Acid reflux (GERD) Causes, Diagnosis, and Treatment

Symptoms

• Regurgitation: You may experience stomach acid, food, or liquids rising back into your throat after eating, often leaving a sour taste.
• Burning sensation: Acid can burn the oesophageal lining. If the pain is in your chest, it’s referred to as heartburn; if it is nearer to the stomach, it’s acid indigestion.
• Noncardiac chest pain: This is oesophageal pain that isn’t a burning sensation. Since the oesophagus shares nerve pathways with the heart, the discomfort may mimic heart-related pain.
• Nausea: Backwash or backflow of acid can lead to queasiness or loss of appetite, sometimes making it feel like food remains undigested even hours after eating.
• Sore throat: Acid reaching your throat may cause soreness, a lump-like sensation, or difficulty swallowing. This often occurs at night.
• Asthma-like symptoms: GERD can lead to chronic cough, wheezing, and shortness of breath if acid particles enter the airways, causing them to constrict.

Causes

The sphincter is a ring-shaped muscle at the lower end of the oesophagus. This muscle acts as a barrier to stop stomach acid from coming up. Acid reflux occurs when this sphincter isn't working properly. Although this is a common issue, the reason for its weakness is often unclear.

In some cases, the cause is more apparent. When stomach pressure exceeds what the sphincter can handle—such as after eating a large meal, during pregnancy, or when bending forward—acid may escape into the oesophagus. A hiatus hernia, where part of the stomach pushes through the diaphragm into the chest, can also increase the likelihood of reflux.

Diagnosis

A gastroenterologist will examine your oesophagus during diagnosis using procedures like:

• Oesophagram: A specialised X-ray that captures real-time images (fluoroscopy) of oesophagus as you swallow a barium-based liquid.
• Upper endoscopy: A thin, flexible tube containing a camera is put via your mouth while you are lightly sedated. This enables direct visualization of your oesophagus.
• Oesophageal pH test: A small wireless receiver placed in your oesophagus during an endoscopy measures acid levels to detect reflux.
• Oesophageal manometry: This test evaluates muscle function in the oesophagus with pressure sensors fixed in a nasogastric tube. It helps determine if the lower oesophageal sphincter (LES) or other muscles are functioning properly.

Managing and Treating Acid Reflux

Many people can manage acid reflux by making lifestyle changes, such as improving their diet, quitting smoking and alcohol, and cutting weight. Doctors often advise patients to make these changes first. However, drugs can help reduce stomach acid. These drugs are quite effective and readily available.

Over-the-counter (OTC) treatment options:

• Antacids lessen the harmful effects of reflux by neutralising stomach acid. They are not appropriate for prolonged use due to their potential side effects, even though they are effective for occasional symptoms.
• Seaweed-derived alginates form a protective barrier that prevents acid from reaching the oesophagus. They can be taken separately or, for further protection, in combination with antacids.

Prescription Medications for GERD

• Histamine receptor antagonists (H2 blockers) – These medications block histamine signal and reduce stomach acid. Even though they are more effective than antacids, their efficacy may decrease over time as the body adapts.
• Proton pump inhibitors (PPIs) – PPIs are stronger acid blockers than H2 blockers. They are often the first-line treatment for severe GERD and are approximately 90% effective in minimising acid reflux.
• Baclofen – This muscle relaxant helps reduce episodes of lower oesophageal sphincter (LES) relaxation, lowering the risk of acid reflux. While not typically a first-choice treatment, it may be used as part of a broader management plan.

Surgical treatments:

• Nissen fundoplication: It is the most popular surgical procedure for treating GERD, with a quicker recovery. It is frequently done laparoscopically. It entails securely fastening the upper portion of the stomach around the lower oesophagus. This strengthens the junction between the stomach and oesophagus, helping to prevent acid reflux. Additionally, it can be used to repair a hiatal hernia if present.
• LINX device: In order to assist maintain the oesophageal-stomach connection tight, a tiny magnetic ring (LINX) is placed around it in this more recent method. It aids in stopping acid from rising again.

Conclusion

Almost everyone experiences acid reflux from time to time. Its symptoms like heartburn, indigestion, and acid regurgitation can be uncomfortable. However, you may be able to reduce how often they occur.

If acid reflux occurs often and interferes with your day-to-day activities, you may have GERD.

For more information or to address any concerns, book an appointment with us today.