Anyone who’s ever reached for an antacid tablet after a really good Thai meal or been abruptly awakened from a restful slumber, gasping for air, can tell you this: Acid reflux is a killjoy. Even less fun? When it becomes a chronic condition, known as GERD.
The discomfort is caused by stomach contents flowing upward into the esophagus, where they lead to symptoms like heartburn. Some people also experience regurgitation, an acidic or bitter taste in their mouths, or chest pain. “Have you ever done shots in a bar?” says Gulchin Ergun, M.D., a gastroenterology specialist in Houston and professor of medicine in digestive disorders at Houston Methodist Hospital. “That’s what it feels like — an uncomfortable burning sensation.” During an episode of nighttime acid reflux, you may find yourself choking or coughing uncontrollably when that acid finds its way up. Difficulty swallowing or the sensation of a lump in your throat are also common symptoms.
Why is this happening?
Everybody needs acid in their stomach — it helps break down food for digestion and kills bacteria. “It’s a defense mechanism and it’s pretty strong,” Ergun says. “Normally, you don’t buy things to clean your house that are as strong as stomach acid. But the stuff in your stomach doesn’t usually come up into your chest. There are mechanisms that the body has created for that.”
At the bottom of the esophagus is a circular band of muscle, called the lower esophageal sphincter, which separates it from the stomach. It generally remains closed, but when we eat and swallow, this valve relaxes to let food and liquid pass through to the stomach, then closes again. Acid reflux occurs when the valve opens when it’s not supposed to, so the stomach contents — be they food, acid or digestive juices — flow backward.
It’s normal for that valve to open from time to time, allowing us to let out a discreet (or hearty) burp. But problematic reflux can cause heartburn, especially after a meal or when you lie down to doze. Gastroesophageal reflux disease (GERD) is chronic acid reflux that becomes problematic. According to the American College of Gastroenterology, it’s believed that as many as 20 percent of U.S. adults suffer from it.
Join today and save 43% off the standard annual rate. Get instant access to discounts, programs, services, and the information you need to benefit every area of your life.
Age can be a factor. Just as our skin gets looser as we get older, the bundle of muscle that makes up the lower esophageal sphincter, as well as the supporting structures of the stomach, may not be as taut, ultimately creating more leeway for digested food to gravitate upward. Producing less saliva — which helps neutralize acid in your esophagus as it goes down — after a certain age can also play a role, Ergun says.
Severe symptoms can cause damage
Ignoring persistent symptoms of GERD can damage the esophagus, since the constant backwash of acid irritates the lining and can cause scar tissue to form over time. “That scar sometimes is helpful, tightening up the area so material doesn’t come up that easily, but it’s at the expense of the esophagus not working right, limiting the food that’s going down,” Ergun says. A normal esophagus is 20 millimeters in diameter, Ergun says, and when it gets to about half its typical diameter, people start to notice food — something like bread or meat — getting stuck.
GERD can also affect tissue that lines the lower esophagus. “Instead of the cells of the esophagus being consistent with the cells of the stomach, they change — a condition known as Barrett’s esophagus,” says Nipaporn Pichetshote, M.D., a gastroenterology specialist in Los Angeles affiliated with Cedars-Sinai Medical Center. “That’s concerning because there is a risk for progression into esophageal cancer.” Though she says the likelihood of this is quite low, it becomes something to watch in people who “have reflux disease for 10 years.”
Another concern: Acid reflux and cardiac problems can sometimes mimic each other. “People will say, ‘Oh, I have indigestion’ and assume it’s the esophagus, when it could be the heart, or vice-versa,” Ergun says. If you’re experiencing chest pain, address it with your doctor to make sure it isn’t something other than acid reflux.
You may also want to pay your physician a visit if you’re experiencing severe GERD symptoms or find yourself popping antacid medication more than twice a week. “If symptoms are becoming more troublesome or not being controlled by lifestyle changes or medications, or you have alarm symptoms, such as difficulty swallowing, we want to investigate further to make sure there’s no other changes in the esophagus that could cause problems down the line,” says Neena Mohan, M.D., assistant professor of clinical medicine in gastroenterology at the Lewis Katz School of Medicine at Temple University. Patients may require further evaluation with an endoscopy — during which a thin tube equipped with a camera is slid down the throat to examine the esophagus to look for changes.
How to banish the burn
“Lifestyle changes can be very effective for those with mild to moderate acid reflux,” says Pichetshote. Start with these tweaks and see if they help.
Avoid certain foods. To find what triggers your acid reflux, Mohan recommends keeping a food journal that includes what you eat and any symptoms that flare up afterwards. You may notice fried and fatty foods in particular cause trouble. “There are chemical components in these foods that can affect receptors in the lower sphincter muscle, causing it to relax,” Mohan says. What’s more, she says, because foods with greater fat content can take longer to digest, they may sit in your stomach longer. And the longer that food stays there, the more likely it is to be refluxed back into your esophagus.
