Do you also often experience heartburn and stomach acid coming up into your throat? (Acid Reflux & GERD)

Have you ever had a burning sensation in your chest or a feeling like something from your stomach is coming up into your throat after eating? Most people have experienced this at least once or twice. Today we are going to talk about this 'acid reflux' or, in medical terms , acid reflux and GERD (gastroesophageal reflux disease) . Since this is a problem that many people have, it is very important to be aware of it.

What exactly is acid reflux, my friend?

Simply put, the food, drink, and acidic fluids in your stomach are only supposed to go one way, which is down. But sometimes, when this stomach acid, that is, acidic substances , flow back up your esophagus into your throat , we call it Acid Reflux.

Imagine, what happens when this acid gets where it shouldn't? That's the problem. This acid can burn, injure, and swell the delicate tissues inside your esophagus. This esophagus is a tube-like part that runs from your stomach through your chest to your throat. So, if it gets damaged, we can have a lot of problems.

We all experience acid reflux from time to time. It can feel like indigestion or heartburn when food is not digested. This occasional acid reflux is uncomfortable, but it is not a disease. However, for some people, it happens all the time. Continuing acid reflux can interfere with your normal life and can actually damage the tissues of the esophagus .

So what is GERD? Is it more serious than that?

GERD is the short name for Gastroesophageal Reflux Disease . In some countries, it is also called GORD, which stands for Gastro-oesophageal Reflux Disease. However, GERD is a condition where acid keeps coming up into your esophagus, which is a chronic acid reflux condition. If you have this acid coming up into your throat more than twice a week, usually for several weeks, it is considered a chronic condition, or GERD.

We can get acid reflux for temporary reasons, like eating too much one day. But GERD is something else, caused by a persistent, mechanical problem . That is, the mechanisms that keep acid from coming up into your esophagus aren't working properly.

How common are these two conditions?

Both occasional, uncomplicated gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) are very common . In the United States alone, it is estimated that about 20% of adults and about 10% of children have GERD. This condition is also seen among many people in Sri Lanka.

What are the symptoms of Acid Reflux and GERD?

There are several symptoms of acid reflux and GERD. See if you have any of these:

• Backwash/Regurgitation: After you finish eating, you may feel as if stomach acid, food particles, or liquids come back up into your throat. It's like vomiting , but it doesn't come out completely. Sometimes, you may have a strange sour taste in your mouth.
• Heartburn: Acid is a strong substance. So it literally feels like it's burning the tissues of the esophagus. If this is in the chest, we call it heartburn . If it's closer to the stomach, some call it acid indigestion .
• Noncardiac chest pain : Some people experience pain in the esophagus that is not caused by inflammation. This pain stimulates the same nerves that sense pain in the heart , so it can feel like chest pain, similar to a heart attack.
• Nausea : Acid reflux or reflux can make you feel nauseous and lose your appetite. Even after a while, you may feel like there's still food in your stomach, like there's more to digest.
• Sore throat : If acid gets into your throat, it can hurt and injure your throat. You may feel like something is stuck in your throat, or you may have difficulty swallowing . Acid often comes up at night while you are sleeping.
• Asthma symptoms: GERD can worsen asthma symptoms in people with asthma, and even in people without asthma, it can cause asthma symptoms such as persistent coughing , wheezing, and difficulty breathing. If acid particles enter the airways, they can narrow.

Symptoms may become severe:

GERD symptoms can get worse during times like these:

• At night or while lying down.
• After eating a large meal or a fatty meal.
• When you bend forward.
• After smoking or drinking alcohol.

Do small babies get GERD too?

Yes, even small babies can get GERD. It's normal for babies to regurgitate a little after they drink. Although there is some acid in the regurgitated contents, it's not enough to cause any major problems for the baby. But GERD is a more serious condition . It can cause discomfort and complications for the baby, including feeding.

Babies who are born prematurely or with a condition related to the esophagus are more likely to develop GERD. If a pediatrician notices that your baby is having difficulty eating or sleeping, they may want to check for GERD.

GERD symptoms in babies (or young children):

• Frequent crying, restlessness (Excessive fussiness).
• Difficulty sleeping.
• Refusal of food.
• Vomiting in small amounts.
• Wheezing or hoarseness when breathing.
• Bad breath.

What are the causes of acid reflux?

For acid to get into your esophagus, it has to pass through the valve at the bottom of your esophagus that normally keeps things from coming back up. This valve is called the Lower Esophageal Sphincter (LES) .

Your LES is a circular muscle. It opens when you swallow something, then closes again to stop the contents of your stomach from coming up. It also opens slightly when you burp or hiccup to let air bubbles escape.

