Do you also get heartburn and chest pain? Let's learn about acid reflux and GERD!

After you eat, do you sometimes feel a burning sensation in your chest, a sour feeling in your throat, or a tightness in your stomach, similar to heartburn? These are common symptoms of acid reflux that many people experience. While it's normal to have this happen occasionally, it's something to be concerned about if it happens frequently.

What is Acid Reflux? Let's understand it simply!

Simply put, acid reflux is when the contents of our stomach, especially gastric acid , flow upward, that is, back into the throat. Normally, the food we eat goes into the stomach and then down. But in this case, the opposite happens.

Think about it, this acid in our stomach is very strong. It's made to digest food. So when something like this gets into the esophagus – the food pipe – it can damage the delicate tissues inside the esophagus and cause inflammation. Many people experience this from time to time. Some call it "indigestion" , others call it "heartburn" , which is a burning sensation felt in the middle of the chest, near the sternum.

This occasional acid reflux problem is not a serious illness. But for some people, it happens all the time. With such constant acid reflux, it is difficult to live a normal life, and it can also damage our esophagus.

So what is GERD?

GERD is the short name for Gastroesophageal Reflux Disease . In some countries, it is also written as GORD (Gastro-oesophageal Reflux Disease) . However it is written, it refers to a condition in which acid reflux in our esophagus occurs for a long time (chronic acid reflux) . If acid comes up like this at least twice a week, for several weeks, then doctors consider it a GERD condition.

Acid can come up for some temporary reasons. For example, lying down after eating a lot. But GERD is not something that is temporary. It is a permanent, mechanical problem . That is, the mechanisms that prevent acid from coming up into the esophagus are not working properly.

How common are these conditions?

Both conditions called gastroesophageal reflux disease (GERD) and GERD are very common. In a country like America, it is estimated that about 20% of adults and about 10% of children have GERD. This condition can be seen in our country to a greater or lesser extent.

What are the symptoms of this? See if you have these too!

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

• Backwash/Regurgitation: After eating, you may feel as if stomach acid, food particles, and liquids come back up into your throat. This is called regurgitation . It can sometimes be accompanied by a sour taste .
• A burning feeling: Because acid is a strong substance, it causes a burning sensation in the esophagus. If this is felt in the chest, it is called heartburn . If it is felt in the stomach, it is called acid indigestion .
• Noncardiac chest pain: Some people experience chest pain that doesn't feel like burning. The nerves that sense pain in the esophagus are similar to the nerves that sense pain in the heart, so it can sometimes be mistaken for a heart attack.
• Nausea: Acid reflux can cause nausea and loss of appetite. Even after a long time has passed, the stomach may still feel full.
• Sore throat: If acid gets into your throat, it can cause a sore throat, a feeling of something stuck in your throat, and difficulty swallowing. Most often, acid gets into your throat 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 coughing, wheezing, and difficulty breathing . This is because acid particles can narrow the airways if they get into them.

When are these symptoms most felt?

• When sleeping or lying down at night .
• After eating a large meal or a high-fat meal .
• When you bend forward.
• When smoking or drinking alcohol .

Do small babies get GERD?

It's very common for newborns to regurgitate milk. A small amount of acid may come with the milk, but it won't cause any major problems for the baby. However, GERD is a more serious condition. It can cause discomfort and problems with feeding.

Babies who are born prematurely or with a medical condition related to the esophagus are more likely to develop GERD. It's a good idea to see a pediatrician if your baby has any of these symptoms:

• If you are always crying for no reason .
• If you have trouble sleeping .
• If you don't like drinking milk .
• If you are constantly vomiting a little bit .
• If you make a wheezing sound when breathing or if your voice is hoarse .
• If you have a bad smell coming from your mouth .

Why does this acid come up? What are the reasons?

To get into the esophagus, acid has to pass through a valve at the lower end of the esophagus that normally prevents things from coming back up. This valve is called the Lower Esophageal Sphincter (LES) .

This LES is a circular muscle. It opens when we swallow food, and then closes again to keep the contents of the stomach in place. It also opens slightly when we burp, like when we hiccups, to let air bubbles out.

Acid comes up when the LES becomes weak or too loose . Some temporary things can cause the LES to relax. For example, lying down after a big meal. But if you have GERD, your LES is constantly relaxing.

