Acid Reflux (GERD)

What is Acid Reflux?

Acid reflux is a symptom of a disorder known as GERD (Gastroesophageal Reflux Disease). It occurs when stomach acid enters and remains in the esophagus (muscular tube connecting the mouth to the stomach) for prolonged periods of time. There are several reasons for its development, however most commonly it is due to weakness of the lower esophageal sphincter (LES) muscle. This muscle serves to prevent free flow of significant amounts of stomach acid from the stomach into the esophagus. Obesity and certain foods can cause weakness or relaxation of the LES. The presence of a hiatal hernia may also increase the risk of reflux symptoms.

Esophagus

Stomach

Intestine

Hiatal Hernia - The diaphragm is a large muscle which separates the chest from the abdominal cavities. The esophagus empties into the stomach through a hole in the diaphragm. The stomach should be entirely below the diaphragm. A hiatal hernia develops when a portion of stomach escapes the abdomen and slips into the chest cavity. Stomach acid can then more easily flow into the esophagus and cause reflux.

What are symptoms of Acid Reflux?

  • Heartburn
  • Burning in the mid chest
  • Sour taste in the back of the throat/mouth, especially in the mornings
  • Constant throat clearing
  • Change in voice quality
  • Chronic dry cough
  • Symptoms may be worse following large meals and when leaning forward or lying down

How is Acid Reflux Diagnosed?

The diagnosis is clinical (made by an interpretation of the symptoms you report to your healthcare provider). GERD can also be diagnosed if your symptoms improve or resolve with diet/lifestyle changes and/or with acid blocking therapy.

In some cases, the diagnosis is made by measuring the amount of acid in the esophagus. This is done by performing a 24 hour pH test using a catheter placed through the nostrils or by attaching a device to the lining of the esophagus during an endoscopy (Bravo pH). pH is a measure of the amount of acid present. The pH data is captured on a wireless device and analyzed by one of the group's physicians.

How is acid reflux treated?

Treatment includes diet and lifestyle modifications such as avoidance of trigger foods, overeating, eating late at night, lying down soon after eating, and acid blocking medications. Weight loss may also alleviate symptoms as does elevating the head by 6 inches during sleep.

Caffeinated beverages, spicy foods, acidic foods, peppermint, chocolate and alcohol can worsen heartburn symptoms. Avoiding meals within 2-3 hours of bedtime can be effective. Examples of acid blocking medications include Tums, Ranitidine (Zantac), Famotidine (Pepcid), Esomeprazole (Nexium) and Omeprazole (Prilosec) which are available over the counter. Others are available by prescription.