Another potential trigger? Carbonated beverages, which can cause acid reflux by expanding our stomach, Pichetshote says: “When we distend our stomach, it can cause a relaxation or lowering of the lower esophageal pressure.”
Other foods are direct irritants, such as citrus fruits. Alcohol has a low pH and irritates the esophagus and stimulates acid production. Coffee can be on the acidic side, depending on how potently it’s brewed. “If you drink something and it burns going down, it’s a good hint that it will bother you if you have too much,” Ergun says. It’s also been shown that people take longer to consume acidic foods. “They take smaller bites, so the acid is in the esophagus much longer than something that is more neutral, like a piece of bread,” says Pichetshote.
Eat regularly throughout the day. Overeating is never a good idea, but an empty stomach can cause problems, too. Go more than three to four hours without chowing down and stomach acid collects. Eat small meals — and drink water — throughout the day.
Don’t eat before bed. Nocturnal acid reflex is a real concern. “Normally, someone who is sitting upright will swallow saliva and neutralize that acid,” Ergun says. “But if you’re sleeping, it could be sitting in your esophagus for a while.” Wait at least two to three hours after eating before you go to bed. And watch how you sleep. “Liquid and gas want to go to the path of least resistance,” Pichetshote says. “If you’re lying flat, it can easily go up toward your head. If you’re sleeping a little more upright, it has to fight gravity.”
Elevate your head six to eight inches by buying a wedge pillow or slipping a wedge-shaped piece of foam underneath your mattress. Some research suggests that lying on your left side can reduce acid reflux. “There’s a pocket in our stomach that has a little more acid than the rest of our stomach,” Pichetshote says. “When we sleep on our right side, the pocket becomes closer to our esophagus and that can give us more reflux.”
Drop some pounds. Obesity or overeating can also up your chances of having GERD by increasing your intragastric (stomach) pressure. “If you had a baby and fed it, you would not squish its stomach because the food would come right back up,” Ergun says. “Well, having an extra 30 pounds of abdominal fat, which is where most people get the extra weight, is the same as squishing the belly. It’s easier for material to come up into your chest.” Even a 10 percent reduction in weight can cause a significant reduction in symptoms, notes Pichetshote.
Hit the gym. Being active can help with reflux as well. “The muscles around the lower esophagus can actually get stronger when you exercise, making the area tighter,” Pichetshote says. “When you have acid in your stomach, there’s more of a barrier so it doesn’t go up into your esophagus.”
Don’t down meds without water. Certain medications — among them, aspirin and ibuprofen, bisphosphonates to prevent bone loss, and some antibiotics — can worsen reflux-related heartburn. What’s more, if they break down before they reach the stomach, they can irritate the lining of the esophagus.
Reflux Rx’s and when to consider surgery
If lifestyle tweaks aren’t doing the trick, you might consider medication. Over-the-counter antacids neutralize stomach acid and offer fast relief. At the next level of treatment, for moderate to severe acid reflux, are H2-receptor blockers (Tagamet and Pepcid), which reduce the production of acid in your stomach. “H2 blockers don’t completely block acid production but affect it enough that people feel improved, and they work pretty fast,” Ergun says.
The next choice: proton pump inhibitors (Prevacid and Prilosec). Stronger than H2-receptor blockers, they block stomach acid secretion and give damaged esophageal tissue time to heal. These drugs are helpful when you have esophagitis or Barrett’s esophagus. And, unlike H2 blockers, you don’t have to take them two or three times a day. Many are found over the counter, but a doctor can prescribe them in higher doses.
The good news: GERD can usually be tamed with medication. But if the problem is persistent, your doctor may suggest using a medical procedure or surgery to get things under control. Laparoscopic fundoplication is one such treatment. During this minimally invasive procedure, a surgeon wraps the top of your stomach around the lower esophageal sphincter to tighten the muscle and prevent reflux.
“The two major components of gastro reflux are heartburn and regurgitation,” Ergun says. “When you have heartburn, if you block the acid, the heartburn gets better. You’re preventing what comes up from being as noxious as it normally is. But although pills may take care of the acid, they won’t do anything for the reflux barrier, which is why people will say, ‘The heartburn is gone, but I still have regurgitation.’ That’s evidence there’s a mechanical problem, such as hiatal hernia, and that’s when surgery makes the biggest difference.”
Barbara Stepko is a longtime health and lifestyle writer, and former editor at Women’s Health and InStyle. Her work has appeared in The Wall Street Journal, Parade and other national magazines.