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gastroenterology and hepatology illness

Acid Reflux

Acid reflux indicates stomach acid backing up into the esophagus. The esophagus or food pipe connects your mouth to the stomach. When acid reflux causes symptoms or damage to the esophagus, it is called gastroesophageal reflux disease or GERD.

Some amount of acid reflux is considered normal or physiologic. When there is excessive acid reflux into the esophagus or when acid reflux causes symptoms, damage to the mucosa or the innermost lining of the esophagus, then it needs to be further investigated and/or treated.

The most common symptom of acid reflux his heartburn which is a feeling of burning in the chest below the breast bone.  Occasionally acid reflux causes regurgitation of acid, bile or undigested food back into the mouth. Other symptoms include non-cardiac chest pain, trouble swallowing solids, alteration in voice, chronic cough, worsening of asthma. These are called atypical manifestations of acid reflux.

Acid reflux is investigated usually with an upper gastrointestinal endoscopy. If the upper endoscopy is normal, further investigation with an esophageal pH study may be warranted.  With this procedure, the acid reflux is accurately quantitated as well as correlated with patient’s symptoms. Usually this study is done with the patient not taking any acid blocking medications.  Upper endoscopy also helps identify anatomic abnormalities such as a hiatal hernia which predisposes to acid reflux by obliteration of the lower esophageal sphincter muscle which is responsible for keeping the acid in the stomach after a meal. Upper endoscopy also helps identify narrowing of the esophagus called a stricture as well as precancerous lining of the esophagus called Barrett’s esophagus. At endoscopy, dilation can be performed of the stricture to give relief to the patient’s symptom of difficulty swallowing.

Management of acid reflux can be undertaken with change in lifestyle or with medications. Lifestyle modifications involve losing weight(if you are overweight), avoiding certain foods such as peppermint, excessive alcohol, smoking, coffee, fatty foods, tomatoes.  It is recommended to avoid eating large meals especially at night so that there is less food in the stomach when you lie down to go to sleep.  It is also recommended to sleep with the head elevated by 6-8 inches to allow gravity to keep the acid in the stomach rather than get it to reflux into the esophagus.

There are several medications used to treat acid reflux. For mild, intermittent symptoms, antacids can help. Another class of medications called H2 receptor blockers may also reduce acid production by the lining of the stomach. If the above 2 classes of medications do not help symptoms, we usually try a potent class of medications called proton pump inhibitors which chemically block the acid secreting pumps in the innermost lining of the stomach.

If acid reflux goes untreated for a long period of time, complications can happen like narrowing of the esophagus called a stricture which can prevent you from swallowing solid food. Other complications include gastrointestinal bleeding, anemia, precancerous lining of the esophagus called barrett’s esophagus which can transform into esophageal cancer.  Esophageal cancer is still increasing in incidence mostly because of increasing prevalence of acid reflux in the community.

Patient is encouraged to contact a gastroenterologist if they have severe or long lasting acid reflux, inability to control symptoms with medications, trouble swallowing, vomiting blood, chest pain or losing weight.

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