The reflux of acid in the esophagus is due to changes in the wall between the esophagus and stomach, lack of ability of lower esophageal sphincter, inability to throw out gastric acid from the esophagus or temporary relaxation of lower esophageal sphincter.
Besides these causes hiatus hernia, pregnancy and obesity may cause acid reflux.
Other causes could be Hypercalcmia, Zollinger Ellision syndrome, steroid (prednisolone) abuse.
Coffee, alcohol, smoking, high fat foods, chocolates, peppermints, acidic foods, cruciferous vegetables and foods containing vitamin C can cause more acid production and the risk of acid reflux.
If the gastric acid reflux reaches throat then it is called as laryngopharyngeal reflux disease. These changes may be temporary or permanent.
Heartburn, regurgitation and difficulty/inability to swallow (dysphagia), are the most common symptoms of acid reflux disease. Sometimes, nausea, vomiting, chest pain, pain while swallowing (odynophagia), sore throat or excessive salivation may be seen but these symptoms are less common. Some rare symptoms are asthma, eroded dental enamel, belching, hypersensitive teeth, long lasting cough or inflammation of the larynx.
The symptoms of acid reflux in children are different than the adults. They may be frequent vomiting, respiratory problems, swallowing problems like gagging & choking, coughing or spitting without any force. Poor sleep habits, inability to gain sufficient weight, non-stop crying, bad breath, belching, burping or no desire for food is some more symptoms. The symptoms may be single or multiple.
Generally the disease is treated on the basis of medical history and clinical examination. If the symptoms are not relieved by treatment or there are additional symptoms like anemia, dysphagia, blood in stool, weight loss changed voice or wheezing then Esophagogastroduodenoscopy (EGD), a type of endoscopy, may be done. The other tests are X-ray, barium swallow, esophageal manometry and 24 hour esophageal impedance pH monitoring, stool quaiac test and Bernstein test for gastric acid reflux. An endoscopy may be done once in 5-10 years in patients with acid reflux disease to find out the condition of esophagus and possibility of severe disease. Biopsies of the esophagus may be taken at the time of endoscopy for histopathological examination.
This includes a combination of lifestyle modifications, food habits alterations and recommended medications.
Avoid coffee, alcohol and Vitamin C (excess amounts) before bedtime.
Eating at least 2-hours before going to bed and having a relatively light meal for dinner help in curbing acid reflux.
Avoiding one time large meals and instead having small frequent meals as a substitute works well too.
Avoiding acidic foods like tomato and citrus fruits and their preparations, chocolates, peppermint, carbonated soft drinks and smoking is also useful in the prevention of acid reflux.
Weight loss, taking medications with plenty of water, sleeping on left side and sleeping in the elevated head position are helpful measures to prevent acid reflux.
Treatment mainstay is usually medications like Antacids, H2 receptor antagonists, Proton pump inhibitors or pro-motility agents.
Nissen fundoplication is a laparoscopic surgical treatment option, sometimes preferred over long term medication usage, which is carried out for acid reflux disease. Another surgical treatment is transoral incisionless fundoplication (TIF) with the use of a device called Esophyx.
There may be esophageal ulcers, hoarseness of voice, bronchospasm,
chronic pulmonary disease, inflammation of the esophagus, stricture or
even more severe complications.
The more severe changes caused due to acid reflux may be categorized into four types.
There may be necrosis or ulceration at the gastro-esophageal junction called as reflux esophagitis-necrosis.
There may be narrowing of the esophagus due to swelling called as esophagel stricture.
The epithelial cells of the distal esophagus may change from squamous to columnar type called as Barret’s esophagus-metaplasia.
The gastric acid may cause esophageal carcinoma which is a rare type of cancer.
If any of the above mentioned symptoms are experienced or if the already existing condition does not get better after life style modifications and medications or if it worsens then it is better to visit your health care provider / family physician.
