ACID REFLUX: TREATMENT AND PREVENTION
Acid reflux disease is the medical term for repeated occurrences of acid reflux, which happens when acid from the stomach goes into the esophagus. When stomach acid travels upwards, people may feel extreme burning chest pain, which is called heartburn. Other symptoms of acid reflux disease are bloating, nausea, weight loss, and regurgitation. Acid reflux can be caused by a hiatal hernia, or it may just be due to eating large meals. Over-the-counter medicines, diet changes, and lifestyle changes can help manage acid reflux disease.
It is estimated that up to 60 percent of adults will have symptoms of acid reflux sometime during any given year. About half of these adults will have weekly bouts with it.
Acid reflux occurs when digestive stomach acid refluxes back into the esophagus. The common name for the symptom it causes is heartburn. It is called this because of the hallmark burning sensation most feel low in their throat or in the upper abdominal region. Chronic acid reflux is called gastroesophageal reflux disease (GERD).
Typical and Not-So-Typical Symptoms of Acid Reflux
The number one reported symptom that motivates people to seek treatment or relief is the burning sensation that is felt when acid refluxes up from the stomach into the esophagus. The sensation is sometimes mistaken for symptoms of a heart attack and vice versa. Often accompanying the burning is a diffuse and non-specific feeling in the stomach area of discomfort. A feeling of nausea is often felt as well.
These symptoms are exacerbated by heavy meals, especially ones that contain high amounts of fat foods. Body position can also cause these feelings. Bending over shortly after a meal or lying down often makes symptoms worse.
Some people do not feel the sensation of burning, or they do not notice it as much because of the length of time they have been suffering from acid reflux. Non-standard symptoms of GERD is often not associated with acid spilling back into the esophagus. Because of this, some sufferers may not consider seeking treatment as a symptom of acid reflux.
Difficulty swallowing can be caused by strictures (scar tissue) caused by acid attacking the lining of the esophagus over a longer period of time. A serious condition known as Barrett’s esophagus can result from prolonged exposure of the esophagus to stomach acid. Barrett’s esophagus has the potential of leading to esophageal cancer in some instances. Asthma symptoms, a sore throat, persistent coughing, a bitter taste in the mouth, pain after eating and even chest pains not related to cardiovascular disease are some of lesser known symptoms of acid reflux disease.
Treating Acid Reflux
Healthy individuals who very infrequently have heartburn/acid reflux symptoms may find complete relief through occasional use of over-the-counter (OTC) acid reflux treatments in the form of antacids such as calcium carbonate (Tums) or aluminum hydroxide (Rolaids). This form of self-treatment would most likely be beneficial to an otherwise healthy person who occasionally overindulges in offending foods or beverages.
Acid reflux treatments include a class of drugs known as proton pump inhibitors (PPIs). They control stomach acid production at its source. In the stomach lining are tiny proton pumps that produce the hydrochloric acid used to digest foods. This class of drugs lessens the amount of acid production in the stomach by slowing production at the proton pump source. The brand names Prevacid, Prilosec and Nexium are examples of PPIs. Nexium is one of the latest drugs of this class that used to be available by prescription only but is now available in a lowered strength OTC form. Some PPI drugs are only available by prescription.
Another class of drugs available by both OTC and by prescription are H2 blockers. They block the H2 histamine type that stimulates the production of stomach acid. Parietal cells in the gastric glands of the stomach secrete hydrochloric acid. The H2 class of drugs act as an antagonist against parietal cells that produce stomach acid. They are one of the older forms of pharmacological acid reflux treatments that was first developed in 1964.
Side Effects of Treatment
All drugs, whether they are OTC or prescription, have the potential for side effects. PPI drugs have been associated with magnesium depletion, an increase in the likelihood of hip fractures, benign polyps in the stomach and even voice box changes.
Cimetidine is one of many H2 acid reflux treatments, but it does have a potential associated side effect of gynecomastia (male breast enlargement). A decreased or complete loss of sex drive and impotence have also been reported as side effects for some people taking it.
