Acid Reflux: Causes and Treatment

Acid reflux, is a common digestive condition whereby the stomach contents leak into your oesophagus (a tube-like structure measuring around 1 inch wide and 10 inches long, extending from your mouth to your stomach).

The lower oesophageal sphincter (LES) is a circular ring of muscles located at the lower end of the oesophagus and connects to the stomach. LES relaxes and opens to allow food to enter the stomach once you swallow, and it then mixes with stomach acid to aid digestion. The LES then closes to prevent reflux of food and stomach acid into the oesophagus.

Occasional reflux is common and often occurs after a heavy meal. Most episodes are brief and do not result in complications or bothersome symptoms. However, you would experience bothersome symptoms or damage to the oesophagus if you have acid reflux.

You may have heard of GERD (Gastroesophageal Reflux Disease), which is defined as a chronic digestive condition and more severe form of acid reflux with persistent symptoms that significantly affect quality of life.

What are the risk factors of acid reflux? 

Certain factors can increase an individual’s risk of developing acid reflux:

  • Obesity
  • Pregnancy 
  • Lifestyle factors (alcohol, smoking, caffeine)
  • Hiatal hernia (a condition in which part of your stomach pushes up to your chest)
  • Certain medications

Lying down immediately or too soon after eating can lead to acid flowing back into the oesophagus, causing heartburn and discomfort.

What are the common symptoms?

Common acid reflux symptoms include:

  • Heartburn (a burning sensation in the chest)
  • Regurgitation (the feeling of stomach contents coming back up through your oesophagus)
  • Sour taste in the mouth
  • Difficulty swallowing or pain when swallowing 
  • Nausea/vomiting 
  • Bad breath
  • Hoarseness of voice
  • Chest pain

How is acid reflux diagnosed and treated?

Diagnosis

Diagnosis is based on your reported symptoms, physical examination and investigations. Your doctor may perform an upper gastrointestinal (GI) endoscopy. A thin, flexible tube with a camera (endoscope) is used to examine the oesophagus and stomach lining. Biopsy samples may be taken to look for damage or signs of infection.

A test called prolonged oesophageal pH study can also be done to measure the severity of acid reflux. This test requires inserting a small tube with a sensor through the nose into the oesophagus or placing a wireless sensor during an upper endoscopy. This sensor will stay in place for 24 hours.

Treatment

For mild acid reflux symptoms, common treatment option is taking antacids like Gaviscon for short-term relief as they neutralise stomach acid. Histamine receptor antagonists like cimetidine and famotidine decrease acid production in the stomach are more efficient than antacids and their effects stay longer.

For moderate to severe symptoms, proton pump inhibitors (PPIs) are most effective at reducing stomach acid. Some PPIs are accessible over-the-counter, whereas prescriptions may be necessary for higher doses. Examples of PPIs are omeprazole, pantoprazole.

What are the potential complications?

The majority of individuals with acid reflux will not develop serious complications, particularly if they are on treatment. However, those with severe acid reflux may occasionally experience potentially serious complications. 

  • Lung and throat problems: Inflammation of the vocal cords, a painful throat, or a hoarse voice can result from stomach acid backing up into the throat. Acid can also be inhaled into the lungs, causing symptoms of pneumonia or asthma. Over time, acid in the lungs may cause irreversible lung damage.
  • Dental problems: The enamel of the teeth can be gradually eroded by repeated episodes of acid reflux.
  • Erosive oesophagitis: This condition occurs when the oesophageal lining is eroded by stomach acid. This can cause erosions or sores that may bleed. Stool tests can be used to detect bleeding from an ulcer that is not always evident.
  • Oesophageal stricture: Damage caused by acid can cause the oesophagus to scar and narrow, resulting in a partial obstruction (stricture) that can cause food or pills to get stuck in the oesophagus.Scar tissue forms as a result of recurrent oesophageal ulceration and subsequent healing.
  • Barrett’s oesophagus: Occurs when squamous cells that normally line the lower oesophagus are replaced by a new cell type (called intestinal cells). This condition is typically caused by repetitive injury to the oesophagus lining; chronic acid reflux is the most common cause. Over time, there is a slight chance that intestinal cells will convert into cancer cells. As a result, individuals with Barrett’s oesophagus are encouraged to have a periodic upper endoscopy to screen for early signs of cancer.

How to prevent acid reflux?

Making dietary and lifestyle adjustments can significantly reduce the frequency and severity of acid reflux episodes.

Dietary adjustments

  • Limit consumption of spicy foods because capsaicin in spicy foods can relax the lower oesophageal sphincter, making it easier for stomach acid to flow into the oesophagus, causing acid reflux.
  • Limit or avoid citrus fruits and juices, tomatoes and tomato-based products, chocolate, mint, fried and fatty foods, carbonated beverages, caffeine, and alcohol.
  • Opt for smaller meal portions throughout the day to prevent overeating. 
  • Avoid eating late at night and allow at least three hours between your last meal and bedtime or lying down.

Lifestyle modifications

  • Lose excess weight and maintain a healthy weight.
  • Sleep on your left side to help direct stomach fluid away from the upper right side of the stomach where the oesophagus connects.
  • Quit smoking.
  • Practice stress-reduction techniques to reduce chronic stress that can increase the risk of acid reflux.

Make an appointment at Pantai Hospitals

If you have any questions or concerns about acid reflux, get in touch with us to book an appointment today for a consultation, or visit our team of Gastroenterologists at your nearest Pantai Hospital.

Pantai Hospitals have been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.

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