Common causes of LES weakness include:

• Hiatal Hernia: This is when the upper part of the stomach pushes up through the hole in the diaphragm where the esophagus goes down. It can then become stuck with the esophagus, causing acid to build up. Also, because the LES is located above the stomach, it has less muscle support. This condition is more common with age and can gradually increase.
• Pregnancy: Temporary acid reflux is very common during pregnancy. The pressure of the growing baby in the abdomen can stretch and weaken the muscles that support the LES. Also, hormones released during pregnancy, such as relaxin ( which relaxes the muscles to make room for the baby), estrogen, and progesterone, can also relax the LES.
• Obesity: Obesity can also increase intra-abdominal pressure, which can affect the LES, just like pregnancy. Obesity can last longer than pregnancy, and the muscles can become permanently weak. This is also a major cause of hiatal hernias. Since fat tissue secretes estrogen, estrogen levels in obese people also increase.
• Smoking: The substances in tobacco relax the LES. This effect can occur whether you smoke or inhale the smoke when others smoke (second-hand smoke). Smoking causes coughing, and when you cough, the LES opens. Continued smoking and coughing can weaken the muscles of the stomach wall and cause a hiatal hernia. Not only that, smoking also slows down digestion and causes the stomach to produce more acid .

Other possible causes of GERD include:

• Some birth defects: For example, conditions involving the esophagus such as esophageal atresia .
• Connective tissue diseases: Diseases such as scleroderma can affect the muscles of the esophagus.
• Prior surgery: Surgery on the chest or upper abdomen may have damaged the esophagus.
• Certain medications: Some medications can relax the LES.
• Benzodiazepines (tranquilizer)
• Calcium channel blockers ( medicines for high blood pressure)
• Tricyclic antidepressants (medicines for depression and pain)
• NSAIDs (Nonsteroidal anti-inflammatory drugs) - painkillers like aspirin and ibuprofen
• Theophylline (a common asthma medication)
• Hormone therapy (HT) for menopause

Does food and drink affect this?

Food and drink alone may not cause acid reflux, but they can make it worse. Eating too much of things like chocolate, coffee, alcohol, mint, garlic, and onions can relax the LES.

Fatty foods increase stomach acid and take longer to digest. So there is a higher chance of acid reflux. If you eat a heavy meal for dinner, it may not be digested before you go to bed.

What complications could arise if this continues?

The acid in our stomach is very powerful. It is designed to digest the food we eat. Our stomach has a thick lining inside to protect it from this acid. But our other organs don't have this protection.

Acid reflux mostly affects the esophagus. But sometimes this acid can also travel up into the windpipe or airways. Even if a small amount of acid comes up, it can cause discomfort, but if it comes up continuously, it can damage these organs.

Possible complications:

• Esophagitis: This is inflammation of the lining of the esophagus. Long-term esophagitis can cause persistent pain and ulcers in the esophagus. Over time, it can lead to scarring or intestinal metaplasia, a precancerous condition that can lead to cancer.
• Barrett's esophagus: This is the name given to a condition called intestinal metaplasia in the esophagus. This is when the lining of the esophagus changes and becomes more like the lining of the intestines. This is caused by long-term exposure to acid and inflammation. This is a risk factor for esophageal cancer .
• Esophageal stricture: Scar tissue can form in the esophagus to protect it from long-term inflammation and damage. This scar tissue can cause the esophagus to narrow. This is called a stricture . This can make it difficult to swallow and eat.
• Laryngopharyngeal reflux (LPR): Some people with GERD also develop LPR. This is when acid comes up into the throat. Acid can sneak up into your throat while you're sleeping. This can cause your throat to swell, your voice to become hoarse, and vocal cord growths . Acid particles can also be aspirated into your airways.
• Asthma: Acid inhalation can worsen asthma in people who already have asthma, and even in people who don't have a pre-existing respiratory condition, asthma-like symptoms can develop. The tiny acid particles can infect the bronchial tubes, causing them to narrow, causing coughing and difficulty breathing.

How do you know for sure if you have GERD? What are the medical tests?

A gastroenterologist will examine your esophagus to determine if you have GERD. There are several tests that can be done to determine this:

• Esophagram: This is an X-ray test. The esophagus is examined using X-rays (fluoroscopy) that move as you swallow. You are given a chalky liquid called barium to drink.
• Upper endoscopy: This involves inserting a thin tube with a camera through your mouth to examine the inside of your esophagus. You will be given light sedation and put to sleep.
• Esophageal pH test: This measures the amount of acid in the esophagus. During an endoscopy, the doctor places a small wireless sensor (wireless receiver) in the esophagus.
• Esophageal manometry: This measures the function of the muscles in the esophagus. This is done using pressure sensors placed in a nasogastric tube. This can determine if the LES or other muscles are working properly.

What are the medical treatments for this?

Some people can reduce their acid reflux by making lifestyle changes, such as changing their eating habits, cutting down on alcohol and smoking, and losing weight. Doctors also encourage people to follow these methods.

But if you have chronic acid reflux or GERD, doctors may prescribe medications that reduce stomach acid. Then, even if the acid does come up, it will be less harmful. These medications are easily available and are very effective for GERD.

