Acid reflux is a common problem that many recognize from the heartburn it causes. But there are other less obvious symptoms too, according to Dr. Dana Sloane, an assistant chief of medical specialties in the division of gastroenterology for the Mid-Atlantic Permanente Medical Group. President Barack Obama was diagnosed with the condition in December after complaining of a sore throat. Sloane said it is usually managed at home with medications and lifestyle changes.
What causes acid reflux and how common is it?
Acid reflux is a condition wherein stomach acid "refluxes," or travels backward, into the esophagus (swallowing tube). It is also known by the common term "GERD," meaning gastro-esophageal reflux disease. Acid reflux can cause significant symptoms, since stomach acid is quite strong. This acid can easily injure the lining of the esophagus, throat and even the upper airway.
Understanding a bit of anatomy can illustrate why reflux may occur. There is a muscle at the bottom of the esophagus, known as the lower esophageal sphincter, or LES. This muscle is intended to act as a one-way valve, permitting food to come down, and preventing food and stomach fluid from coming back up. The LES can sometimes become "leaky" or "relaxed", especially after a meal, permitting acid from the stomach to come back into the esophagus. This is thought to be one of the key problems in acid reflux.
GERD is very common, although it is difficult to know the exact prevalence of the disease.
Despite the fact that exact prevalence of GERD is not known, some serious consequences of GERD — including Barrett's esophagus (a change in the lining of the esophagus that can increase the risk of esophageal cancer) as well as a particular type of esophageal cancer — have become more common in the U.S. during the past two decades.
What are the obvious, and less obvious, symptoms?
The classic symptom of GERD is heartburn — burning discomfort just behind the sternum or breastbone, or in the upper abdomen. This discomfort often follows meals, and can sometimes spread to the neck, arms, or back. The burning can sometimes be associated with a sour taste in the mouth.
It's important to note, however, that many people with GERD will not have these classic symptoms. Other possible GERD symptoms include: chest pain, nausea, cough, swallowing difficulty, hoarseness, or throat discomfort or fullness. Many readers may recall that President Obama recently sought medical attention for a sore throat which was ultimately attributed to GERD.
When is it a problem that requires medical attention?
Most people with GERD will do fine, with no significant problems. There are, however, some key signs that may indicate a more concerning problem. If GERD symptoms have been present for many years, have stopped responding to routine or over-the-counter antacid medication, or are accompanied by a new swallowing problem, this should be evaluated promptly by a physician. Any sign of black or red bowel movements should also be evaluated by a physician as soon as possible.
Can it be managed or cured with lifestyle changes?
Absolutely. In fact, lifestyle changes — even in people who use anti-acid medication — are critical to achieve long-term control of GERD-related symptoms.
Diet and nutrition play an essential role in acid reflux. It is important to pay attention to food triggers. There are some common foods — such as caffeine, chocolate, citrus fruits and juices, tomato-based products and alcohol — that can provoke GERD symptoms. Anyone with GERD should identify their own food triggers and avoid those foods.
In terms of diet, it is also important not to eat large meals. When the stomach is very full, this can increase the likelihood of reflux events. When possible, it is a good strategy to make lunch (or an early supper) the largest meal of the day. Late meals — eating within three hours of bedtime — should also be avoided. Going to sleep with food in the stomach can cause silent acid reflux to occur during sleep.
For people who have nighttime GERD symptoms, it may be helpful to sleep on a wedge pillow. This is a triangular pillow that permits one to sleep at a slight incline, which can minimize reflux events.
Lastly, the importance of maintaining a healthy weight cannot be overstated. Many studies have identified a clear relationship between the increasing prevalence of GERD symptoms and the obesity trend, particularly in the United States. Increased body weight can significantly increase the frequency and severity of acid reflux.
Other important strategies include smoking cessation and minimizing use of alcohol. Both tobacco and alcohol can increase the risk of serious esophageal disease, including cancer.
How is it treated when those changes don't work?
Acid reflux symptoms that persist despite routine medications, or which are accompanied by swallowing problems, may require evaluation by a specialist.
Some people may benefit from having an upper endoscopy, which involves passing a thin video camera through the mouth, down the esophagus and into the stomach. This is a brief test, performed under light sedation, which permits a direct look at the lining of the esophagus and stomach.
There are many excellent prescription options used to control acid production in the stomach. Like any medication, these have the potential for long-term side effects, including bone loss or diarrhea, which should be discussed with a physician.
A small number of people may also benefit from surgical management of acid reflux, although this is typically reserved for those who do not respond to medical therapy.