Managing Acid Reflux (GERD)

That burning sensation in your chest after a meal is all too familiar for millions of people. Acid reflux is one of the most common digestive complaints, and when it becomes chronic, it’s known as gastroesophageal reflux disease (GERD). Understanding this condition can help you find relief and prevent potential complications.

What Is Acid Reflux?

Acid reflux occurs when stomach acid flows backward into the esophagus, the tube connecting your mouth to your stomach. At the junction of the esophagus and stomach is a ring of muscle called the lower esophageal sphincter (LES). Normally, the LES opens to allow food into the stomach and closes to prevent stomach contents from flowing back up. When the LES weakens or relaxes inappropriately, acid can reflux into the esophagus, causing irritation and discomfort.

Occasional acid reflux is common and not usually a concern. However, when reflux occurs frequently, two or more times per week, and causes bothersome symptoms or complications, it’s classified as GERD. GERD affects approximately 20% of the American population, making it one of the most common chronic digestive conditions.

Related terms:

• Heartburn - The burning sensation in the chest caused by acid reflux
• Acid indigestion - General discomfort in the upper abdomen
• Regurgitation - When stomach contents come back up into the throat or mouth
• Barrett’s esophagus - A complication where esophageal tissue changes due to chronic acid exposure

Causes and Risk Factors

Several factors can contribute to acid reflux and GERD.

Physical factors:

• Weakened or dysfunctional lower esophageal sphincter
• Hiatal hernia (when part of the stomach pushes through the diaphragm)
• Slow stomach emptying
• Pregnancy (due to pressure on the stomach and hormonal changes)
• Obesity (increases abdominal pressure)

Lifestyle factors:

• Eating large meals, especially close to bedtime
• Lying down soon after eating
• Certain foods and beverages (see trigger list below)
• Smoking
• Alcohol consumption
• Wearing tight-fitting clothes around the abdomen

Common food and beverage triggers:

• Fatty and fried foods
• Spicy foods
• Citrus fruits and juices
• Tomatoes and tomato-based products
• Chocolate
• Mint
• Garlic and onions
• Coffee and caffeinated beverages
• Alcohol
• Carbonated drinks

Medications that may worsen reflux:

• NSAIDs (aspirin, ibuprofen)
• Certain blood pressure medications
• Some asthma medications
• Antidepressants
• Sedatives
• Iron supplements

Common Symptoms

Acid reflux and GERD symptoms can range from mild to severe and may vary from person to person.

• Heartburn (burning sensation in the chest, often after eating, worse when lying down)
• Regurgitation (sour or bitter taste in the mouth)
• Difficulty swallowing (dysphagia)
• Feeling of a lump in the throat
• Chronic cough, especially at night
• Hoarseness or sore throat
• Laryngitis
• New or worsening asthma
• Disrupted sleep
• Chest pain (can mimic heart pain)
• Nausea
• Bad breath
• Dental erosion (from acid exposure)

Warning signs of complications:

• Difficulty or pain when swallowing
• Unexplained weight loss
• Vomiting blood or material that looks like coffee grounds
• Black, tarry stools
• Persistent symptoms despite treatment
• Chest pain (always rule out cardiac causes)

Diagnosis

GERD is often diagnosed based on symptoms and response to treatment, but additional tests may be needed to confirm the diagnosis or evaluate complications.

Diagnostic methods:

• Medical history and symptom review - Discussing your symptoms, their frequency, and triggers
• Trial of acid-suppressing medication - Symptom improvement with treatment supports the diagnosis
• Upper endoscopy (EGD) - A camera examines the esophagus and stomach; can detect inflammation, ulcers, or Barrett’s esophagus
• Biopsy - Tissue samples taken during endoscopy
• Esophageal pH monitoring - Measures acid levels in the esophagus over 24-48 hours
• Esophageal manometry - Measures muscle contractions and LES pressure
• Barium swallow - X-ray imaging after swallowing a contrast solution

Treatment Options

Treatment aims to relieve symptoms, heal any esophageal damage, and prevent complications.

Lifestyle modifications (often first-line):

• Dietary changes
• Weight loss
• Elevating the head of the bed
• Not eating close to bedtime
• Smoking cessation

Over-the-counter medications:

• Antacids - Neutralize stomach acid for quick, short-term relief (Tums, Rolaids, Maalox)
• H2 blockers - Reduce acid production (famotidine, ranitidine)
• Proton pump inhibitors (PPIs) - Stronger acid reduction (omeprazole, lansoprazole, esomeprazole)

Prescription medications:

• Prescription-strength PPIs
• Prescription-strength H2 blockers
• Prokinetics (strengthen LES and speed stomach emptying)
• Baclofen (reduces LES relaxation)

Surgical options (for severe or refractory GERD):

• Fundoplication - The top of the stomach is wrapped around the LES to strengthen it
• LINX device - A ring of magnetic beads placed around the LES
• Transoral incisionless fundoplication (TIF) - Endoscopic procedure to strengthen the LES

What You Can Do

Lifestyle modifications can significantly reduce acid reflux symptoms and may reduce or eliminate the need for medication.

1. Identify and avoid your triggers - Keep a food diary to track what causes your symptoms. Common triggers include fatty foods, spicy foods, citrus, tomatoes, chocolate, coffee, and alcohol.

2. Eat smaller, more frequent meals - Large meals stretch the stomach and put pressure on the LES. Smaller portions reduce this pressure and give your stomach less to process at once.

3. Don’t lie down after eating - Wait at least 2-3 hours after eating before lying down or going to bed. Give your body time to digest food while gravity helps keep stomach contents down.

4. Elevate the head of your bed - Raise the head of your bed 6-8 inches using blocks or a wedge pillow. This uses gravity to keep acid in your stomach. Extra pillows alone don’t work as well because they bend your body rather than elevating it.

5. Maintain a healthy weight - Excess abdominal fat puts pressure on your stomach, pushing contents upward. Even modest weight loss can improve symptoms significantly.

6. Wear loose-fitting clothes - Tight waistbands and belts increase abdominal pressure and can worsen reflux.

7. Quit smoking - Smoking weakens the LES, stimulates acid production, and impairs saliva production (which normally helps neutralize acid).

8. Limit or avoid alcohol - Alcohol relaxes the LES and can irritate the esophagus. If you drink, do so in moderation and not close to bedtime.

9. Eat slowly and chew thoroughly - Rushed eating and large bites can trigger reflux. Take your time and chew food well before swallowing.

10. Manage stress - While stress doesn’t cause GERD, it can worsen symptoms. Practice relaxation techniques and find healthy ways to cope with stress.

When to See a Doctor

Consult a healthcare provider if:

• You have heartburn more than twice a week
• Symptoms persist despite over-the-counter medications
• You have difficulty or pain when swallowing
• Symptoms are interfering with your daily life or sleep
• You’ve been taking over-the-counter antacids for more than two weeks
• You experience nausea or vomiting
• You have unexplained weight loss

Seek immediate medical attention if:

• You have chest pain (especially if accompanied by arm, jaw, or back pain, or shortness of breath - these could indicate a heart attack)
• You’re vomiting blood or material that looks like coffee grounds
• You have black, tarry stools
• You have severe difficulty swallowing
• You feel like food is stuck in your throat or chest

Key Takeaways

• Acid reflux occurs when stomach acid flows back into the esophagus; when chronic, it’s called GERD
• Lifestyle modifications including dietary changes, weight management, and not eating before bed can significantly reduce symptoms
• Over-the-counter and prescription medications are effective for most people
• Persistent or severe symptoms should be evaluated by a healthcare provider to prevent complications like esophageal damage or Barrett’s esophagus