Acid reflux is a common condition that features a burning pain, known as heartburn, in the lower chest area. It happens when stomach acid flows back up into the food pipe.
Gastroesophageal reflux disease (GERD) is diagnosed when acid reflux occurs more than twice a week.
Chronic heartburn can lead to serious complications.
Facts on acid reflux
Acid reflux is also known as heartburn, acid indigestion, or pyrosis.
It happens when some of the acidic stomach contents go back up into the esophagus.
Acid reflux creates a burning pain in the lower chest area, often after eating.
Causes
A person’s diet can increase their risk of acid reflux.
Acid reflux is when some of the acid content of the stomach flows up into the esophagus, into the gullet, which moves food down from the mouth. Despite the name, heartburn has nothing to do with the heart.
The stomach contains hydrochloric acid, a strong acid that helps break down food and protect against pathogens such as bacteria.
The lining of the stomach is specially adapted to protect it from the powerful acid, but the esophagus is not protected.
A ring of muscle, the gastroesophageal sphincter, normally acts as a valve that lets food into the stomach but not back up into the esophagus. When this valve fails, and stomach contents are regurgitated into the esophagus, the symptoms of acid reflux are felt, such as heartburn.
Risk factors
GERD affects people of all ages, sometimes for unknown reasons. Often, it is due to a lifestyle factor, but it can also be due to causes that cannot always be prevented.
One cause that is not preventable is a hiatal (or hiatus) hernia. A hole in the diaphragm allows the upper part of the stomach to enter the chest cavity, sometimes leading to GERD.
Other risk factors are more easily controlled:
Obesity
Smoking (active or passive)
Low levels of physical exercise
Medications, including drugs for asthma, calcium-channel blockers, antihistamines, painkillers, sedatives, and antidepressants
Pregnancy can also cause acid reflux due to extra pressure being placed on the internal organs.
Food and dietary habits that have been linked to acid reflux include:
Caffeine
Alcohol
A high intake of table salt
A diet low in dietary fiber
Eating large meals
Lying down within 2 to 3 hours of eating a meal
Consuming chocolate, carbonated drinks, and acidic juices
Symptoms
Acid reflux can cause a burning pain in the lower chest.
Acid reflux usually produces heartburn, whether it is due to a single episode of overeating or persistent GERD.
Heartburn is an uncomfortable burning sensation that occurs in the esophagus and is felt behind the breastbone area. It tends to get worse when lying down or bending over. It can last for several hours and often worsens after eating food.
The pain of heartburn may move up toward the neck and throat. Stomach fluid can reach the back of the throat in some cases, producing a bitter or sour taste.
If heartburn occurs two or more times a week, it is known as GERD for short.
Other symptoms of GERD include:
Dry, persistent cough
Wheezing
Asthma and recurrent pneumonia
Nausea
Vomiting
Throat problems, such as soreness, hoarseness, or laryngitis (voice box inflammation)
Difficulty or pain when swallowing
Chest or upper abdominal pain
Dental erosion
Bad breath
Risks and complications
Without treatment, GERD can lead to serious complications in the long term, including an increased risk of cancer.
Persistent exposure to stomach acid can damage the esophagus, leading to:
Esophagitis: the lining of the esophagus is inflamed, causing irritation, bleeding, and ulceration in some cases
Strictures: damage caused by stomach acid leads to scar development and difficulties swallowing, with food getting stuck as it travels down the esophagus
Barrett’s esophagus: a serious complication where repeated exposure to stomach acid causes changes in the cells and tissues lining the esophagus with potential to develop into cancer cells
Both esophagitis and Barrett’s esophagus are associated with a higher risk of cancer.
During pregnancy
Some women may experience heartburn during pregnancy, even if they did not have it before.
Lifestyle modifications are recommended during pregnancy, such as not eating too late at night and consuming small meals.
Any woman who is experiencing severe reflux during pregnancy should speak to her doctor about treatment options.
Diagnosis
Acid reflux and heartburn are common and relatively easy to diagnose, however, they can be confused with other chest complaints such as:
Heart attack
Pneumonia
Chest wall pain
Pulmonary embolus
GERD is often diagnosed simply by finding no improvement in heartburn symptoms in response to lifestyle changes and acid reflux medication.
Gastroenterologists may also arrange the following investigations:
Endoscopy: camera imaging
Biopsy: taking a tissue sample for laboratory analysis
Barium X-ray: imaging the esophagus, stomach, and upper duodenum after swallowing a chalky liquid that helps provide contrast on images
Esophageal manometry: pressure measurement of the esophagus
Impedance monitoring: measuring rate of fluid movement along the esophagus
PH monitoring: acidity testing
