Acid Reflux & GERD
Acid Reflux & GERD
What is Acid Reflux?
Acid reflux is when your stomach acid comes back up into your esophagus. There is a valve between your stomach and your esophagus call the lower esophageal sphincter (LES), typically the LES closes as soon as food passes through it. Acid reflux happens when the LES doesn’t close all the way or if it opens too often, causing your stomach acid to move into your esophagus. This causes symptoms like burning chest discomfort called heartburn. If acid reflux symptoms happen more than 2x per week you may have acid reflux disease, AKA gastroesophageal reflux disease, or GERD.
What causes Acid Reflux?
There are many common causes of acid reflux, but one common cause is a hiatal hernia, which is a stomach abnormality. A hiatal hernia is when the upper part of the stomach and the LES move above the diaphragm which is the muscle that separates your stomach from your chest. Usually, the diaphragm works to keep acid in your stomach, but when you have a hiatal hernia acid is able to move up into your esophagus causing symptoms of acid reflux. The other most common causes for acid reflux include:
- Eating large meals or lying down right after a meal
- Being overweight or obese
- Snacking close to bedtime
- Eating certain foods like citrus, tomato, chocolate, mint, garlic, onions, spicy or fatty foods
- Drinking certain beverages like alcohol, carbonated beverages, coffee, or tea
- Benign pregnant
- Taking aspirin, ibuprofen, some muscle relaxers, or blood pressure medications
Symptoms of Acid Reflux
The most common symptoms of acid reflux include:
- Heartburn, which is a burning pain or discomfort that moves from your stomach to your abdomen or chest and sometimes up into your throat.
- Regurgitation, which is a sour or bitter-tasting acid that backs up into your throat or mouth.
Other symptoms of acid reflux could include:
- Blood or black stools or bloody vomiting
- Dysphagia (the sensation of food being stuck in your throat)
- Hiccups that don’t go away
- Weight loss for unknown reasons
- Dry cough
- Chronic sore throat
- Regurgitation of food or sour liquid
How is Acid Reflux Diagnosed?
It may be time to seek help from a doctor if you are having acid reflux symptoms that happen two or more times per week or if medications don’t bring relief from your symptoms. Your doctor will review your symptoms as well as your medical history and can often make a diagnosis of acid reflux with that information. Your doctor will likely recommend lifestyle changes and medication to help reduce your symptoms. If those recommendations to not bring relief or you have increased or more severe symptoms your doctor may order a test to confirm your diagnosis and check for other problems. These tests include:
- Upper GI series - This is an x-ray technique that looks at your upper GI tract. It is often called a barium swallow as you are required to drink barium to coat the inner lining of your upper GI tract. This study does not show that you have acid reflux, but will determine if you have other problems like hiatal hernias, esophageal strictures, or ulcers as a side effect of your acid reflux.
- Esophageal manometry - This is a test that checks the function of your esophagus and LES. It is a procedure performed in an office, your healthcare provider will numb the back of your throat with a spray/liquid anesthetic. They will pass a soft, thin tube through your nose and down into you stomach, you will then swallow as the doctor pulls the tube slowly back into your esophagus. A computer will measure and record the pressure of the muscle contractions in your esophagus and this will determine if your symptoms are caused by a weak sphincter muscle.
- pH monitoring - This test checks for acid in your esophagus. Your doctor will insert a device into your esophagus which will need to remain in place for 1-2 days. This monitor will measure the amount of stomach acid in your esophagus. It is important to keep a diary during this time of when you have symptoms and what you did or ate prior to those symptoms to help determine your acid reflux triggers.
- Upper GI endoscopy - This procedure typically takes place in a hospital or outpatient clinic as it requires a sedative to help you stay relaxed and comfortable during the procedure. During this procedure, your doctor will numb your throat and feed then endoscope down your esophagus and into your stomach. There is a small camera on the endoscope that sends video images to a monitor and helps your doctor visualize if there are any internal issues with your esophagus or stomach.
- Biopsy - A biopsy may be taken during your endoscopy by taking small pieces of tissue from the lining of your esophagus or stomach. These samples are then examined by a pathologist to determine if there is an infection or other abnormalities.
Where can I get treatment for Acid Reflux?
