Acid reflux is a condition in which stomach acid backflows into the lower esophagus, and creates a burning sensation for the affected person. The burn you may feel in your chest is commonly called a heartburn, despite that your heart is not affected. If this condition occurs more than twice weekly, then you may have a condition called acid reflux disease (also known as gastroesophageal reflux disease, or GERD).
GastroEsophageal Reflux Disease (GERD)
Acid reflux disease is also called GERD because the acid reflux happens at the gastroesophageal junction (the opening that allows passage of food from the esophagus to the stomach). The esophagus is a tube with one end attached to the mouth and the other end attached to the stomach, purpose of which is to allow passage of food. Normally, the gastroesophageal opening is not left wide open for acid to backflow into the lower esophagus, the opening and closing of the junction is usually regulated by the lower esophageal sphincter (LES).
The LES is a ring of muscle that opens and closes the gap between the esophagus and stomach. When food passes through the esophagus, the sphincter opens to allow food to pass through and enter into the stomach, then the sphincter would close abruptly after all the food has gone through the opening. If this sphincter, which acts as a “check” valve, malfunctions, i.e. opens too often or doesn’t shut tight properly, then acid can reflux back into the lower esophagus.
Although stomach acid can damage the esophagus through reflux, the stomach is protected from the strong acid that it secretes. To read more about stomach acid and the stomach environment, and why acid reflux is harmful, please visit my website link at the bottom of this article.
Symptoms of Acid Reflux Disease
Common symptoms of acid reflux are heartburn, regurgitation, bloating, bloody/black stools or bloody vomiting, burping, dysphagia, hiccups that don’t let up, nausea, weight loss for no known reason, wheezing, dry cough, hoarseness, or chronic sore throat.
Heartburn, also called acid indigestion, is a burning pain or discomfort that may move from your stomach to your abdomen or chest, or even up into your throat.
Signs and Symptoms of Heartburn
burning pain behind the breastbone area that usually occurs after eating
pain that is worse when bending over or lying down
bitter taste in the mouth
* Regurgitation is the backing up of a sour or bitter-tasting acid into your throat or mouth; this can come as a “wet burp” or even vomit up some of the food contents you ingested earlier.
* Dysphagia — a narrowing of your esophagus, which creates the sensation of food being stuck in your throat
Causes of Acid Reflux Disease
The cause is quite complicated. Many patients, who have GERD, also have a stomach abnormality called a hiatal hernia. However, patients with hiatal hernias do not always have acid reflux disease.
A muscle wall called the diaphragm separates your abdomen from your chest. This muscle wall has 3 openings in it, one of which is an opening in which the esophagus passes through and connects to the upper part of the stomach. A hiatal hernia is a condition in which the LES and upper part of the stomach is pushed upwards through this esophageal opening into the lower part of the esophagus during swallowing, this specifically is called a sliding hiatal hernia. About 90% of all hiatal hernias are the sliding type.
Over-the-Counter Medications to Reduce Acid Reflux
There are a variety of over-the-counter medication available for reducing acid reflux which are antacids, histamine-2 receptor antagonists, and proton pump inhibitors.
Antacid products reduce stomach acid by changing the pH of the stomach environment by increasing the pH and thereby neutralizing the acidity in the stomach. These products can contain aluminum-based antacids, bicarbonate-based antacids,bismuth-based antacids, calcium (carbonate or phosphate), citrate ion as citric acid or salt, glycine, magnesium-based antacids, milk solids dried, phosphate-based antacids, potassium-based antacids, sodium-based antacids, silicates, tartaric acid or its salts. Antacids can reduce stomach gas in itself, but they are sometimes in combination products with anti-gas ingredients. There are also separate products that have only anti-gas ingredients.
You may have heard of some of these commonly known antacid brands, if you look in the active ingredient section on the drug facts label you can see what the active ingredient is and can look for a cheaper generic brand with the same active ingredient.
