Heartburn And Acid Reflux
5 Jul 2017
- What is Acid Reflux Disease?
- What are the Risk Factors of Acid Reflux Disease?
- What are the Causes of Acid Reflux Disease?
- What are the Symptoms of Acid Reflux Disease?
- What are the Symptoms of Heartburn?
- How is Acid Reflux Diagnosed?
- What are the Causes of Heartburn?
- What Treatments are Available for Acid Reflux?
- OTC Remedies for Acid Reflux
What is Acid Reflux Disease?
Sitting at the passage down from your oesophagus to your stomach is a small valve. This is a little muscle known as the lower oesophageal sphincter (LOS). Normally the LOS shuts when food passes through it to lock the contents in and to prevent it returning upwards. However, if this valve fails or the LOS doesn’t completely close the way or opens when there isn’t any food passing acid produced by your stomach, and other stomach contents can direct upwards into your oesophagus and stomach contents are regurgitated into the esophagus and the symptoms of acid reflux are felt, such as heartburn.
This can cause unpleasant symptoms like burning chest pain known as heartburn. If acid reflux symptoms occur more than twice a week, then you can be diagnosed as having acid reflux disease, also known as gastro-oesophageal reflux disease ( GORD). What causes acid reflux disease? We all may experience acid reflux occasionally, often associated with certain food and drink.
Recurrent acid reflux that leads to disease has other causes and risk factors and is termed gastroesophageal reflux disease (GERD). Gastroesophageal reflux disease is seen in people of all ages, sometimes for unknown reasons (idiopathic). Often, the cause is attributable to a lifestyle factor, but it can also be due to causes that cannot always be prevented. One such cause of GERD is a hiatal (or hiatus) hernia. A common culprit of acid reflux disease is a stomach irregularity known as a hiatus hernia.
This happens when the upper part of the stomach and LOS maneuver above the muscle that separates your stomach from your chest known as the Diaphragm with its job of keeping the acid down in our stomach. But if you have a hiatus hernia, this can allow acid to move up your oesophagus and cause symptoms of acid reflux disease.
What are the Risk Factors of Acid Reflux Disease?
• Eating large meals quickly and not properly chewing food before swallowing
• lying down right after a meal as this will slow down the digestion of the food
• Being overweight or obese
• Snacking close to bedtime
• Eating high acidic foods such as citrus, tomato, garlic, onions, or spicy or fatty foods
• Drinking certain beverages such as alcohol, fizzy drinks, coffee or tea as these can be stomach irritants
• Being pregnant
• Taking aspirin, ibuprofen, certain muscle relaxants or certain blood pressure medications
What are the Causes of Acid Reflux Disease?
We all may experience acid reflux occasionally, often associated with certain food and drink. Recurrent acid reflux that leads to disease has other causes and risk factors and is termed gastroesophageal reflux disease (GERD).
Gastroesophageal reflux disease is seen in people of all ages, sometimes for unknown reasons (idiopathic). Often, the cause is attributable to a lifestyle factor, but it can also be due to causes that cannot always be prevented.
One such cause of GERD is a hiatal (or hiatus) hernia. A common culprit of acid reflux disease is a stomach irregularity known as a hiatus hernia. This happens when the upper part of the stomach and LOS manoeuvre above the muscle that separates your stomach from your chest known as the Diaphragm with its job of keeping the acid down in our stomach. But if you have a hiatus hernia, this can allow acid to move up your oesophagus and cause symptoms of acid reflux disease.
These are other common risk factors for acid reflux disease:
- Eating large meals quickly and not properly chewing food before swallowing
- lying down right after a meal as this will slow down the digestion of the food
- Being overweight or obese
- Snacking close to bedtime
- Eating high acidic foods such as citrus, tomato, garlic, onions, or spicy or fatty foods
- Drinking certain beverages such as alcohol, fizzy drinks, coffee or tea as these can be stomach irritants
- Being pregnant
- Taking aspirin, ibuprofen, certain muscle relaxants or certain blood pressure medications
What are the Symptoms of Acid Reflux Disease?