Acid reflux happens when your LES becomes weak or loose enough to allow acid to come up . Some temporary things, like lying down after eating a big meal, can cause the LES to relax. But if you have GERD, your LES is constantly loose.

How does the LES weaken?

There are many reasons why the LES can weaken temporarily or permanently. Sometimes, occasional acid reflux can develop into chronic GERD when several of these causes combine or persist for a long time. Here are some common causes of acid reflux and GERD:

• Hiatal Hernia: This may sound complicated, but let me put it simply. There is a muscle called the diaphragm that separates your chest and stomach. Your esophagus is connected to your stomach through this diaphragm. In a hiatal hernia, the upper part of your stomach pushes up through the opening in your esophagus and into your chest . It can then become trapped with your esophagus, causing acid to build up there. Also, the LES valve we talked about earlier also moves up through the diaphragm, so it has less muscle support. This condition is more common as you age, develops gradually, and can become more severe over time.
• Pregnancy: It is very common to experience temporary acid reflux during pregnancy. The increased pressure and space in the stomach can cause the muscles that support the LES in the esophagus to stretch, tighten, and weaken. Pregnancy hormones can also cause the LES to relax. During this time, a hormone called relaxin is released in greater amounts. This relaxes the muscles to make room for the baby. Estrogen and progesterone levels also increase, which can cause the LES to relax.
• Obesity: Obesity also increases the pressure and space in the stomach, just as pregnancy does, which can affect the LES. However, as obesity continues beyond pregnancy, the muscle can become permanently weakened. This is also a major cause of hiatal hernias. Also, since estrogen is secreted by adipose tissue, estrogen levels also increase as body fat increases.
• Smoking: Tobacco smoke relaxes the LES, whether you smoke it yourself or inhale second-hand smoke. Smoking also causes coughing, which opens the LES. Continued smoking and coughing can weaken the muscles in the diaphragm, leading to a hiatal hernia. Smoking also slows down your digestion and increases stomach acid production.

What are the possible complications of persistent acid reflux (GERD)?

Stomach acid is a very powerful substance. It is designed to break down the food you eat. Your stomach has a strong lining to protect it from this acid. But your other organs don't have this protection. Acid reflux mostly affects your esophagus. But sometimes it can even go up into your windpipe or airways. A little acid can cause a momentary discomfort. But too much acid can damage these organs.

Possible complications:

• Esophagitis: This is inflammation of the lining of the esophagus, which means swelling and soreness. If esophagitis persists, it can lead to complications such as persistent pain and ulcers in the esophagus. Over time, it can lead to tissue changes such as scarring or intestinal metaplasia , which is a precancerous condition.
• Barrett's Esophagus: This is the name given to the condition of intestinal metaplasia in the esophagus. This means that the lining of the esophagus changes and becomes more like the lining of the intestine. This occurs when there is prolonged exposure to acid and inflammation. This is a risk factor for esophageal cancer.
• Esophageal stricture: Scar tissue can form in your esophagus to protect it from ongoing inflammation and injury. This scar tissue can cause the esophagus to narrow. This is called a stricture. This can make it difficult to swallow , which can make it difficult to eat or drink, and can cause other problems.
• Laryngopharyngeal Reflux (LPR): Some people with GERD also develop a condition called LPR. This is when acid comes up into the throat. Acid can sneak up into your throat while you're sleeping. It can cause your throat to swell, your voice to become hoarse, and vocal cord growths to form. Acid particles can also be aspirated into your airways.
• Asthma: If acid enters the respiratory tract, it can worsen the condition of someone who already has asthma, and even someone who has not had a previous respiratory disease can develop asthma-like symptoms. The small acid particles can irritate the bronchial tubes and cause them to constrict. This can cause coughing and difficulty breathing.

What are the medical treatments for GERD?

Some people can reduce acid reflux by making lifestyle adjustments, such as changing their diet, cutting down on alcohol and smoking, and losing weight. Doctors encourage you to follow these steps. But if you have persistent acid reflux or GERD, doctors may recommend medications that reduce stomach acid. This will help reduce the amount of acid that comes up, but it will be less harmful.

Medicines

Surgery

For severe GERD or cases that are not controlled with medication, surgery to tighten the LES muscle may be recommended, such as a Nissen fundoplication .

Things to help control acid reflux at home

Try these things to control acid reflux at home:

• Eating small meals: Large meals fill your stomach and put pressure on the LES.
• Eating dinner early: Eat dinner at least 2-3 hours before going to bed.
• Sleeping on the left side: This places the LES above the stomach contents.
• Reduce abdominal pressure: Wear loose clothing and lose weight if necessary.
• Quit smoking and alcohol: These weaken the LES and increase acidity.