The active antacid ingredient in Tums is calcium carbonate. The regular strength is 500 mg, and the extra strength is 750 mg. Tums work fast, but its effects also disappears fast, which is why multiple doses may be needed per day. The additional benefit to this product is that it adds calcium to your diet.
Maalox is both an antacid and antigas drug, which lowers the acidity in the stomach, as well as break up gas bubbles. Maalox has both antacid and antigas active ingredients. The antacid components in Maalox are aluminum hydroxide and magnesium hydroxide, which both comes in 200 mg for the regular strength product, and 400 mg each for the max product. The antigas component is simethicone, which comes in 20 mg for the regular strength product and 40 mg for the max strength.
Mylanta is also an antacid and antigas combined drug. The active ingredients and strengths are the same as the Maalox products.
Pepto-Bismol is a combination product that serves an anti-diarrheal purpose while is also an upset stomach reliever. The active ingredient in Pepto-Bismol is bismuth subsalicylate, the regular strength is 262 mg, and the max strength is 525 mg.
Histamine-2 Receptor Antagonists
H-2 receptor antagonists block the action of histamine on the cells of the stomach that produces stomach acid, thereby decreasing stomach acid production from these cells. Acid-reducing drugs with H-2 receptor antagonists lasts up to 12 hours for its acid-reducing purpose.
- Ranitidine is sold under the trade name Zantac, the OTC regular strength is 75 mg, and the max strength that ranitidine is sold OTC is 150 mg.
- Famotidine (brand name: Pepcid AC) is sold OTC in 10 mg for regular strength and 20 mg for max strength.
- Cimetidine (brand name: Tagamet) is sold over-the-counter in 200 mg. Cimetidine comes with a number of possible side effects, which you may want to avoid, of which include impotency for men.
Generic alternatives are available, just look for any of these active ingredients: ranitidine, famotidine, and cimetidine.
Proton Pump Inhibitors
Drugs with proton pump inhibitors reduce stomach acid secretion by inhibiting the gastric proton pumps, halts the final stage before acid secretion, and makes the inhibition irreversible. Due to these properties, proton pump inhibitors almost completely stops stomach acid production for up to 24 hours, making these drugs more effective and longer lasting than h-2 receptor antagonists.
- Prilosec OTC contains 20 mg omeprazole.
- Zegerid OTC (omeprazole/sodium bicarbonate): omeprazole, 20 mg; sodium bicarbonate, 1100 mg
- Prevacid OTC 24 HR (lansoprazole): regular strength: 15 mg; max strength: 30 mg
Behavioral/Diet Changes That May Benefit Acid Reflux Sufferers
- Eat Smaller, More Frequent Meals
Eating large meals would expand your stomach, this increases the upward pressure against your lower esophageal sphincter.
- Limit Intake of Acid-Stimulating Foods and Beverages.
Such foods include citrus or acidic fruits and veggies like lemons, oranges, strawberries, pineapples; beverages like coffee and tea.
- Don’t Lie Down For About 2 Hours After You Eat. Don’t Snack Before Bed.
Keep upright during digestion allows gravity to help keep the stomach acid from backflowing.
- Elevate Your Head a Few Inches While You Sleep.
You can add another pillow in addition to your existing one for extra head elevation during sleeping. This method helps those with night time heartburn by reducing the pressure of having the stomach contents pressed flat against the LES when the head is not elevated.
- Don’t Smoke/Quit Smoking.
Nicotine relaxes the LES. The act of smoking also stimulates the production of stomach acid, worsening the existing acid reflux problems you may already have.
- Don’t Drink/Quit Drinking Alcohol.
- Relax or Reduce the Stress Factors in Your Environment.
There is insufficient evidence to say that stress is linked to heartburn, but stress is known to lead to behaviors that cause heartburn.
- Don’t Wear Belts or Clothes that are Tight Fitting Around the Waist.
As you can probably figure out by now, any upward pressure on the stomach will not be good for those with acid reflux. Having tight clothing squeeze your abdomen leads to an upward reflux of food contents into the lower esophagus through the LES.