To receive treatment for acid reflux you can make an in-person appointment with your healthcare provider. But, because acid reflux can be diagnosed with your health history and symptom review you can simply schedule an appointment with an online doctor with the use of telemedicine. This is an extremely convenient option for those who have limited time in their schedules. Please see the following list of online companies that can treat your acid reflux:
- Lemonaid Health
- Alpha medical
- Cabinet Health
- Carie health
Treatment options for Acid Reflux
Doctors will typically recommend that you first try lifestyle changes and over-the-counter medications. If you do not find relief from your symptoms within a few weeks your doctor may prescribe prescription medication or possibly surgery.
Lifestyle Changes To Treat Acid Reflux
Making lifestyle changes can be one of the most effective ways to treat your acid reflux, simply avoid foods and drinks that trigger your symptoms. Here are common lifestyle changes you can make:
- Eat smaller, more frequent meals throughout the day
- Quit smoking
- Eat at least 2-3 hours before lying down
- Sleep in a chair for daytime naps
- Avoid tight clothing or belts
- If you are overweight or obese take steps to lose weight
- Try sleeping at a slight angle by raising the head of your med 6-8 inches by putting blocks under the head of your bed or by using extra pillows
- Talk to your doctor about any medications you could be taking that could be triggering your symptoms of acid reflux
Best Medications For Acid Reflux (OTC)
- Antacids - work to neutralize stomach acid, they provide quick relief but they ultimately will not heal an inflamed esophagus damaged by stomach acid. If you use antacids too often they can cause side effects like diarrhea or kidney problems. Common antacids include:
- H-2 receptor blockers - work to reduce acid production. They don’t work as quickly as antacids but provide longer relief and decrease acid production from the stomach for up to 12 hours. More powerful versions are available by prescription. Common H-2 blockers include:
- Cimetidine (Tagamet HB)
- Famotidine (Pepcid AC)
- Nizatidine (Axid AR)
- Ranitidine (Zantac 75)
- Proton pump inhibitors - work to block acid production and heal the esophagus. This medication is a stronger acid blocker than H-2 blockers and provides time for damaged esophageal tissue to heal. Common proton pump inhibitors include
- Lansoprazole (Prevacid 24 HR)
- Omeprazole (Prilosec OTC, Zegerid OTC)
Best Medications For Acid Reflux (Prescription)
- Prescription-strength H-2 receptor blockers - work to reduce acid production. Long-term use may be linked with a small increase in risk of vitamin B-12 deficiency and bone fractures. Medications include:
- Prescription-strength famotidine (Pepcid)
- Prescription-strength proton pump inhibitors - works to block acid production and heal the esophagus. Some side effects may include diarrhea, headache, nausea, vitamin B-12 deficiency. Long-term use may increase the risk of hip fracture. Medications include:
- Esomeprazole (Nexium
- Lansoprazole (Prevacid
- Omeprazole (Prilosec, Zegerid)
- Pantoprazole (Protonix)
- Rabeprazole (Aciphex)
- Dexlansoprazole (Dexilant)
- Prokinetics - work to help strengthen your LES, empty your stomach faster, and reduce acid reflux. Side effects could include fatigue, nausea, diarrhea, depression, or anxiety.
- Metoclopramide (Reglan)
- Bethanechol (Urecholine)
Surgery and procedures
If medications don’t resolve your acid reflux symptoms and the symptoms are severely interfering with your life your doctor may recommend surgery.
- Fundoplication - this is one of the most common surgeries to treat acid reflux and can lead to long term reflux control. This surgery is performed using a laparoscope which is a thin tube with a small video camera. Your surgeon will sew the top of your stomach around your esophagus which will add pressure to the lower end of your esophagus to reduce your reflux.
- LINX device - this is a procedure that involves placing a ring of magnetic beads, called the LINX device, around the outside of the lower end of the esophagus. This device helps by preventing stomach contents from backing up into your esophagus. The magnetic attraction between the beads is strong enough to keep the space between the stomach and esophagus closed to refluxing acid, but weak enough to allow food to pass through.
- Transoral incisionless fundoplication (TIF) - this procedure involves tightening the LES by creating a partial wrap around the lower esophagus using polypropylene fasteners.
With the use of telemedicine, we are able to receive care for numerous medical issues without ever having to leave the comfort of our homes. Telemedicine provides easier more affordable access to the best medications for acid reflux and many other issues. There are a number of trustworthy companies that can connect you with high-quality health care providers who can treat your acid reflux today. Check out our list of the top online doctors to treat your acid reflux symptoms today.