Acid Reflux or gastroesophageal reflux (GER) occurs when the stomach contents reflux or back up into the esophagus during or following a meal.
At the bottom of the esophagus, there is a ring of muscle called the lower esophageal sphincter (LES), which opens and closes to allow food to enter the stomach. Typically, the LES opens after meals to release gases. Sometimes when the LES opens, the stomach contents, including digestive juices or acids, reflux back up into the esophagus. This can lead to a burning sensation, or in the case of babies and infants, spitting up or vomiting.
More than 20 million Americans have a form of acid reflux, and it is common in healthy infants within the first three months of life. Managing reflux for adults typically requires avoiding fatty, spicy or acidic foods. Infants usually stop spitting up between 12 and 24 months of age.
Without proper management and treatment, acid reflux can develop into advanced or severe acid reflux known as gastroesophageal reflux disease (GERD), which can lay the foundation of risk for developing a complication known as Barrett’s Esophagus. Barrett’s esophagus occurs when the tissue of the esophagus is replaced by tissue similar to that which lines the intestines. People with Barrett’s esophagus have an increased risk for an esophageal cancer called esophageal adenocarcinoma.
Symptoms of acid reflux are generally mild, but more severe symptoms are possible and could suggest the advancement of the condition to GERD, a more serious form of the condition.
When acid reflux occurs, food or fluid can be tasted in the back of the mouth as the stomach contents and acid rises. When refluxed stomach acid touches the lining of the esophagus, it may cause a burning sensation in the chest or throat, which is called heartburn or indigestion.
Persistent reflux occurring more than twice in a weeklong period is a sign of GERD. People with GERD may also have symptoms such as dry cough and asthma-like symptoms.
Acid reflux is common in babies and usually does not produce symptoms. However, some babies do show symptoms, including spitting up, vomiting, coughing, irritability, poor feeding and possibly blood in the stools. More serious symptoms are possible in infants and can include poor growth due to inability to hold down food, refusing to feed due to pain, blood loss from acid burning the esophagus and breathing problems. These symptoms could indicate a disorder other than acid reflux. See a doctor or health care professional to determine if your child has acid reflux or a different condition.
The most common tests used to diagnose acid reflux include the following:
- Upper gastrointestinal series x-rays. Upper gastrointestinal series x-rays are taken to check for damage to the esophagus, stomach or intestines. A chalky drink called a barium swallow is used to help make the images on the x-rays easier to see. The x-ray is used primarily to rule out other problems that could cause similar symptoms to acid reflux.
- Endoscopies. An endoscopy involves a small, flexible tube with a very small camera on the end that is then inserted through the mouth and esophagus into the stomach. The camera gives the doctor a view of the lining of the esophagus, stomach and small intestine by transmitting images from the small camera to a television screen. During this procedure, the doctor can perform a biopsy (removal of a small piece of tissue). Looking at that tissue sample under a microscope can help the doctor determine the level of acid damage to the tissue.
- Esophageal pH probes. An esophageal pH probe involves a thin light wire with an acid sensor at its tip that is inserted through the nose and into the lower part of the esophagus. This probe can detect and record the amount of stomach acid refluxing back up into the esophagus.
If an infant is consistently spitting up or vomiting, acid reflux may be the cause. Visit your child's doctor and ask for an examination to determine if your child has the condition. If the infant is healthy, content and growing well, often no tests or treatments are needed. Infants usually stop spitting up between 12 and 24 months of age.
In healthy infants, treatment for acid reflux is usually not needed. Adults can clear up symptoms and manage the condition by steering clear of fatty, spicy or acidic foods or by eating smaller meals. If you are a smoker, quitting can provide significant relief against reflux-like symptoms.
There are over-the-counter medications available to aid in heartburn relief. Acid-reducing agents called antacids and anti-secretory medications such as H2 blockers and proton-pump inhibitors can assist in blocking symptoms. These medications include the following:
- Cimetidine (Tagamet)
- Famotidine (Pepcid AC)
- Nizatidine (Axid)
- Ranitidine (Zantac)
- Esomeprazole (Nexium)
- Lansoprazole (Prevacid)
- Omeprazole (Prilosec, Zegerid)
- Pantoprazole (Protonix)
- Rabeprazole (Aciphex)
Foods that contribute to acid reflux symptoms and should be avoided include:
- citrus fruits
- caffeinated beverages
- fried foods
- mint flavorings
- spicy or fatty foods
- tomato-based foods such as spaghetti sauce, salsa, chili and pizza
Maintaining a healthy weight can also help. Try not to lie down for at least three hours following a meal and raise the head of your bed six to eight inches to aid in the digestive process.
