How to manage acid reflux

It’s common, bothersome and can strike at the most inconvenient times: For millions of Americans, acid reflux is an all-too-common problem that can disrupt everyday life.

But it’s a problem that can be controlled. It just takes a few changes to your diet and habits, or possibly medication if the reflux is particularly persistent.

What is acid reflux?

Acid reflux, often referred to as heartburn, happens when the valve between the esophagus and stomach relaxes or loosens. This allows stomach acid to travel up into the chest area and throat.

While acid reflux generally tends to be mild, it can affect quality of life if it goes uncontrolled.

Acid reflux vs. GERD

Acid reflux, the flow of stomach acid back into the esophagus, is a symptom. GERD – gastroesophageal reflux disease – is a chronic condition.

Many people who have acid reflux do not have GERD. Doctors diagnose GERD based on various findings, including excessive acid reflux, inflammation or damage to the esophagus lining or a narrowed esophagus due to scarring.

Current evidence shows that nearly 1 in 3 Americans experiences weekly symptoms of GERD.

Risk factors for acid reflux

The main risk factors for acid reflux are any conditions or activities that cause pressure on the abdomen. This can lead to loosening of the valve that prevents the acid from backing up.

It can also lead to a widening of the hole in the diaphragm – a muscle between the chest and abdomen through which the esophagus passes. This, in turn, causes part of the stomach to slide up into the chest. This is called a hiatal hernia, which is often accompanied by heartburn.

Among risk factors:

• Obesity or excess weight, especially around the abdomen
• Pregnancy – along with weight gain, increased levels of the hormone progesterone can cause muscles to relax
• Chronic constipation
• Weightlifting
• Uncontrolled sleep apnea
• Stress, especially in people who are highly sensitive to acid in the esophagus
• A genetic tendency
• Conditions that cause tissues to be lax, such as Ehlers-Danlos syndrome
• Chronic cough
• Uterine fibroids or polycystic liver disease

Managing acid reflux

If you focus on certain diet and lifestyle changes, you can often control acid reflux on your own.

Diet

Including fresh fruit, cereal and oily fish in the diet may help with acid reflux, according to some studies. Other evidence shows that following a Mediterranean diet also may protect against acid reflux.

But not everyone will be affected the same way by the same foods. It’s a good idea to track your diet to identify your personal triggers and to avoid the foods that worsen your symptoms.

Other diet-related changes that may help control acid reflux:

• Eat smaller meals; avoid large meals.
• Finish dinner at least 2 to 3 hours before lying down (preferably longer).
• Avoid high-fat, high-fiber foods, especially in the evening.
• Reduce processed food in your diet.
• Limit acidic, citrusy and spicy foods.
• Limit carbonated beverages.
• Limit alcohol.
• Avoid chocolate and peppermint.
• Drink water instead of coffee, tea and soda.
• Avoid peppermint gum, which can stimulate action in the esophagus and stomach.

While some people believe probiotics may help with acid reflux, there’s no evidence to support this. However, they may help with constipation and bloating that worsen reflux symptoms.

Lifestyle

Lifestyle changes you can make to help control acid reflux:

• Lose weight, if it’s appropriate for you.
• Don’t smoke.
• Elevate the head of your bed about 6 to 8 inches and sleep on your left side.
• Wear comfortable, loose-fitting clothing.

Stopping a bout of acid reflux

There’s no proven, diet-based quick-fix for reflux.

But, if you’re in the middle of an episode, you may find relief with an over-the-counter antacid, such as Tums, or an acid reducer, such as esomeprazole (Nexium), famotidine (Pepcid) or omeprazole (Prilosec). Also available are pills that combine multiple medications.

When prescription medication may be needed for acid reflux

If over-the-counter medications don’t help, or if you’re having symptoms more than three times a week, prescription medications may be needed.

These often are stronger versions of medications that are available over the counter, and patients may be asked to use them more often.

Certain newer medications are available only by prescription.

Patients generally take prescription medications for six to eight weeks. If symptoms improve, the dose may be lowered and the patient may eventually be able to stop using the medication, take it intermittently or use it on an as-needed basis.

It’s important to note that these medications don’t stop acid reflux. They work by reducing the amount of acid produced in the stomach. You may still have reflux, but it won’t be as uncomfortable, and it won’t be as damaging to the esophagus.

Types of acid-reducing medications

There are two main types of acid-reducing medications: proton pump inhibitors (PPIs) and H2 receptor antagonists (H2RAs). They work in different ways to reduce the release of acid into the stomach.

PPIs tend to work better, with a 12-week healing rate of 84%, compared with 52% for H2RAs.

Newer medications called potassium-competitive acid blockers (P-CABs) offer a third way to reduce the release of acid.

These medications are safe and well-tolerated when used appropriately. However, caution should be used in patients with low magnesium levels or with a kidney disease or a bone disease, such as osteoporosis.

Surgery for acid reflux

If medications don’t help, surgery may be an option. It’s important to confirm that GERD is the issue before surgery, so that we can rule out other conditions, such as the swallowing disorder achalasia.

• Fundoplication tightens and reinforces the lower esophageal sphincter by wrapping the top of the stomach around the base of the esophagus. The minimally invasive transoral incisionless fundoplication (TIF) may be considered for select patients.
• Also minimally invasive, magnetic sphincter augmentation reinforces the lower esophageal sphincter with a ring of magnetic beads.
• Some patients who are overweight may benefit from weight loss surgery like Roux-en-Y gastric bypass.

Discuss with your doctor which option may be best for you.

While surgery is sometimes a permanent fix, more than 25% of surgical patients resume PPIs during long-term follow-up.

Why persistent acid reflux shouldn’t be ignored

Complications from acid reflux are uncommon, but they can be serious, caused by chronic esophageal inflammation and scarring caused by the exposure to acid.

Among possible complications:

• Peptic stricture, a narrowing of the esophagus caused by longstanding inflammation from acid reflux with resulting scarring, which can block the passage of food
• Barrett's esophagus, in which acid causes changes to the lining of the esophagus, and can, rarely, lead to esophageal cancer
• Choking or difficulty swallowing, by inhibiting the action of the esophagus muscle
• Hoarseness, if acid gets into the throat
• Pneumonia, if acid gets into the lungs, or if food gets into the lungs due to swallowing difficulties

When to see a doctor about acid reflux

• Symptoms are happening more than three days per week
• Sudden reflux
• Over-the-counter medicines are not helping
• Trouble swallowing
• Chest pain
• Persistent cough or hoarseness
• Nausea or vomiting
• Coughing up blood, or blood in vomit
• Family history of Barrett's esophagus or esophageal cancer

Don’t ignore chest pain

While chest pain can be a symptom of acid reflux, it can also be a sign of a heart, lung or blood vessel condition.

If you have chest pain, seek care immediately.

If heart-related conditions and other issues are ruled out, pursue evaluation for acid reflux symptoms.