Common symptoms of acid reflux are:
- Heartburn - a burning pain or discomfort felt behind your breastbone that may move up through the centre of your chest and into your throat
- Regurgitation - a sour or bitter-tasting acid backing up into your throat or mouth
Other possible symptoms of acid reflux disease include:
- Dysphagia - difficulty swallowing or a sensation of food being stuck in your throat
- Hiccups that don't let up
- Weight loss for no known reason
- Wheezing, dry cough, hoarseness or chronic sore throat
Despite its name, heartburn actually is not related to the heart in a literal sense. Heartburn is an irritation of the oesophagus caused by stomach contents and acid that refluxes (moves up) from the stomach. Heartburn is also a symptom of more serious gastro-oesophageal reflux disease, or GORD.
When we swallow, food passes down the throat and through the oesophagus to the stomach. Normally a muscular valve called the lower oesophageal sphincter (LOS) opens to facilitate letting the food into the stomach (or to permit belching) before shutting. The stomach then releases strong acids - hydrochloric acid - to help break down the food with the acid released being a similar PH level to car battery acid. But if the lower oesophageal sphincter opens too regularly or if it doesn’t shut tight enough, stomach acid and other stomach contents can reflux or seep back into the oesophagus. This can cause damage called Oesophagitis where the oesophagus is harmed by the acid.
Not only can stomach acid in the oesophagus cause heartburn, but it can also cause ulcers, strictures (narrowing) of the oesophagus and cancer of the oesophagus.
Exact figures vary but acid reflux is considered very common, and diseases resulting from acid reflux are the most common gut complaint seen by United States hospital departments.
The American College of Gastroenterology says that over 60 million Americans experience heartburn at least once a month, and at least 15 million as often as daily.
Gastroesophageal reflux disease has the highest rates in Western countries, affecting an estimated 20-30 percent of the population.
Most people have felt heartburn at one time or another in their lives. Around 40% of people report having symptoms of heartburn in the UK each year so it is not uncommon. Although uncomfortable, heartburn does not usually pose a serious health problem for most people who only experience the symptoms sparingly.
If heartburn symptoms are frequently and persistently apparent, it may be a sign of a more serious problem, such as gastro-oesophageal reflux disease (GORD). GORD is a chronic reflux of acid into the oesophagus. Left untreated GORD can cause a host of complications, including oesophagitis, oesophageal ulcers, hoarseness, spasm of the “voicebox” muscles ( laryngospasm), chronic lung disease and Barrett's oesophagus (a change in the lining of the oesophagus that increases the risk of developing cancer of the oesophagus).
What are the Symptoms of Heartburn?
Heartburn has several symptoms including:
- A burning feeling in the chest just behind the breastbone that occurs after eating and lasts a few minutes to several hours
- Chest pain, especially after bending over, lying down or eating
- Burning in the throat, or hot, sour, acidic or salty-tasting fluid at the back of the throat
- Difficulty swallowing
- Feeling of food "sticking" in the middle of the chest or throat
Reporting these symptoms to your GP is usually all that is needed for your GP to diagnose heartburn. However, your GP may refer you to perform special tests such as an endoscopy or pH monitoring to determine the severity of your problem or to monitor your treatment.
How is Acid Reflux Diagnosed?
Acid reflux and heartburn are common and relatively easy to diagnose, however, they can be confused with other chest complaints such as:
- Heart attack
- Chest wall pain
- Pulmonary embolus
Gastroesophageal reflux disease is often diagnosed simply by finding no improvement in heartburn symptoms in response to lifestyle changes and acid reflux medication.
Gastroenterologists may also arrange the following investigations:
- Endoscopy - camera imaging down the oesophagus
- Biopsy - taking a tissue sample for laboratory analysis
- Barium X-ray - imaging the oesophagus, stomach, and upper duodenum taken in different positions after swallowing a thick liquid that helps provide contrast on images
- Oesophageal manometry - pressure measurement of the oesophagus
- Impedance monitoring - measuring rate of fluid movement along the oesophagus
- pH monitoring - acidity testing
What are the Causes of Heartburn?
