Causes of Acid Reflux
There are a few known causes of acid reflux:
Hiatal hernia
This happens when the top portion of the stomach moves up into the chest cavity. Without the support of the diaphragm, the lower esophageal sphincter opens more easily.
Age
As we age, our muscles lose tone or strength, including the lower esophageal sphincter, or LES. This muscle serves as the connection between the esophagus and stomach; the LES should remain closed after food passes through. However, sometimes the LES
doesn’t close all the way.
Being overweight or obese
Carrying too much weight in the abdomen causes increased pressure on the stomach, which in turn forces stomach acid into the esophagus.
Certain lifestyle habits
Overeating, drinking alcohol and smoking are all known to cause acid reflux.
Certain medications
Taking non-steroidal anti-inflammatory medications like ibuprofen or aspirin; calcium channel blockers for heart conditions and drugs that slow the contractions of the muscles in the intestines can all lead to
acid reflux.
Certain medical conditions
People with scleroderma or Zollinger-Ellison syndrome have a tendency to develop acid reflux. Pregnant women also have higher incidence rates of reflux.
Managing Acid Reflux
Acid reflux, also known as heartburn or gastroesophageal reflux disease (GERD), is condition marked by the migration of stomach acid into the esophagus.
To understand how acid reflux happens, it’s important to know a little about normal digestion first. After you chew and swallow food, it enters the esophagus, which has a delicate lining called the mucosa. Digestive muscles push the food down the
esophagus and through a valve-like opening called the lower esophageal sphincter, which connects the esophagus and the stomach. In most people, the lower esophageal sphincter remains closed after the food passes through it.
When the food enters the stomach, a mix of acid and enzymes that our bodies produce help break the food down more. The acid is quite powerful; in fact, a similar acid is often used to clean concrete. The stomach also pulverizes the mix before pushing
the food and stomach juices into the small intestines.
In people with acid reflux, the lower esophageal sphincter (LES) doesn’t close properly, and the acid in the stomach splashes into the esophagus during digestion; for some, the migration happens when the person reclines, bends over or lifts something
heavy. While the stomach lining is able to resist the intensity acid, the esophageal lining is more fragile. When it is repeatedly exposed to acid, the lining wears away, causing a condition called erosive esophagitis. Left untreated or undertreated,
the condition can advance to a precancerous condition (Barrett's esophagus) or esophageal cancer.
Hot to Treat Acid Reflux
Most often, medication is used in the treatment of acid reflux. However, many people require surgery to help reinforce the lower esophageal sphincter.
Treating Acid Reflux Through Lifestyle Modification
While you should always consult a doctor regarding reflux symptoms, there are some steps you can take to try to reduce your chances of having an episode of acid reflux, including:
- Stopping smoking
- Reducing or eliminating alcohol for your diet
- Losing weight
- Sleeping with the head and chest elevated six to eight inches
- Eating smaller meals
- Not eating within four hours of bedtime
- Avoiding foods that seem to trigger reflux (chocolate, citrus fruits, acidic foods, peppermint, fried or fatty foods and carbonated beverages)
It is important to note that these steps do not treat the underlying cause of reflux.
Treating Acid Reflux With Medication
Medications for the treatment of acid reflux fall into the following categories:
- Proton pump inhibitors – Available in prescription and over the counter strength, these widely used drugs temporarily reduce the secretion of acid in the stomach. Because these medications may reduce calcium absorption, long-term
use of these medications have been linked to decreased bone strength. The FDA recently warned consumers of the possible increased risk of bone fractures related to taking high doses or prolonged courses of these medications.
- H2 receptor antagonists – Histamines prompt certain cells in the stomach (parietal cells) to secrete acid. These drugs block the action of histamine on the parietal cells, thus reducing the acid that is secreted. The drugs in
this category generally are tolerated well but have short-lived effects and must be taken in advance of eating.
- Antacids – These medications, available over the counter in drug stores, help to neutralize the acid in the stomach. Some of these drugs also help to coat the lining of the esophagus. These medications have short-lived effects.
- Prokinetics – These medications help by more quickly moving food through the stomach and small intestines. Serious side effects of some of these drugs often limit their use.
In general, reflux is first treated with medication. However, procedures are are considered for certain situations and are available at our Center for Research and Esophageal Cancer Prevention.
Treating Acid Reflux with Surgery
In general, acid reflux is first treated with medication. Acid reflux surgery is considered in the following situations:
- Acid reflux symptoms cannot be treated by lifestyle modification or medical therapy
- Bone fracture risk from long-term use of proton pump inhibitors
- Nighttime cough or sleep difficulties due to breathing in stomach acid
- Worsening of asthma due to acid reflux
- Chronic throat or voice irritation
- Difficulty swallowing
- Barrett’s change that increases risk of cancer
- Large hiatal hernia
Types of Acid Reflux Surgery
Physicians specialize in performing acid reflux surgery that corrects the underlying cause of reflux, reducing or eliminating the need for medication. These acid reflux surgical procedures include:
- Laparoscopic fundoplication – The most common type of acid reflux surgery is fundoplication. In this procedure, the top portion of the stomach, called the fundus, is wrapped partially or fully around the lower esophageal sphincter,
or LES, and stitched in place, helping the LES to function properly. Beaumont’s acid reflux surgeons perform the vast majority of these procedures in a minimally invasive manner with a laparoscope. Often patients are able to return home
the next day and return to normal activities in 3-7 days.
- Transoral Incisionless Fundoplication – Performed without the need for external incisions through the skin, the TIF procedure offers patients who require an anatomical repair an effective treatment option to correct the underlying
cause of GERD. Studies show that for up to three years after the TIF procedure, esophageal inflammation (esophagitis) is eliminated and most patients are able to stop using daily medications to control symptoms. Because the procedure is incisionless,
there is reduced pain, reduced recovery and no visible scar.
- BARRX – Used in patients with Barrett’s esophagus, the technology uses a special tool that uses radiofrequency waves to gently remove Barrett’s tissue, allowing healthy cells to regenerate. The procedure takes about
an hour and is done on an outpatient basis. The frequency that the patient will have the procedure depends on the severity of the condition.