There is a valve at the entrance to the stomach made up of a ring of muscle called the lower esophageal sphincter (LES). Normally once food passes from the esophagus through the LES entering into the stomach, the LES closes quickly and tightly not allowing the food to reverse course coming back up into the esophagus. But if the LES is weak or not closing completely, strong acid produced by the stomach can spatter back up into the esophagus causing an annoying burning sensation.
If heartburn is an infrequent occurrence, it usually does not cause problems. However if it is happening more than twice a week, you may have acid reflux disease also known as gastroesophageal reflux disease (GERD) and you should be seen by your physician to correctly diagnosis it.
Heartburn is probably the most common symptom usually involving a burning pain with a sour or bitter tasting acid backing up into your throat or mouth. Other symptoms could include bloating, burping, dysphagia or the sensation of food being stuck in your throat, hiccups that won’t let up, hoarseness, or a chronic sore throat.
Causes of heartburn or acid reflux disease
There can be a number of causes resulting in acid reflux with one of the more common reasons being a hiatal hernia. A hiatal hernia is a condition in which part of the stomach pushes up through the diaphragm muscle which normally helps keep acid in our stomach preventing acid reflux.
Other common risk factors for acid reflux disease can be:
· Eating a large meal or lying down right after a meal
· Being overweight or obese
· Snacking close to bedtime
· Eating certain foods such as citrus, tomato, chocolate, mint, garlic, onions, or spicy or fatty foods
· Certain beverages such as alcohol, carbonated drinks, coffee or tea
· Taking aspirin, ibuprofen, certain muscle relaxers, or blood pressure medications
If you are experiencing symptoms of acid reflux at least twice a week or more and medications are not helping, it’s time to go see your doctor about how to control it. Your doctor may want to order tests to confirm a diagnosis and for any other problems. Tests that may be used include:
· Barium swallow or esophagram – This will look for ulcers or a narrowing of the esophagus.
· Esophageal manometry – This will check the function of the esophagus and lower esophageal sphincter.
· pH monitoring - A device will be inserted into your esophagus and left in place for 1 to 2 days to measure the amount of acid in your esophagus.
· Endoscopy – A long, flexible, lighted tube is inserted down the throat to check for problems in the esophagus or stomach.
· Biopsy – While performing an endoscopy a biopsy to check tissue samples may be taken to look for infection or abnormalities.
If medications are not alleviating the symptoms as much as you like, there are several lifestyle changes you can try that often help to treat acid reflux. Most are strategies involving dietary changes. Here are steps in addition to medication that can help:
· Avoid large meals – Eating large amounts of food increases the chance of reflux. Try eating several smaller meals throughout the day.
· Reduce total fat intake – Fried foods and foods high in fat can weaken the LES muscle in addition to staying too long in the stomach as they take longer to digest.
· Certain foods can weaken the LES muscle – chocolate, coffee, peppermint, spicy foods, carbonated beverages, citrus juices and tomato products.
· At the end of a meal, drink a small glass of water. This washes down and dilutes stomach acid that could backflow into the esophagus.
· Drink beverages that don’t promote heartburn – water, mineral water, noncitrus juice, decaffeinated tea, and nonfat or lowfat milk.
· Increase fiber – the more fiber you eat, the less likely you’ll experience heartburn. Include more fruit, vegetables, whole grains, beans, nuts, and seeds.
Nondietary modifications to try:
· Lose weight if overweight – excess weight can press against the stomach and increase the pressure going up toward the LES.
· Avoid wearing tight fitting clothing around the abdominal area.
· Don’t smoke
· Stay upright for at least 2 hours eating – Lying down can lead to the stomach contents splashing up toward the LES.
· Avoid exercise for at least 2 hours after eating.
· Avoid eating 3 hours before bedtime. Elevating the head of your bed 6 to 8 inches may prevent heartburn or try stacking extra pillows under your upper body may help too.