Medicine

Over-the-counter (OTC) medications available from pharmacies without a prescription:

• Antacids: Antacids, such as Tums® and Rolaids®, neutralize stomach acid. This means that even if the acid comes up, it won't cause too much damage to the esophagus. These are good for occasional acid reflux, but they can cause side effects if taken regularly, so they're not a good long-term solution.
• Alginates: Alginates are natural sugars extracted from seaweed. They float on top of the acid, creating a physical barrier between the acid and the esophagus. There are medications that contain alginates alone, as well as medications that combine alginates with antacids.

Prescription medications:

• Histamine receptor antagonists (H2 blockers): H2 blockers reduce the production of stomach acid. This is because they block the chemical (histamine) that tells the body to produce acid. These can be taken more often than antacids, but they don't always work long-term. The body can get used to them.
• Proton pump inhibitors (PPIs): PPIs are a type of medication that block acid more effectively and promote tissue healing. Your doctor may recommend these first if your GERD is severe or if you have signs of damage to the tissues in your esophagus. They are 90% effective at reducing acid reflux.
• Baclofen: Baclofen is a muscle relaxant. It is often given to reduce muscle spasms. It can also reduce the number of times the LES relaxes, which can reduce the amount of acid that comes up. It is not a first-line drug for acid reflux, but it may be part of your treatment plan.

Is there no way to completely stop or cure the acid reflux?

Although medications can reduce the symptoms and effects of GERD, they cannot completely stop it. Even if someone with severe GERD is taking medication, you may still experience complications, even if you don't realize it.

In such cases, a more permanent solution is needed to stop the acid from coming up. This usually means surgery to tighten the LES . These are usually not major surgeries, are outpatient procedures, and are very successful.

Surgery

Surgeries for GERD:

• Nissen fundoplication: This is the most common surgery for GERD. If possible, it is done laparoscopically . This means that it is done through small incisions, which means that the recovery time is shorter. The surgeon takes the upper part of the stomach, wraps it around the lower part of the esophagus, and stitches it together. This surgery is also done for people with hiatal hernias.
• LINX device: This is a new procedure. A device called LINX is surgically inserted. The LINX device is a small ring of magnets. It helps keep the connection between the stomach and esophagus closed.

What can you do to control acid reflux at home?

Try these things to control acid reflux at home:

• Eat small meals: Large meals fill the stomach and put pressure on the LES. Small meals are digested quickly and do not produce as much acid in the stomach.
• Eat dinner early: It's best to eat a few hours before you lie down and go to bed at night, as gravity helps keep acid down.
• Sleep on your left side: When you sleep this way, your LES sits above the contents of your stomach, like an air pocket. Sleeping on your side or right side can cause the valve to collapse.
• Reduce pressure on your stomach: Wear loose clothing. If you are overweight, try losing weight. This will help in the short term as well as the long term.
• Stop smoking and drinking alcohol: Both tobacco and alcohol weaken the LES. They also increase stomach acid, which increases digestion time.
• Over-the-counter medications: Keep medications like antacids and alginates on hand . Use these especially if you know you're going to eat a heavy, acidic meal.

What do you do if acid suddenly comes up?

Try doing these things at that exact moment:

• Stand up: gravity is on your side.
• Drink a sip or two of water: Don't drink a lot, but a few small sips of water can help flush out the acid.
• Loosen the waistband: Unbutton the belt, or change pants if you can.
• Take an antacid: If you don't have one nearby, something like Pepto Bismol® may help.

When should I see a doctor about this?

If you have frequent heartburn, definitely see a doctor . It's important to understand how it's affecting your body. GERD isn't just uncomfortable - it can actually be harmful. And, there are good treatments for it.

Many people experience heartburn from time to time. Heartburn, stomach ache, and acid reflux can make it difficult to get through the day. There are things you can do to reduce the frequency of these symptoms.

But if you have frequent heartburn and it's affecting your life, you may have GERD. It's worth talking to a doctor about your symptoms. They can help you decide if treatment might help.

Remember the most important thing (Take-Home Message)

Acid reflux and GERD are conditions that affect many people. While it's normal to have them occasionally, it's important to be aware of them if they're a regular problem.

• Identify your symptoms. Watch for things like a sour taste in the throat, chest pain, and difficulty swallowing.
• Simple lifestyle changes can make a big difference. Think about what you eat, when you eat, and how you sleep.
• Stay away from smoking and alcohol. These actually increase the problem.
• If you can't control it with home remedies, be sure to seek medical advice . GERD is a treatable condition. However, if left untreated, it can lead to complications.
• Don't worry. This condition can be managed well with the right advice and treatment. Talk openly with your doctor.

I hope you find this information useful. Stay healthy!

` Acid reflux, GERD, heartburn, stomach inflammation, indigestion, esophagitis, medical treatment