Standard calcium carbonate and aluminum hydroxide medications also have potential side effects as well as having the potential to cause drug interactions. Calcium carbonate can reduce the absorption of other medications. Aluminum hydroxide can cause constipation, and it can also interfere with absorption of some medications.
Some sufferers of acid reflux may have a structural abnormality such as a hiatal hernia, where the stomach protrudes up into the diaphragm, or other physiological issues that is causing their acid reflux symptoms. Surgical intervention may be necessary to alleviate the problem.
Gastropareses is a form of nerve damage of the stomach that leads to delayed emptying of its contents and may cause acid reflux. Helicobacter pylori (H. pylori) bacterial infection can lead to acid reflux, and issues with bile (produced in the liver and used in fat digestion) in the stomach may also lead to acid reflux.
Eosinophilic esophagitis is another condition, though it is still not well understood. Eosinophils are a type of white blood cell. This condition can mimic some symptoms of GERD, and it may be concomitant along with the acid reflux GERD.
Preventing Acid Reflux
Unfortunately in America, the standard expectation of many people is to take a treatment for symptoms rather than correct an underlying cause. The Standard American Diet (SAD) of high fat and high sugar in highly processed foods is considered to be the cause of much of the nation’s suffering with GERD. Sedentary living is another fundamental issue. It leads to weight gain, and the excess fat presses on the stomach. This puts excessive force on the lower esophageal sphincter (LES), which is supposed to keep stomach acid in the stomach. An aggravating issue is the SAD often includes consumption of alcohol, caffeine, chocolate and highly acidic prepared foods that act to weaken the strength of the LES. Nicotine use can also weaken the LES, causing acid reflux, and stress can increase acid production in the stomach.
Acid reflux can be caused and further aggravated by combinations of what a person eats and drinks, their weight, fitness level, daily stressors and nicotine use. People rarely want to give up all of the things they find pleasing in their daily life. Instead, they often opt to take a medication to lessen the symptoms of GERD rather than taking steps to eliminate it.
For those who want to prevent acid reflux, a systematic approach of correcting one potential cause at a time until symptoms cease is a good approach. That horrible heartburn may be caused by an occasional chocolate indulgence or that slice of pizza for lunch. It could be drinks on Friday night after work or even an extra morning caffeine boost.
Standard recommendations advise not to drink alcohol or caffeine several hours before bedtime, and the final meal or snack should be eaten at least four hours before bedtime. Suggestions to wear loose fitting clothing and no binding belts also abound in articles. However, these are methods used to minimize symptoms rather than to eliminate them altogether. If a person is overweight, then losing the extra pounds lessens the pressure on the LES. Not eating fatty meals greatly lowers the need for extra stomach acid and bile secretions that add to the uncomfortable burn. Abstaining from using all forms of nicotine is a standard medical recommendation, and alcohol, chocolate and caffeine may need to be eliminated as well to prevent acid reflux from returning.
Vigilant persistence in maintaining a healthy diet high in minimally processed fruits and vegetables along with lower quantities of lean meats are a beginning. Since the stomach and throat are the parts that are affected by GERD, and they process every food or drink item swallowed, it makes sense to begin preventing acid reflux by monitoring and controlling what goes into the stomach in the first place. Daily exercise is proven to help maintain muscle mass and control weight as well as reducing stress, all of which go a long way in preventing the symptoms of acid reflux.
Fundamentally, controlling acid reflux involves keeping the stomach acid in the stomach and lowering the acid level in the stomach. The LES is the valve that keeps the acid in the stomach. Not weakening it by pressure from being overweight or through foods, drugs and chemicals that cause it to loosen and open unintentionally is a great help in acid reflux prevention. Keeping stomach acid at bay by not eating high fat or highly acidic foods is another help. Since each person varies widely in their dietary styles and other habits, it is suggested that those seeking to prevent, or prevent the recurrence of, acid reflux should make a list of all potential causes that are present in their own life and begin eliminating them one by one to live healthier and be free of acid reflux.