What are Signs of Acid Reflux?

If you’ve ever experienced a painful, burning sensation in your throat or chest, you might be familiar with the uncomfortable symptoms of acid reflux, also referred to as heartburn.

This article will outline what acid reflux is, its symptoms, risk factors for developing it and treatment options.

What is acid reflux?

Acid reflux occurs when stomach acid and other contents in the stomach travel up into the esophagus through an area called the lower esophageal sphincter, or LES. These acidic contents are largely made up of hydrochloric acid (HCl), as well as enzymes and other stomach secretions. Under normal circumstances, the LES functions to allow food to enter the stomach to be digested and absorbed, and then closes to prevent stomach contents from re-entering. However, the LES can become weak or damaged, which causes it to not close properly and thus leads to symptoms of acid reflux.

Gastroesophageal reflux disease (GERD) is a chronic form of acid reflux that must be diagnosed by a doctor. It can be more serious than typical acid reflux and usually requires medical intervention. Heartburn is another term commonly used to describe a symptom of acid reflux. It can sometimes be confused with the symptoms of a heart attack, though a heart attack is much more serious. Heartburn often feels like a burning sensation in the chest and is most likely to occur after eating or when lying down. A heart attack, on the other hand, may feel like physical pain or tightening in the chest and can occur randomly. When in doubt, always call your doctor or go to the emergency room if you are unclear of the severity of your symptoms.

It is estimated that about20 percent of Americans (1) experience acid reflux on a regular basis, with the prevalence of GERD being similar. Unfortunately, the prevalence of both has been increasing over time, which may be caused by a combination of lifestyle and medical factors.

What are the symptoms of acid reflux?

Symptoms can vary in frequency and range from mild to severe. Symptoms can also be different from one person to the next.

Some of the classic signs and symptoms of reflux(2) include:

• Heartburn
• Burning sensation in the throat or mouth, which can lead to a chronic sore throat
• Sour, bitter, or other altered taste in the mouth
• Indigestion, or a feeling of food not being properly moved into the stomach and rather sitting in the throat or upper part of the stomach
• An uncomfortable feeling of fullness, even if only a small amount of food was consumed
• Difficulty swallowing
• Vomiting or excessive burping
• Dry cough, sometimes coupled with a hoarse voice

Symptoms are more likely to occur after eating, and are even more common for individuals who lie down after eating, which interferes with digestion. While nearly everyone will experience some symptoms of reflux at some point in their life, it becomes more of an issue when symptoms are frequent, prolonged or unexplained.

What causes acid reflux?

Like many conditions, there are many possible causes of acid reflux. It can arise as a result of a number of different reasons and risk factors, with some being more severe or long term, and others being temporary or more easily treatable.

Some of the risk factors for developing signs and symptoms of reflux include:

• Having a hiatal hernia. This occurs when the upper part of the stomach bulges into the diaphragm and weakens the LES.
• Advanced age. Muscles, including the LES, tend to weaken with age. In addition, people older adults tend to have more of the other conditions that are associated with a greater likelihood of developing reflux.
• Being overweight or obese (3). Excess body weight, especially if it's in the central part of the body, puts more pressure on the abdomen and internal organs. This increased pressure makes it harder for the LES to work properly, and can therefore lead to a weakened muscle and result in symptoms of reflux.
• Pregnancy (4). Similarly to being overweight, a growing fetus and uterus put extra pressure on the abdomen and can cause things to be pushed up into the esophageal region. Symptoms are most common during the third trimester, but don’t affect all pregnant women and will typically resolve once the baby is born.
• Smoking. Nicotine (5)in tobacco causes the LES to relax, leading to symptoms.
• Drinking high amounts of caffeine and/or alcohol. Both can relax the LES and make symptoms worse.
• Taking certain medications. Certain medications like some antibiotics and non-steroidal anti-inflammatory(6) drugs like ibuprofen may make symptoms of reflux worse, yet they don't necessarily cause reflux in healthy individuals without symptoms. Other medications may also cause symptoms of reflux as a side effect, so it's always a good idea to review side effects before agreeing to take a new medication.
• Low stomach acid levels. While it may seem counterintuitive, stomach acid is essential for a normal digestive process, low levels can lead to maldigestion which can produce gas and increase pressure near the LES, causing it to weaken. Things that can cause low stomach acid levels include advanced age, chronic stress, use of acid-reducing drugs, having a history of intestinal surgery, infections, zinc deficiency and eating a high-sugar or high-carbohydrate diet.

