Heartburn, Gastroesophageal Reflux Disease (GERD), Gastro-oesophageal Reflux Disease (GORD)
Acid reflux happens when acid stomach contents regularly flow back into the esophagus. This is because the little adductor muscle (sphincter), which is located at the transition from the esophagus to the stomach, is open more often. Acid reflux occurs, among other things, in pregnant women, obese people and in people with a diaphragmatic hernia.
There are several causes for the regular flowing back of gastric acid into the esophagus. The most common causes are:
- Diaphragmatic hernia. In case of a diaphragmatic hernia, the opening in the diaphragm is too big. A small part of the stomach will then lie in the chest cavity. This causes the sphincter not to work properly anymore and to remain open.
- Pregnancy. As the baby grows, there is less and less space in the abdominal cavity for the stomach. The pressure on the stomach is increasing. Therefore, the sphincter doesn’t close properly any longer.
- Overweight. Due to overweight (obesity), the pressure in the abdomen is higher than normal. As a result, the acid will flow easily back into the esophagus.
- Constipation. Constipation can also lead to an increased abdominal pressure.
- A lazy stomach. In case of a lazy stomach, the food stays longer in the stomach than normal, making it more likely that too much acid stomach contents flow back into the esophagus.
- Age. Due to old age, the sphincter can weaken and close less well.
- Foods like chocolate and peppermint. Due to using these foods, the sphincter gets weak and cannot properly close off the stomach anymore.
- Smoking and drinking. Nicotine and alcohol have the same effect as chocolate and peppermint.
Common signs and symptoms of acid reflux are:
- Painful, burning sensation behind the breastbone, just above the stomach. Some people feel a crushing, squeezing pain that is often confused with heart problems. The pain may radiate to the neck, the back and between the shoulder blades.
- Irritated throat and cough. This occurs when stomach contents regularly flow upwards to the pharynx.
- Acid belches, in which some stomach contents flow back into the oral cavity.
- Feeling like there is constantly a lump in the throat. This is also called the ‘globus sensation’.
- Difficulty swallowing.
- Bad teeth.
Many people with acid reflux suffer from the symptoms especially at night. Additionally, symptoms often occur after meals.
The doctor can make the diagnosis of acid reflux on the basis of the symptoms. In some cases, further examination is necessary:
- Gastroscopy. A diaphragmatic hernia or an esophageal inflammation can be determined during an exploratory examination of the inside of the esophagus and the stomach.
- Esophageal Ph Test. During a period of 24 hours, the acidity in the esophagus is measured. This way, the doctor can assess whether acid stomach contents are present in the esophagus too often.
- Esophageal manometry (stationary manometry). An examination in which the pressure in the esophagus and the sphincter between the esophagus and the stomach is measured. This allows the doctor to assess the movements (motorics) of the esophagus and the functioning of the sphincter.
Sometimes, the doctor provides dietary advice and rules of life that can reduce the symptoms. The following medications may be prescribed:
- Stomach protectors: apply a protective layer to the inside of the esophagus and the stomach.
- Antacids: bind, neutralize and inhibit the production of gastric acid.
- Prokinetics: stimulate the functioning of the esophageal and stomach muscles.
If medication in combination with dietary advice and rules of life don't sufficiently help to reduce the symptoms, the doctor may suggest surgery. This operation is also called an anti-reflux operation. During this keyhole surgery, the upper part of the stomach is twisted around the bottom of the esophagus as a kind of cuff. The stomach is no longer able then to rise up through the diaphragmatic hernia.
Most cases of acid reflux are treated effectively with changes in lifestyle, by using self-care products or by prescription of drugs. Relapse is common when treatment is completely stopped.
Acid reflux can potentially lead to inflammation of the throat, larynx, esophagus and airway. Serious complications, such as bleeding or difficulty swallowing, are quite rare. When untreated, chronic acid reflux can occasionally lead to esophageal cancer.
- Avoid large, heavy meals and fatty foods. Rather take small meals, spread throughout the day.
- Don't lie down immediately after dinner. When lying down with a full stomach, the contents of the stomach can more easily flow back into the esophagus.
- Avoid constipation. In case of constipation, the pressure in the abdominal cavity is higher. Gastric acid will enter the esophagus more easily. Constipation can be prevented or reduced by eating healthy with high-fiber food, drinking plenty of fluids and exercising regularly.
- Be careful with the following products, because they may worsen the symptoms: alcohol, peppermint, chocolate, hot spices, carbonated drinks and acidic juice of citrus fruits, such as lemon, grapefruit, mandarin and orange.
- Maintain a healthy body weight.
- Don't wear tight clothing at the level of the stomach.
- Don't bend forwards. When bending over, gastric acid easily flows into the esophagus.
- Quit smoking.
- Place the headboard of the bed on blocks, so that the head is 10 to 15 centimeters higher than the foot. As a result, gastric acid may not flow back as easily into the esophagus. An extra pillow under the head is not a good solution, because it pinches the stomach.
- The term ‘reflux’ is derived from the Latin word refluere (flowing back).
- The prevalence of acid reflux is 10%.