inches by putting blocks under the bedposts (do not just use extra pillows)
• Avoid foods and drinks that trigger your symptoms, such as fatty foods, spicy foods, chocolate, caffeine, alcohol, and carbonated drinks
• Lose weight if you are overweight
• Quit smoking if you smoke
• Wear loose-fitting clothing to avoid pressure on your abdomen

Medical treatments

Your doctor may suggest medicines that neutralize stomach acid or reduce the amount of acid your stomach makes. These include antacids, histamine-2 (H2) blockers, and proton pump inhibitors (PPIs). Some are available without a prescription, but you should talk to your doctor or pharmacist before using them, especially for long periods. Always follow the recommended dose and duration. Do not take PPIs continuously without medical supervision, as long-term use can have side effects.

When is surgery considered?

Surgery may be an option if your reflux is severe, you have complications like strictures (narrowing of the esophagus) or Barrett's esophagus, or if medicines do not control your symptoms. One common procedure is fundoplication, where the top of the stomach is wrapped around the lower esophageal sphincter to strengthen it. A newer option is a magnetic band placed around the sphincter. Talk to your doctor about the benefits and risks.

Living with this condition

Living with acid reflux means being mindful of what and when you eat. Keep a symptom diary to identify your triggers. Plan your meals so that you do not eat too late. Carry antacids if your doctor or pharmacist says they are safe for you. Most people can manage reflux well with routines.

Lifestyle tips

• Maintain a healthy weight
• Elevate the head of your bed
• Quit smoking and limit alcohol
• Eat slowly and in a relaxed setting
• Avoid tight belts or waistbands
• Manage stress, as stress can make reflux worse

Diet and exercise

Eat a balanced diet rich in vegetables, fruits, and whole grains. Steer clear of large, fatty meals and spicy or acidic foods if they cause symptoms. Regular exercise, like walking, can help with weight control, but avoid intense exercise right after eating. Also, avoid bending or lifting heavy weights immediately after meals.

Mental health and emotional wellbeing

Living with frequent reflux can be stressful and affect sleep and social life. The ongoing discomfort may cause anxiety or frustration. It is important to address these feelings. Talk to your doctor about how reflux affects your daily life, and consider relaxation techniques like deep breathing, meditation, or talking to a counsellor if you feel overwhelmed.

Prevention

You cannot always prevent acid reflux, but you can lower your chances of having frequent episodes by keeping a healthy weight, avoiding known triggers, eating smaller meals, not lying down after eating, and staying upright for a few hours after meals.

Vaccines

There is no vaccine for acid reflux.

Screening programmes

There is no routine screening for acid reflux. However, if you have long-standing reflux, your doctor may recommend an endoscopy to check for damage to the esophagus, including Barrett's esophagus, which can increase the risk of esophageal cancer.

Complications

If left untreated

• Esophagitis: inflammation or irritation of the esophagus
• Esophageal stricture: narrowing of the esophagus, which can make swallowing hard
• Barrett's esophagus: changes in the cells lining the esophagus, which can raise the risk of esophageal cancer
• Chronic cough, asthma worsening, or repeated respiratory infections from breathing acid into the lungs

Long-term outlook

The outlook for acid reflux is very good. Most people can control their symptoms with lifestyle changes and medicines. For those who need more help, surgery is effective in many cases. While long-term, severe reflux can damage the esophagus, regular medical care and monitoring can reduce these risks. With the right treatment plan, you can live comfortably and protect your digestive health.

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