Gastroesophageal Reflux Disease (GERD): Causes, Symptoms, and Treatment

How is acid reflux diagnosed?

Acid reflux is usually diagnosed on the basis of symptoms and a physical exam. In rare cases, more thorough testing may be required, especially if medication and measures taken to avoid reflux triggers are not providing the desired relief, or if your physician suspects there may be complications.

Medications that can relieve acid reflux

There are several over-the-counter (OTC) medications that can help alleviate the symptoms of acid reflux. If you’re thinking about taking some, seek out the professional advice of your pharmacist, who can help you choose the right product, and prescribe it for you.

• Antacids neutralize stomach acidity. While they quickly relieve reflux symptoms, within 5 to 10 minutes, their effect is short term only. If you are taking other medications, ask your pharmacist whether you should take them at a different time from the antacid, as some drugs are not absorbed as well when taken together.
• Alginic acid creates a foam over the stomach contents to act as a protective barrier that prevents stomach acid from eroding the esophagus.
• Histamine H2-receptor antagonists (or “H2 blockers”) reduce the secretion of stomach acid. These products must be taken one hour before meals, and their effect lasts longer than that of antacids or alginic acid. They may be a good choice if your reflux symptoms occur at night.
• Proton pump inhibitors (PPIs) block the secretion of acid by the stomach’s mucous membrane. Their effect lasts the longest (about 24 hours). Some PPIs are sold over the counter after a consultation with a pharmacist, while others are available only with a prescription.

If your condition hasn’t improved after 14 days of starting an OTC medication, you’ll need to see a doctor to determine the exact cause of your problem and treat it properly.

Possible complications of acid reflux

It is important not to underestimate the severity of acid reflux. It can cause sores in the esophagus and lead to bleeding, cracks, or inflammation of the esophageal wall. In the long term, reflux can also cause a narrowing of the esophagus, ulcers, or even cancer.

Symptoms of acid reflux

Some common acid reflux symptoms:

• Pain or burning sensation in the stomach, behind the breastbone (mid-chest), which can move up into the throat. Pain usually occurs after eating and may worsen when you lie down.
• Acid regurgitation, i.e., when stomach contents flow back up into the throat without a vomiting action, often causing a sour taste in the mouth.

Other reflux symptoms may also occur. However, they may be harder to identify, as they are also associated with other diseases:

• nausea
• persistent cough
• a hoarse or raspy voice
• difficulty breathing normally or asthma symptoms
• pharyngitis or laryngitis
• erosion or wearing down of the teeth

The frequency and intensity of symptoms vary from one person to another and from one episode to the next. In some people, the least distinctive symptoms, including nausea, can be more significant than those typically associated with acid reflux (burning sensation, acid regurgitation).

Other ways to prevent acid reflux symptoms

There are certain lifestyle habits and practical tips that can help prevent or relieve symptoms related to acid reflux.

• Eat a healthy, balanced diet.
• Learn to recognize foods that cause your symptoms, and avoid them as much as possible.
• Serve yourself reasonable-size portions and avoid eating copious meals. Eat a healthy snack between meals if you need to.
• Eat and drink slowly.
• Wait two hours after a meal before lying down or doing intense physical exercise.
• Avoid eating for at least two hours before bedtime.
• Maintain a healthy weight.
• Limit your alcohol intake.
• Don’t smoke. Smoking relaxes the esophageal sphincter, slows the sore-healing process, and increases your risk of developing an ulcer. If you need help to quit, ask your pharmacist for advice.
• Avoid wearing tight clothing that compresses your stomach.
• Bend your knees instead of leaning over, for example, to lace up your shoes or pick up an object.

What factors increase the risk of acid reflux?

Various factors can promote the onset of acid reflux or aggravate the symptoms of the condition.

Clinical situations that increase the risk of acid reflux:

• Suffering from obesity
• Having a hiatal hernia
• Suffering from a disease that slows the emptying of the stomach, e.g., gastroparesis
• Being pregnant

The following factors can worsen the symptoms of acid reflux, and should be avoided where possible:

• Smoking
• Drinking alcohol
• Eating copious or very rich meals, especially if you lie down within 2 to 3 hours of eating
• Eating foods that trigger symptoms (see below)
• Certain prescription or over-the-counter medications

If you suffer from acid reflux, ask your pharmacist whether it could be caused by a medication you are taking. If so, they can recommend a more appropriate product or reach out to your care team to determine how best to proceed.

What is acid reflux?

The esophageal sphincter (a sort of valve) manages the flow of food between the esophagus and the stomach. It relaxes to allow food that you have just swallowed to pass, then contracts to prevent the contents of your stomach from flowing back up into the esophagus.

In some people, this sphincter doesn’t work as well as it should, and relaxes too quickly, in which case, the contents of the stomach are no longer held back and can flow up into the esophagus. This is what’s known as acid reflux.

Since the contents of your stomach are acidic, if they flow up into the esophagus, they can irritate the esophageal lining, which is not protected by a mucous membrane. The stomach wall does have a mucous membrane that protects it from the stomach acid your body produces to aid digestion. This acidity doesn’t cause stomach pain unless you have a sore or an ulcer.

When to consult a doctor

You should see a doctor in the following situations, as you could have a more serious health problem:

• You have unexplained weight loss.
• You have frequent and severe vomiting.
• You have blood in your vomit.
• Your stool is black (resembles coffee grounds).
• You have difficulty swallowing or pain when you swallow.
• You are over 50 and this is the first time you’ve had reflux symptoms.
• You have chest pain that resembles an angina attack.

Which foods should you avoid?

While foods themselves do not cause reflux, they can aggravate your symptoms, either by irritating the esophagus or by slowing digestion, which can prolong the period during which acid reflux can occur.

• Fatty foods such as deli meats, bacon, sausage, high-fat dairy products, and fried foods
• Products containing caffeine (coffee, tea, chocolate, etc.)
• Soft drinks
• Onions and garlic
• Foods containing mint
• Tomatoes, including tomato juice and tomato-based sauces (salsa, ketchup, pasta or pizza sauce)
• Citrus fruit and citrus juices (orange, grapefruit, lemon)
• Spicy foods and chili peppers
• Vinegar and foods containing vinegar, e.g., dressings, marinades, mustard

That doesn’t mean you should avoid these foods altogether! Every person reacts differently to foods, and everyone has a different tolerance threshold.

QUESTIONS ABOUT ACID REFLUX? YOUR PHARMACISTS ARE THERE FOR YOU!

Be sure to seek out the professional advice of your pharmacists if you have questions about how to treat acid reflux. They can help you adopt effective measures to relieve your symptoms or recommend or prescribe a treatment tailored to your needs.