Gastroesophageal reflux disease (GERD), caused when the lower esophageal sphincter (LES) does not close properly, and stomach contents leak back (reflux) into the esophagus. When refluxed stomach acid touches the lining of the esophagus, it causes a burning sensation (heartburn). GERD may lead to histopathological changes in the esophagus.

Do you ever feel a backwash of sour fluid rising to your throat? Is it accompanied by burning in your chest? These are two symptoms of acid reflux. If episodes occur more than twice weekly, it’s crucial to see a gastroenterologist. Ongoing reflux can seriously injure your esophagus, the food tube connecting your stomach and throat. Here’s an explanation of acid reflux and ways to resolve it.

Valve Laxity

The anatomical cause of reflux is a weak valve at your stomach entrance. A band of muscle comprises this valve, called a “sphincter.” Its purpose is to promptly close after food passes through it. When the sphincter shuts only partially, stomach acids flow into your esophagus and throat, triggering burning sensations.

GERD

Persistent acid reflux progresses to gastroesophageal reflux disease or “GERD,” evidenced by esophageal inflammation. GERD symptoms are wheezing, coughing, abdominal burning, difficulty swallowing, nausea, bloat, repetitive burping, and hiccups. At worst, GERD renders black or bloody stools, bloody vomit, hoarseness, chronic sore throat, and the sense that food is lodged in your throat.

Causes

Often responsible for reflux is hiatal hernia. This is bulging of the stomach into the chest above the diaphragm, a dome-shaped muscle separating the chest and abdomen. The diaphragm has an opening or “hiatus,” through which the esophagus passes, to join the stomach. When the diaphragmatic muscle around the hiatus weakens, the stomach protrudes through the opening, forcing acids into the esophagus.

In addition to hiatal hernia, the following can prompt reflux:

  • carbonated beverages, alcohol, coffee, acidic juices, and tea
  • low fiber and high salt intake
  • chocolate, tomatoes, citrus, mint, onions, garlic, spices, and fatty foods
  • smoking
  • being overweight
  • large meals, followed by lying down or bending over
  • medications to control asthma, blood pressure, allergies, pain, muscle spasm, anxiety, and depression
  • pregnancy

Lifestyle Changes

You may be able to quell reflux by modifying your diet and habits. First, eliminate food and beverages that trigger regurgitation. Rather than having large meals, eat small portions at more frequent intervals. Allow adequate time to dine at a relaxed pace. After eating, wait three hours before lying down.

If you smoke, hopefully reflux will motivate you to quit. Avoid cinching your abdomen with tight clothing and belts. If you nap during the day, try resting upright in a chair, rather than your bed. For nighttime sleeping, use a wedge pillow to raise the head of your bed by 6 to 10 inches. Also, rest on your left side.

Acid-Taming Foods

Consuming certain foods can also halt or decrease reflux. Some coat the stomach and esophageal lining. Others neutralize acids and soothe irritation. Fibrous foods lower acid production by spending less time in your digestive tract. Try to incorporate the following into your diet:

  • fennel tea
  • asparagus, avocado, broccoli, green beans, cucumber, cauliflower, leafy greens
  • oatmeal and almond milk
  • apples, bananas, cantaloupe, honeydew, watermelon

Over-the-Counter Drugs

Occasional reflux may respond to OTC drugs. Some work by neutralizing stomach acid, such as Rolaids, Tums, Maalox, Alka-Seltzer, Mylanta, and Riopan. Liquid and foaming antacids coat the esophageal lining and reduce stomach acid, like Pepto-Bismol and Gaviscon. Only use OTC antacids for infrequent reflux. Taking them regularly can result in diarrhea, constipation, and electrolyte imbalance.

For heartburn accompanied by pressure, gas, and bloat, try anti-flatulence aids. Examples are Beano, Gas-X, and Phazyme, which break up gas bubbles and make them easier to pass.

H2 receptor blockers, such as Zantac and Pepcid AC, target reflux that occurs about three times per month. These medicines inhibit histamine, a hormone-like chemical that launches acid production. Although H2 blockers provide more long-term relief than antacids, they don’t work immediately. Take an H2 receptor blocker 30 minutes before meals or at bedtime.