Long term effects of acid reflux

If not treated, acid reflux, particularly GERD, can lead to potentially serious health complications(7) over time. These include:

• Erosive esophagitis, or inflammation and restriction of the esophagus which can interfere with the ability to eat
• Peptic stricture, which is a narrowing of the esophagus and can cause difficulty swallowing
• Barrett’s esophagus, which happens from prolonged inflammation in the esophagus causing its lining to change and resemble the lining of the intestines. It can lead to cancer if untreated
• Esophageal cancer

Treatment options

Management of all types of acid reflux can involve lifestyle modification, medical therapy and in severe cases, surgery. Which treatment method used should always be in line with the underlying cause of the symptoms, so it's important to try to determine that first, before starting an intervention.

Here are some treatment options along with their known pros and cons for use:

1. Acid-reducing drugs

These are amongst the most common treatments for acid reflux, and most often involve a class of drugs known as proton pump inhibitors (PPI’s). The indication for their use stems from the belief that too much stomach acid is the cause behind the symptoms of reflux, so reducing acid levels would improve symptoms.

Pros: May lead to symptom relief.

Cons: PPI’s rarely treat the underlying cause of acid reflux, and may even do more harm than good. Too much acid in the stomach is rarely the cause of reflux, and any amount of acid could lead to negative symptoms. Stomach acid serves many important purposes, including helping to prevent bacterial overgrowth (8), helping digest and absorb certain nutrients and more. Long-term use of drugs like PPI’s has been shown to lead to low stomach acid levels, bacterial overgrowth, nutrient deficiencies, certain digestive disorders and even an increase in reflux symptoms in some cases. Research(9)supports the use of PPI’s for short-term symptom management but cautions against long-term use.

2. Acid supplements

These are the exact opposite of acid-reducing drugs, and work to instead introduce more acid into the stomach. They are most often recommended by holistic healthcare practitioners who have a natural medicine approach. Examples of acid supplements include betaine hydrochloric acid (HCl) andapple cider vinegar, both of which can be purchased over-the-counter.

Pros: May provide symptom relief if low stomach acid was believed to be an underlying cause of symptoms. Since stomach acid plays a number of crucial roles as outlined above, supplementing may help improve digestion and/or kill bacteria that could be leading to symptoms.

Cons: May make symptoms worse if an incorrect dose is used, or if acid levels were already high. In addition, acid supplementation is contraindicated for individuals with active gastritis (inflammation of the stomach), intestinal bleeding or ulcers.

3. Lifestyle changes

There are a variety of lifestyle modifications that can be very effective at treating acid reflux, such as:

• Avoiding eating too close to bedtime (generally within 2-3 hours)
• Elevating the head of the bed for individuals who require eating while lying down
• Gradual weight loss
• Stopping or avoiding smoking
• Decreasing alcohol and caffeine intake
• Slightly reducing meal size and especially avoiding large evening meals
• Limiting intake of spicy and greasy foods

Pros: Can be very effective at treating and preventing recurrence of symptoms. Many of these changes also lead to better overall health due to adopting a better diet and promoting a healthy weight.

Cons: Takes time to adopt, and may be difficult to change habits. These interventions also may or may not be enough to treat the symptoms and underlying cause, and may need to be coupled with additional interventions.

4. Surgery

This is reserved for only severe cases, such as a hiatal hernia or esophageal cancer.

Pros: If the surgery is effective, it will often provide immediate and long-term symptom relief and may prevent the need for medications.

Cons: May come with complications and may not resolve the entire issue, based on the severity. Surgery also may require an overnight hospital stay and interrupt normal daily living while recovering.

In summary

Acid reflux is a common yet potentially serious condition that is important to manage. It can be caused by a number of different factors, with some being temporary and easily treatable, and others being more serious. There are a variety of treatment options available, and which treatment to use depends on the underlying cause of the symptoms. It is always best to work closely with a trusted healthcare practitioner to help determine potential causes of reflux and decide on what treatment options are best for you.

Joanna Foley - Contributing Writer, Physician's Choice