Acid reflux is when the acid that is normally in one’s stomach rises up into the esophagus (tube that carries food from your mouth to your stomach). Acid reflux disease is also medically called “gastroesophageal reflux disease,” or GERD.
When we eat and swallow food, it is carried down from the mouth to the stomach by a tube-like structure called the esophagus. At the junction of the esophagus and the stomach there is a ring-like muscular structure that prevents the food already in the stomach flowing back to the esophagus. This ring relaxes when we swallow food allowing it to reach the stomach.
However, sometimes this ring is weak or it becomes relaxed because the stomach is distended, allowing liquids in the stomach to wash back into the esophagus. This happens occasionally in all individuals. Most of these episodes occur shortly after meals and are brief, and do not cause symptoms. Normally, acid reflux should occur only rarely during sleep. This food and contents from the stomach are very acidic, and when this frequently flows back to the esophagus, it damages it causing bothersome symptoms.
The commonest symptom of acid reflux disease (GERD) is a heart burn. Heartburn is experienced as a burning sensation in the centre of the chest, which sometimes spreads to the throat and there also may be an acid taste in the throat. Less common symptoms include; Stomach pain (pain in the upper abdomen), non-burning chest pain, difficulty or pain on swallowing, or food getting stuck, persistent voice hoarseness, persistent sore throat, chronic cough, new onset asthma, or asthma only at night, recurrent lung infections (called pneumonia), waking up with a choking sensation.
When not managed properly, acid reflux disease can have long term and more serious complications on one’s health. Ulcers can form in the esophagus as a result of burning from stomach acid, and when these ulcers heal, they can cause the esophagus to scar and narrow, causing a blockage (stricture) that can cause food or medication to get stuck in the esophagus. The constant exposure of the lining of the esophagus to the corrosive acid environment increases the risk of developing esophageal cancer.
The diagnosis of acid reflux disease is made by taking history of one’s symptoms, physical examination of the patient to rule out other causes of similar complaints and investigations are carried to confirm the diagnosis.
Acid reflux is usually diagnosed based upon symptoms and the response to treatment. In people who have symptoms of acid reflux but no evidence of complications, a trial of treatment with lifestyle changes, is often recommended, without testing. Specific testing is required when the diagnosis is unclear or if there are more serious signs or symptoms.
It is important to know that some other potentially life threatening conditions can cause symptoms similar to those of acid reflux disease, such as chest pain which can also be a symptom of a serious heart disease. Hence medical care should be sought early so that a proper diagnosis and intervention done accordingly.
When the diagnosis of acid reflux disease isn’t clear or ones symptoms so severe or complications of acid reflux disease suspected, investigations can be done.
Commonly done investigation is an endoscopy. A small, flexible tube is passed into the esophagus, stomach, and small intestine. The tube has a light source and a camera that displays magnified images. Damage to the lining of these structures, stomach acid over secretion can be evaluated and a small sample of tissue (biopsy) can be taken to determine the extent of tissue damage and rule out any cancerous developments.
Other tests such as a 24-hour esophageal pH study to determine the frequency of acid reflux and tests to measure the muscle contractions of the esophagus but these are not always available.
Acid reflux disease can be managed with medicines and lifestyle changes. Medicines which reduce the amount of acid produced by the stomach and those that can neutralize the acid produced are usually prescribed. For severe cases of acid reflux disease not responding to medical treatment, surgery to enhance the lower esophageal ring and prevent flow of food back from the stomach can be performed.
In addition to medical treatment, lifestyle modification can help to reduce on the symptoms of acid reflux disease; losing weight (if you are overweight) or raising the head of your bed by 6 to 8 inches (for example, sleeping on 2 pillows) are recommended. Avoid foods that make your symptoms worse (examples include coffee, chocolate, alcohol, pepper containing foods, and fatty foods). Cutting down on the amount of alcohol one drinks or better quitting alcohol drinking and smoking cessation are ideal. Eat a bunch of small meals each day, rather than two or three big meals, Avoid lying down within 3 hours after a meal.
Dr. Ian Shyaka is a
General Practitioner at Rwanda Military Hospital