Different lifestyle and dietary factors can affect heartburn by reclining the lower oesophageal sphincter and facilitating its opening, unnecessarily increasing the volume of acid in the stomach and thus also upping the pressure on the stomach or by making the oesophagus more sensitive to potent acids. These factors include:
- Eating large food portions in a single sitting
- Eating certain foods including onions, chocolate, peppermint, high-fat or spicy foods, citrus fruits, garlic and tomatoes or tomato-based products
- Drinking certain beverages, including citrus juices, alcohol, caffeinated drinks and fizzy drinks
- Eating close to bedtime
- Being overweight
- Wearing tight-fitting clothing or belts
- Lying down or bending over, especially after eating
- Bulging of part of the stomach into the chest cavity, also called hiatus hernia
- Taking certain medications, especially some antibiotics and aspirin
What Treatments are Available for Acid Reflux?
In this section we will first list the potential treatments for acid reflux and heartburn, then go on to explain how they work:
- Proton-pump inhibitors - including rabeprazole, and esomeprazole
- Prescription Treatments such as Omeprazole, Lansoprazole, Losec, Nexium
- H2 blockers - including cimetidine, ranitidine, and famotidine
- OTC treatments - antacids
- Alginate drugs - including Gaviscon
The main treatment options for people who repeatedly experience acid reflux in GERD are either proton-pump inhibitors (PPIs) or H2 blockers, both of which are medications.
Proton-pump inhibitors and H2 blockers decrease acid production and thereby reduce the potential for damage caused by acid reflux.
These medications are generally safe and effective, but like any prescription drug, they are not appropriate for all people with reflux disease and can cause side effects.
For instance, they can cause problems absorbing nutrients, which can lead to malnutrition.
OTC Remedies for Acid Reflux
For people who experience heartburn or indigestion infrequently, perhaps in association with occasional food and drink triggers, OTC treatments to reduce the acidity of the stomach contents are available.
These liquid and tablet formulations are called antacids, and there are dozens of brands available, all with similar effectiveness. They may not work for everyone, and any need for regular use should be discussed with a doctor.
Antacids provide rapid but short-term relief by reducing the acidity of the stomach contents.
They contain chemical compounds such as calcium carbonate, sodium bicarbonate, aluminium, and magnesium hydroxide. They can also inhibit nutrient absorption, leading to deficiencies over time such as Iron.
Gaviscon is probably the best-known OTC heartburn treatment. It has a different mode of action than antacid drugs. Alginate remedies such as Gaviscon vary slightly in composition, but they usually contain an antacid.
The alginic acid works by creating a mechanical barrier against the stomach acid, forming a foamy gel that sits at the top of the gastric pool itself to prevent the acid escaping upwards.
Any reflux is then relatively harmless as it consists of alginic acid and is not as damaging as stomach acid as the PH level is lower.
Rennies are available in small square shaped flavoured mints. Rennies help neutralise the acid in the stomach to a more alkaline PH level in an attempt to limit the discomfort of acid veering up the Oesophagus. Rennie’s do not slow down or limit the production of stomach acid itself.
Zantac – Ranitidine
This is available OTC in 75mg tablets but can also be issued by prescription as 150mg tablets. Ranitidine. Zantac works by reducing the amount of acid your stomach produces but isn’t as strong as other prescription medications and PPI’s.
In rare cases, gastroesophageal reflux disease that is severe and unresponsive to medical treatment may warrant surgical intervention in the form of a procedure called fundoplication. (NHS link)
Common symptoms of acid reflux are:
• Heartburn - a burning pain or discomfort felt behind your breastbone that may move up through the centre of your chest and into your throat
• Regurgitation - a sour or bitter-tasting acid backing up into your throat or mouth Other possible symptoms of acid reflux disease include:
• Dysphagia - difficulty swallowing or a sensation of food being stuck in your throat
• Hiccups that don't let up
• Weight loss for no known reason
• Wheezing, dry cough, hoarseness or a chronic sore throat