Q. What is acid reflux? What is heartburn? What is GERD? What is gastroesophageal
reflux?
A. Heartburn, acid reflux, GERD, gastroesophageal reflux are all names
for conditions that result from acid in the stomach irritating and sometimes
damaging sensitive linings of your gut. Your gut starts in the swallowing
tube (esophagus), then the stomach, then the duodenum, then the rest of
the intestines which are less likely to be affected by acid.
Q. What does acid reflux feel like?
A. It often can cause a range of symptoms such stomach pain after eating
or laying down, vomiting, feeling of stomach fullness or incomplete/difficult
swallowing, epigastric cramping and soreness, heartburn, bitter taste,
and nocturnal wakening. When patients complain to me of burning abdominal
pain that keeps them awake, I think of gastroesophageal reflux (GERD).
That's because when someone with GERD lies down, the acid travels from
the stomach to the esophagus and causes burning pain. Other symptoms can
include (although these can be from other causes as well):
Q. How can you get acid reflux?
A. There are many contributing factors, not all of which have to be
present in any one person:
-
bending, stretching, exercise, especially later at night
-
a loose lower esophageal sphincter (what cinches off the stomach
from the esophagus swallowing tube) from overeating, alcohol, caffeine,
tobacco
-
eating later at night
-
drinking liquids earlier in your meal
-
overproduction of stomach acid, by stimulating acid production by
the aromas or expectation of a meal, then not eating
-
excess body weight (e.g. pregnancy), obesity
-
fatty & spicy foods
-
hiatal hernia - where part of the stomach slips through to the chest
cavity so the sphincter doesn't cinch off as well
Q. How can I find out if acid reflux is the reason for my symptoms?
A. Although many providers will try medication to see if it takes away
your symptoms, there are tests available, but less frequently performed
unless you have potential complications:
-
Esophagoscopy - fiberoptic tube to look directly at the lining of
your swallowing tube and stomach
-
Barium swallow test - an x-ray to look at the lining of the swallowing
tube - esophagus
-
24-hour pH monitoring - pH goes down in the swallowing tube (esophagus)
if acid is escaping from the stomach into it
-
Esophageal manometry - testing the squeezing power of the lower esophageal
sphincter
-
Gastric emptying studies - to see how quickly foodstuffs pass through
Q. Is acid reflux contagious?
A. Although many providers will try medication to see if it takes away
your symptoms, there are tests available, but less frequently performed
unless you have potential complications:
Only as much as you convince others to take on behaviors that are predisposing
you to have this problem. No, it's not catching, really.
Q. How can I treat acid reflux?
A. Although many providers will try medication to see if it takes away
your symptoms, there are tests available, but less frequently performed
unless you have potential complications:
PPI's proton pump inhibitors (nexium and prilosec and aciphex and protonix)
are the most helpful medicines for this problem, but when they're not
giving enough relief in a few weeks, I find that adding an antacid at
maximal dose (H2 blocker such as tagamet, zantac, pepcid) at night helps
with nighttime symptoms since the PPI has worn off by then. Proton pump
inhibitors (PPIs) such as Prilosec (omeprazole) are stronger than H2
blockers such as Zantac HB (ranitidine), Pepcid AC (famotidine), and
Tagamet HB (cimetidine). The reason is that PPIs prevent the top of
the stomach (antrum) from producing the acid. H2 blockers only prevent
the hormonal receptors from receiving the instructions to produce more
acid, which is less effective. Both PPIs and H2 blockers can be taken
at the same time. If these over the counter medicines are needed for
more than 2 weeks, go see your doctor.
Prop the head of the bed up so you sleep on an incline. Not eating/drinking
in the evening helps. Eating larger meals earlier in the day helps.
Waiting on drinking fluids until after eating helps (the food absorbs
the acid in your stomach). Eating smaller meals more frequently helps.
Behavior change can also help decrease these symptoms. Cut out alcohol,
caffeine, laying down after eating. Eating largest meals early in the
day allows for digestion while one is up and around. Eat less at one
time, since smaller food boluses in one's stomach are less likely to
regurgitate to the esophagus. Don't snack at night.
Lose weight, eat smaller meals, increase exercise earlier in the day
to use up excess calories.
The great thing about acid reflux is that you can do something about
it. If it's not getting better, it's worth seeking a doctor's visit for
to rule out more serious problems such as an ulcer, or very rarely, cancer.
Q. Can surgery help acid reflux?
A. Yes, some patients are not helped enough by medication and decide to
undergo nissen fundoplication which nowadays is done by keyhole surgery
(laparoscopic antireflux surgery). This is very helpful for some people
with good results.
|