Diagnosis

If symptoms don’t abate with lifestyle changes, therapeutic foods, and OTC drugs, make an appointment with Digestive Care Physicians. One of our caring and highly skilled doctors will discuss your symptoms and conduct an evaluation. Your doctor may perform tests to find anatomical causes of reflux and assess for GERD.

Upper Endoscopy

For this test, your doctor will introduce a flexible tube or “endoscope” into your throat and esophagus, equipped with a light and video camera. First, your throat is sprayed with a numbing agent. Your doctor can also give a sedative to aid relaxing. The endoscope will display pictures of your upper digestive system on a TV monitor. A scope can also be used to stretch the esophagus, stop bleeding, and obtain a tissue sample or “biopsy.”

Esophageal Manometry

This test measures the coordination and strength of your esophagus and sphincter during swallowing. Manometry identifies an area of weakness or abnormality that’s preventing the sphincter from closing, such as a hiatal hernia.

After anesthetizing one of your nostrils, the doctor inserts an endoscope. Lying on your left side, you’ll swallow water at paced intervals. A machine connected to the scope measures esophageal pressure at rest and during swallowing. The machine then creates a graph of esophageal contractions, which your doctor interprets.

pH Recording

pH is a clue to the presence of acids in the esophagus. If you’ve been taking medication for GERD, pH monitoring can assess its effectiveness and whether surgery is warranted.

Using an endoscope, the doctor attaches a small capsule to your esophageal wall, to collect pH data. Then, the capsule transmits the information to a receiver on your waistband or belt.

Whenever reflux occurs, you activate the receiver. You’ll document reflux episodes over 48 hours, including the times, symptoms, and associated activities. You’ll also record your bedtime, awakening, and when you begin and stop eating.

Your doctor will analyze the data provided by the receiver and your notes, to determine a diagnosis and treatment. A few days after testing, the pH capsule will pass in your stool.

GERD Treatments

To block acid production, your doctor may advise taking a proton pump inhibitor (PPI), such as Prilosec OTC, Nexium, or Prevacid 24. Proton pumps are specialized stomach cells that release acid. PPIs work by deactivating proton pumps. Prescription strength PPIs are also available, such as Aciphex, Dexilant, and Protonix.

Another pharmaceutical option is prescription strength H2 receptor blockers, such as Axid and Tagamet.

Prokinetic agents strengthen the sphincter and accelerate digestion, shortening the time acids stay in the stomach. Examples are Reglan and Urecholine. In rare cases, when medications can’t control GERD, a doctor may advise surgery.

Barrett’s Esophagus

GERD poses the risk of developing Barrett’s esophagus, damage to the esophageal lining from constant exposure to stomach acids. If not treated, Barrett’s esophagus increases the likelihood of esophageal cancer by up to 80 percent.

Our Doctors

Our professional team includes five board-certified physicians, each with extensive experience in treating gastrointestinal disorders. When calling to make an appointment, request Dr. Moole if you need a doctor who speaks Hindi and Telugu. For a doctor fluent in Vietnamese, ask for Dr. Nguyen. Here’s the full list of conditions addressed by our doctors.

Offices

Serving metro Atlanta residents, we have four convenient locations, in Cumming, Johns Creek, Alpharetta, and Lawrenceville. Our endoscopy suite is accredited by the Association for Ambulatory Health Care, ensuring your safety and expert care.

Don’t ignore acid reflux or try to placate severe illness with medications. Call us at (770) 227-2222 to schedule a prompt appointment. To see a doctor in our Lawrenceville office, please call (470) 210-7766.

Quench the burn of acid reflux, and protect your GI health!

Note – The information in this article cannot replace professional medical care. Be proactive about acid reflux by seeing a doctor at Digestive Care Physicians.


Board certified physicians Dr. Ranvir Singh, Dr. Stephen Rashbaum, and Dr. Nitin Parikh, Dr. Sumana Moole, Dr. Long B. Nguyen, Tammi D’Elena, PA-C; Vanessa T. Dang, MSN, APRN; care for patients in the north Atlanta, GA; area including Alpharetta, GA; Johns Creek, GA; Cumming, GA; and Lawrenceville, GA.  The In-House Endoscopy Suite at Digestive Care Physicians is a Certified facility which has achieved the highest level of accreditation by the Association for Ambulatory Health Care (AAAHC). If you suffer from acid reflux, contact us at (770) 227-2222 to schedule an appointment.