If your acid reflux symptoms become severe and the condition progresses to GERD or Barrett’s esophagus, you may need to talk to your doctor about treatment options such as surgical or endoscopic procedures.
Stomach or gastric contents contain acids needed to break up and digest food. In acid reflux, these harsh contents and their chemicals wash up into the esophagus through the lower esophageal sphincter (LES). It is not clear why the LES sometimes fails to close properly, but when it doesn't close, it allows acids to rise up from the stomach cavity and damage the tissue lining the esophagus.
Research suggests that the LES of those with acid reflux relaxes while the rest of the esophagus is still working. Conditions like hiatal hernia may also contribute to the development of this condition. A hiatal hernia happens when the upper part of the stomach and the LES move above the diaphragm, the muscle wall separating the stomach from the chest. Normally, the diaphragm helps the LES keep acid from rising up into the esophagus, but with a hiatal hernia, acid reflux can happen more easily. This hernia can occur in people of any age, although it is normal in otherwise healthy individuals over the age of 50.
Obesity, pregnancy and smoking all contribute to acid reflux. Certain foods also can contribute to or worsen acid reflux symptoms. These foods include the following:
- citrus fruits
- caffeinated drinks
- fatty and fried foods
- garlic and onions
- mint flavoring
- spicy foods
- tomato-based foods
Acid reflux can be harmful without proper treatment and management. About 5 percent of the 20 million Americans with acid reflux have significant episodes two to three times a day, which may be a sign of a more serious issue called gastroesophageal reflux disease (GERD). If you believe you have GERD, talk to your doctor or a health care professional, as there are medications and surgical treatments available for this more severe condition.
If advanced acid reflux is completely ignored, it can develop into Barrett’s esophagus, which often requires surgery to correct. Barrett’s also heightens the risk for developing esophageal cancer.
Every case of acid reflux differs from person to person. While fatty, spicy and acidic foods most commonly set off reactions, there could be more specific foods that trigger your symptoms. Keep track of what sets off your reactions and discuss your findings with a doctor.
If you have continually lived with advanced acid reflux symptoms for many years, ask your doctor if you should be tested for Barrett’s esophagus. Barrett’s presents no new additional symptoms and therefore could be present in the body for years without you knowing. Because Barrett's esophagus can lead to cancer, it is crucial to get treatment for the condition.
How do I know if I have acid reflux or the more serious GERD (gastroesophageal reflux disease)?
- Acid reflux is a much more mild condition usually involving frequent heartburn, or the burning sensation in the chest and back of throat as acid rises from the stomach. GERD is more serious than acid reflux. Some patients with GERD do not even have the symptom of heartburn. Instead, they may experience a dry cough, asthma-like symptoms and trouble swallowing. If you are experiencing these symptoms or are having reflux episodes anywhere from two or three times a week to two or three times a day, you could have GERD and should visit your doctor.
I know to avoid fatty, spicy and acidic foods. Are there any other particular foods I should watch out for?
- In addition to staying clear of fatty, spicy and acidic foods, try avoiding tomato-based foods such as spaghetti sauce, salsa, chili and pizza. Citrus fruits such as limes and lemons, chocolate, caffeinated beverages, alcohol, fried foods, garlic, onion and mint flavoring can all contribute to reflux reactions as well.
Living with acid reflux can be uncomfortable and painful. Getting into the habit of avoiding certain foods can help ease the discomfort and provide relief. Try eating out less frequently, as it can be hard to monitor what is put in your food if you do not make it yourself. See if avoiding fatty, spicy and acidic foods, as well as alcohol, improves your symptoms. If you smoke, quitting may provide substantial relief against acid reflux.
Speaking with a doctor or health care professional can help greatly in the management of acid reflux. Your doctor can provide medications and advice to suit your particular situation. As acid reflux differs from person to person, talk to your doctor about all treatment options available and work together to come up with a unique treatment plan tailored to you.
If you are overweight, consider small lifestyle changes to lose weight and get into shape. Being obese heightens your chances of acid reflux, and if you already have the condition, it does little to help you overcome it.