Acid reflux occurs when stomach acid flows backward into the esophagus, the tube connecting your mouth to your stomach. This happens when the lower esophageal sphincter (LES), a muscle at the bottom of the esophagus, does not close properly, allowing stomach contents to travel upward. This backward flow can irritate the esophageal lining.
Common symptoms of acid reflux include a burning sensation in the chest, often called heartburn, and the regurgitation of sour liquid or food into the throat or mouth. Other symptoms can include a sore throat, coughing, or a sensation of a lump in the throat. Acid reflux can manifest in two primary forms: occasional heartburn or a chronic condition known as Gastroesophageal Reflux Disease (GERD). Occasional acid reflux is a common experience, often triggered by specific foods or activities, and typically resolves on its own or with over-the-counter remedies. This type of heartburn usually lasts from a few minutes to a few hours, subsiding once the offending meal has been digested.
In contrast, GERD is defined by persistent and frequent acid reflux symptoms, typically occurring more than twice a week. This chronic condition signifies a more fundamental issue with the mechanisms designed to keep stomach acid contained. While occasional acid reflux is generally temporary, GERD is a long-lasting condition that does not typically resolve without intervention and may require ongoing management.
While temporary heartburn is usually not a concern, GERD can cause significant discomfort and potentially lead to more serious complications if left unmanaged.
Causes of Chronic Acid Reflux
Several factors can contribute to acid reflux becoming a persistent, chronic condition. A primary cause often involves a weakened or improperly functioning lower esophageal sphincter (LES). When this muscle relaxes too frequently or does not close completely, stomach acid can readily flow back into the esophagus, leading to ongoing irritation.
A hiatal hernia is another common physical abnormality that can lead to chronic reflux. This occurs when the upper part of the stomach pushes through the diaphragm into the chest cavity, which can weaken the LES and allow stomach acid to reflux more easily.
Obesity significantly increases the risk and severity of GERD. Excess weight, particularly around the abdomen, puts increased pressure on the stomach, which can force acid up into the esophagus. This added pressure can contribute to compromised LES function.
Lifestyle choices also contribute. Smoking, for instance, can relax the LES, increase stomach acid production, and reduce the effectiveness of saliva in neutralizing acid, all of which worsen reflux. Certain dietary habits, such as consuming high-fat foods, spicy items, citrus, chocolate, caffeine, and alcohol, can also trigger or exacerbate symptoms by relaxing the LES or increasing stomach acidity. Additionally, some medications, including certain blood pressure drugs, antidepressants, and nonsteroidal anti-inflammatory drugs (NSAIDs), can contribute to reflux by relaxing the LES or irritating the esophageal lining.
Managing Persistent Acid Reflux
Managing persistent acid reflux often involves a combination of lifestyle adjustments and medical interventions. Lifestyle modifications aim to reduce reflux triggers and symptoms. This includes making dietary changes, such as avoiding high-fat foods, spicy dishes, citrus, chocolate, and caffeine, which can relax the lower esophageal sphincter or increase stomach acid production. Eating smaller, more frequent meals instead of large ones can also help minimize stomach pressure and prevent acid backflow.
Weight management is a significant lifestyle factor, as excess weight, particularly around the abdomen, can increase pressure on the stomach and worsen reflux. Elevating the head of the bed can utilize gravity to keep stomach contents down, especially for those experiencing nocturnal symptoms. Avoiding eating for at least two to three hours before lying down is also recommended.
For many, over-the-counter medications provide relief. Antacids work by neutralizing stomach acid for quick, temporary symptom relief, though they do not heal esophageal damage. Histamine-2 (H2) blockers reduce acid production and offer longer-lasting relief than antacids.
When lifestyle changes and over-the-counter options are insufficient, prescription medications are often considered. Proton pump inhibitors (PPIs) are more potent acid reducers that block acid production and allow the esophageal lining to heal. For severe cases not managed by these approaches, surgical options may be explored. These procedures involve reinforcing the weakened sphincter, providing a more permanent barrier against reflux.
Potential Complications of Untreated GERD
If chronic acid reflux is left untreated or poorly managed, it can lead to several potential long-term complications affecting the esophagus. One such complication is esophagitis, which is inflammation of the esophageal lining caused by constant exposure to stomach acid. Prolonged inflammation can result in open sores, known as esophageal ulcers, and may also cause bleeding.
Another potential issue is esophageal stricture, a narrowing of the esophagus that develops from scar tissue due to chronic inflammation. This narrowing can make swallowing difficult and painful, often causing food to feel stuck. Esophageal strictures can significantly impact a person’s ability to eat and drink comfortably.
A more serious complication is Barrett’s esophagus. This condition involves precancerous changes in the cells lining the lower esophagus, where the normal squamous cells are replaced by cells similar to those found in the intestine. While most people with Barrett’s esophagus do not develop cancer, it does increase the risk of a specific type of esophageal cancer called adenocarcinoma.
Although the overall risk of developing esophageal cancer from GERD is small, the consistent irritation and cellular changes associated with chronic, untreated reflux contribute to this elevated risk. Early diagnosis and consistent management of acid reflux are important to prevent these progressive and potentially severe complications.