Reflux/Acid Reflux (GERD)

What is reflux?

The medical name for this condition is gastroesophageal reflux disease (GERD). It’s sometimes called acid reflux or heartburn. Reflux occurs when the acid from the food and liquid in your stomach backs up into your throat (esophagus). It can occur at any age, even in babies. Many times, you or your doctor can determine the triggers for your reflux.

Symptoms of reflux

There are several symptoms of reflux, including:

• A burning feeling in the back of the throat, in the middle of the chest, or behind the sternum (breastbone)
• An acid taste in your mouth.
• A dry cough, asthma, and difficulty swallowing (these may occur without the burning sensation)
• Excessive saliva and a sore throat that doesn’t go away

How is reflux diagnosed?

Your doctor will begin by discussing your symptoms. Not everyone who has an episode of reflux has GERD. Your doctor may have you undergo testing to see if you have GERD. Such tests could include:

• Ambulatory acid (pH) probe test: This test measures the acid in your stomach for 24 hours. Your doctor will insert a small, thin tube into your nose and down into your throat. The tube is connected to a small computer you strap around your waist. Another version of this involves a small probe placed in your throat. The probe transmits a signal for a period of time. After 2 days, the probe falls off and is passed in your stool.
• X-ray: The X-ray will look at the inside your upper digestive system (throat, stomach, and upper intestine). For this test, you will you be given a chalky liquid to swallow. This liquid coats your digestive tract to provide better views of the inside.
• Endoscopy: This is similar to the small, thin tube used for the (pH) test. However, the tube is connected to a small camera at the end. This allows your doctor to look inside your upper digestive tract. He or she may also take a sample of the tissue inside your tract for further testing.
• Esophageal motility test (manometry): This test measures the movement and pressure of your esophagus. It involves inserting small, thin tube through your nose and down your throat.

Can reflux be prevented or avoided?

There are many lifestyle changes you can make to reduce or eliminate reflux, including:

• Not drinking alcohol
• Not eating too close to bedtime
• Losing weight
• Not wearing tight clothing
• Cutting back on foods known to trigger GERD, such as chocolate, caffeine, peppermints, and greasy, spicy, and acidic foods
• Eating smaller meals or avoiding overeating

Reflux treatment

If your symptoms are mild, treatment may not be necessary. Ask your doctor if he or she recommends taking medicine to relieve symptoms. Over-the-counter medicine is effective for treating mild cases of reflux. These medicines include:

• Antacids: This is a quick-acting medicine that reduces stomach acid. Unfortunately, antacids alone won’t heal the damage stomach acid causes in your esophagus. Sometimes, overusing antacids can cause diarrhea or constipation.
• H-2 receptor blockers: These medicines reduce acid production. They don’t work as quickly as antacids. However, they provide longer relief (up to 12 hours). Stronger versions of these medications are available by prescription from your doctor.
• Proton pump inhibitors: These medicines block acid production and heal the damage in your throat. They are stronger than H-2-receptor blockers.

If these medicines are not providing relief after a few weeks, contact your doctor. Your doctor may give you a prescription version of H-2 receptor blockers or proton pump inhibitors.

Additionally, your doctor may prescribe medicine to strengthen the lower esophageal sphincter. The medicine may decrease the number of times your muscle relaxes. It is often used for severe reflux. Side effects include fatigue or confusion. Another medicine your doctor may prescribe helps your stomach empty faster. This will cause the food to move along the digestive tract and not back up into your throat. Your doctor may combine more than one medicine, depending upon the severity of your reflux.

In some cases, surgery may be required to treat reflux. This is when medicine doesn’t help, or if you want a long-term solution. Types of surgery may include:

• Nissen fundoplication: This surgery reinforces the lower muscle in the esophagus. A surgeon will wrap the very top of the stomach around the outside of the lower esophagus. This reduces reflux by putting pressure on your esophagus. This is a laparoscopic surgery. This means the surgeon makes three or four small cuts in the abdomen (stomach region). He or she will insert instruments, including a flexible tube with a tiny camera, through the cuts.
• Linx surgery: This surgery strengthens the muscle in the esophagus. The Linx device is a ring of tiny beads made of titanium. The surgery wraps the ring around the area between the stomach and esophagus. The magnetic attraction of the beads keeps the opening between the two closed. This helps keep acid from backing up into your throat. However, it’s weak enough to allow food to pass. The surgery is minimally invasive.

Living with reflux

Living with reflux can be miserable if left untreated. Planning and being aware of the triggers for your reflux can help. Make changes in your diet and lifestyle that can improve your quality of life. For example, if you know eating before bedtime causes your reflux, avoid eating late. If you can’t avoid a trigger, plan to take over-the-counter medicine to treat the symptoms of reflux. If you’ve tried all of these things and nothing has helped, see your doctor.

Questions to ask your doctor

• Why do certain foods trigger my reflux at times and other times they don’t?
• Is reflux hereditary?
• Can the damage to your throat heal over time once you have it under control?
• Does pregnancy increase reflux?
• What are my alternatives to taking medication?
• How long to I have to stay on medication?

Resources

National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases: Acid Reflux in Adults

U.S. National Library of Medicine, Medline Plus: Gastroesophageal Reflux Disease