Understanding Acid Reflux

Acid Reflux, also known as GERD  (Gastro esophageal reflux disease) is a condition where the stomach throws back its contents like juices and food into the gullet or oesophagus.  Heartburn, burning in the throat and stomach, a sour-bitter taste in the mouth, trouble while swallowing and regurgitation are symptoms that could lead to diagnosis.  Other symptoms include,  nausea, chest pain, painful swallowing and excessive salivation.  Atypical symptoms are  loss of dental enamel, sensitive teeth, wheezing and asthma like symptoms, hoarseness of voice and sinusitis. Heartburn may not subside even after taking antacids.

GERD can also affect infants and children. Babies will cry inconsolably especially when laid down flat.  They may vomit excessively, burp or get hiccups too often.  As a natural reflex they may tend to arch while sleeping. Some may suffer from frequent ear infections due to sinusitis, have a running nose, dribble, and sometimes even gag or choke.  They may refuse feeds or get 'gas-filled' and find it difficult to burp after one. Bowel movements may be loose and frequent or there may be constipation. Breath could have an acidic smell.  Some have a 'silent reflux' and may not vomit.  In such cases the acid contents will  go up to the throat and return  to the stomach, causing double the amount of pain. Many infants outgrow this condition by the time they are a year old. Some may carry it into adulthood due to a family history of the disease.

GERD can result in injury to the gullet, or cause necrosis (death of tissue) of the epithelium.  It may also cause ulcers at the juncture of the stomach and esophagus.  Sometimes the esophagus may get constricted from inflammation that is reflux induced.  Adenocarcinoma, a rare cancer of the esophagus, can also cause gastro esophageal reflux symptoms.  A hiatus hernia can also manifest GERD symptoms.

Fatty food, chocolate, caffeine, alcohol, cigarettes, obesity, delayed stomach emptying and pregnancy, may contribute to acid reflux.  Pregnancy and obesity both increase pressure within the stomach causing food to get pushed back into the gullet. Some have stomachs that are naturally slow in emptying its contents.  Lying down supine when the stomach is too full can make you prone to reflux.

Tests and Diet Changes

Apart from physical examination of throat and larynx,  the doctor may suggest  tests like Upper Endoscopy, Barium x-rays, Bernstein  or acid perfusion test, Esophgeal Manometry, Esophageal Motility Testing and pH Monitor test to  chronic sufferers of  GERD. Some may also be suggested endoscopy  every 5-10 years, to rule out Barret's esophagus, a lesion,which is a precusor to esophageal carcinoma. A biopsy can be carried out  during a gastroscopy, which is a form of endoscopy.

The physician may suggest lifestyle and food changes. The patient may be asked to have smaller meals at shorter intervals.  Foods that are acidic or induce acid production in the stomach may be restricted. Coffee, alcohol, Vitamin C rich foods and supplements, can stimulate gastric acid secretion and must be avoided before bedtime. Antacids containing calcium carbonate cause acid release in the stomach are therefore avoided. However, antacids with aluminum hydroxide are permitted. Aerated drinks with or without sugar, citrus fruits, spinach, tomatoes, cabbage, broccoli, onions, chocolate and peppermint should be avoided.  High fat foods and smoking can reduce the competence of the lower sphincter muscles and hence are better avoided. Fat from food can delay emptying of the stomach.  Refrain from taking milk and milk-based foods at least 2 hours before bedtime.

Treatment And Natural Remedies

 Medicines that may be suggested are antacids to reduce gastric acidity; gastric acid receptive blockers like ranitidine, and alginic acid  (Gaviscon) to coat mucosa in the stomach, increase pH and reduce reflux. Proton pump inhibitors like omeprazole are prescribed to reduce gastric acid production. Sucralfate to prevent damage to the gullet, and Prokinetics to strengthen the lower sphincter muscles and hasten stomach emptying, may also be suggested.

 The doctor may also suggest that the head of the bed be raised so as to prevent gastric juices from flowing back. A slouched posture may be recommended.

 Natural Remedies

 Some natural remedies for GERD are ginger, licorice, aloe vera, apple cider vinegar and glutamine. 

 When the smooth muscles of the gullet relax with ginger, acid reflux is prevented. Can be taken in capsule form before mails, or had pickled or candied. Consuming tea made from ginger powder also helps. But those with sensitive stomachs should try taking a tincture dissolved in water in small doses.

 Deglycyrrhizinated licorice, or DGL, is beneficial because it can stop heartburn, boost the immune system and is a potent anti-flammatory.  It can stimulate production of mucus that protects the digestive tract lining and is thus helpful for preventing heartburn.  Capsules of DGL can be taken with water, but are better sucked, so as to allow slow dissolving.

 A quarter cup of aloe vera juice about 20 minutes before a meal can soothe an inflamed or irritated esophagus.

 Apple cider vinegar is itself acidic, but some people find that it helps with heartburn because it can aid digestion.  One tablespoon before a meal is suggested.  It may show efficacious results, anywhere between 3 days to nine months from taking.

GERD once detected can be handled effectively with change in diet and lifestyle, combined with natural remedies and/or allopathic medicines.