Acid reflux

Although heartburn can strike anyone, if you get it all the time, you may suffer from a condition called acid reflux, gastric reflux or gastroesophageal reflux disease (GERD). Learn how to treat this condition and prevent its complications.

What is acid reflux?

Between the stomach and the esophagus is a sphincter (or valve) that prevents stomach acid from getting into the esophagus. Whenever this valve relaxes, stomach acid will move up into the esophagus. This condition is known as acid reflux, gastric reflux or gastroesophageal reflux disease (GERD).

The stomach wall has a mucous membrane that protects it from the stomach acid produced to digest food. This acidity doesn’t cause stomach pain unless you have a sore or ulcer. The wall of the esophagus, however, isn’t protected by a mucous membrane. When reflux occurs, the esophagus gets irritated by the acidity, which causes a burning sensation or pain.

Acid reflux symptoms

Some common acid reflux symptoms are:

• Pain or burning in the stomach behind the breastbone, which can move up into the throat.
• The stomach contents leak backwards up into the throat without a vomiting action and often cause a sour taste in the mouth (acid regurgitation).

Other reflux symptoms are less recognizable because they are also symptoms of other diseases:

• nausea
• persistent cough
• a hoarse or raspy voice
• difficulty breathing normally or asthma symptoms
• pharyngitis or laryngitis
• erosion or wearing down of the teeth

The frequency and intensity of symptoms often vary from person to person and from episode to episode.

Possible acid reflux complications

While acid reflux may not seem serious, it can be. It can cause sores in the esophagus and lead to bleeding, cracks, or inflammation of the esophageal wall. In the long term, reflux can also cause a narrowing of the esophagus, ulcers(hyperlien vers la fiche ulcère gastro-oesophagien), and even cancer.

What causes acid reflux?

Different factors can contribute to acid reflux. A number of these factors can be modified or avoided:

• Meals that are too rich or heavy (too much fat, large portions).
• Smoking.
• Alcohol.
• Stress and anxiety.
• Overweight.
• Certain medications, such as iron or potassium supplements, bisphosphonates, and anti-inflammatories, particularly acetylsalicylic acid (aspirin).
• Certain conditions or diseases, such as a hiatal hernia or diabetic gastroparesis.
• Pregnancy.
• Wearing clothes that are too tight and that compress the throat and chest.

Foods to avoid

To relieve your reflux symptoms, you need to know which foods to avoid. A number of foods can cause reflux symptoms:

• Fatty foods such as deli meats, bacon, sausage, butter and fried foods.
• Products with caffeine (coffee, tea, chocolate, etc.).
• Soft drinks.
• Onions and garlic.
• Mint.
• Tomatoes and tomato juice.
• Citrus fruit and citrus juices (orange, grapefruit, lemon).
• Spicy foods and chili peppers.
• Vinegar.
• Some sauces (tomato sauce, ketchup, mustard, salsa).

Other ways to prevent acid reflux or GERD symptoms

Some lifestyle habits and tips can help you prevent or relieve acid reflux or GERD symptoms.

• Eat a healthy diet.
• Learn to recognize the foods that cause your symptoms and avoid them as much as possible.
• Serve yourself reasonable portions and don’t eat meals that are too large. Eat a healthy snack between meals if you need to.
• Eat and drink slowly.
• Wait 2 hours after a meal before stretching or doing intense exercise.
• Avoid eating 2 hours before bedtime.
• Maintain a healthy weight.
• Limit your alcohol intake.
• Don’t smoke. Smoking prevents sores from healing and increases your risk of developing an ulcer. If you need help to quit, ask your pharmacist or doctor for advice.
• Avoid wearing tight clothing that compresses your stomach.
• Elevate the head of your bed by 10 cm to 15 cm (4 in. to 6 in.). Sleeping with a few extra pillows isn’t enough. You can also try sleeping on your left side.
• Crouch down instead of bending over to lace up your shoes or pick up an object.

Medications that can relieve GERD

Several over-the-counter (OTC) medications can help alleviate GERD symptoms. If you’re thinking about taking any, ask your pharmacist, who can help you choose the right product for you.

• Antacids neutralize stomach acidity. They quickly relieve symptoms within 5 to 10 minutes, but they don’t get rid of the cause of the reflux. A change in lifestyle is essential to eliminate GERD. You should take antacids at least 2 hours before or after taking another medication to make sure the antacid doesn’t modify the drug’s effect.
• Alginic acid is often combined with other antacids in various products. Once in the stomach, it creates a foam over the stomach contents to act as a protective barrier that prevents acid from eroding the esophagus.
• Histamine H2-receptor antagonists (or “H2 blockers”) inhibit the secretion of stomach acid. These products must be taken 1 hour before a meal, and their effect lasts longer than that of antacids or alginic acid. They are a good choice if your reflux symptoms occur at night.
• Proton pump inhibitors (PPI) block the secretion of acid by the stomach mucosa. Their effect lasts about 24 hours. A PPI called OLEX™ (omeprazole) is available as an OTC medication, but you have to ask for it at the pharmacy counter and you can only use it for 14 days.

If your condition hasn’t improved after 14 days of using an OTC medication, you’ll need to see a doctor to determine the exact cause of your problem. If you indeed have GERD, your doctor may prescribe medication or a combination of different agents.

When to consult a doctor

You should see a doctor in the following situations, as you could have a more serious health problem:

• You’ve had reflux symptoms for over 2 weeks.
• You have unexplained weight loss.
• You have frequent and severe vomiting.
• You have blood in your vomit.
• Your stool is black.
• You have problems or pain when swallowing.
• You are over 50 and this is the first time you’ve had reflux symptoms.
• You have chest pain that feels like an angina attack.

GERD in infants

Babies can spit up milk during or after a feeding. Unlike vomiting, spitting up happens when a small amount of what your child has just eaten (approximately 30 ml or 1 ounce) simply comes back out. This mild reflux is usually normal and harmless. It happens because the sphincter between your baby’s stomach and esophagus hasn’t developed enough yet. Acid reflux in babies usually disappears around the age of 9 to 12 months. 

You can prevent mild reflux with a few simple precautions:

• During feedings, take 3 or 4 breaks to burp your baby (don’t hit your baby on the back).
• Use a slow flow nipple if your baby is bottle-fed.
• After a feeding, hold your baby upright for a few minutes to help her digest her food.
• Between feedings, put her in an inclined baby seat or in a baby carrier.
• Elevate the head of your baby’s bed by placing a pillow under the mattress.
• Avoid putting her in clothing or diapers that are too tight.

See a doctor if your baby shows the following signs:

• Crying during feedings.
• Signs of pain during or after feedings.
• Irritability.
• Weight loss or insufficient weight gain.
• Blood in spit-up.
• Projectile vomiting or vomit that is green or yellow.
• Sleep problems.
• Respiratory problems, coughing or choking.

Your doctor may recommend tests to determine that your child indeed has GERD. If necessary, you may receive a prescription to decrease your child’s stomach acidity.