Nowadays, a burning pain- in the lower chest area- known acidity or heartburn, in folk parlance, is happening in you, myself as well as millions of others worldwide. Acid reflux is also known as heartburn, acid indigestion, or pyrosis. It happens when some of the acidic stomach contents go back up into the esophagus. It happens when stomach acid flows back up into the food pipe [ esophagus].
Acid reflux usually produces heartburn, whether it is due to a single episode of overeating or persistent GERD.
The American College of Gastroenterology says that over 60 million Americans experience heartburn at least once a month, and at least 15 million as often as daily. Exact figures vary, but diseases resulting from acid reflux are the most common gut complaint dealt by Physicians in every nook and corner of the Universe.
Heartburn is an uncomfortable burning sensation that occurs in the esophagus and is felt behind the breastbone area. It tends to get worse when lying down or bending over. It can last for several hours and often worsens after eating food. The pain of heartburn may move up toward the neck and throat. Stomach fluid can reach the back of the throat in some cases, producing a bitter or sour taste. If heartburn occurs two or more times a week, it is known as GERD for short.
Chronic heartburn can lead to GERD:
Gastroesophageal reflux disease (GERD) is diagnosed when acid reflux occurs more than twice a week. GERD is most common in people on more processed diet. So Western diet being more processed, western countries, have an estimated affected population of 20 to 30 percent . To consume more processed food and acidic in nature is the real cause of acidity. Lifestyle risk factors obesity and smoking also contribute to this malady.
Possible Causes are:
To help digestion hydrochloric acid [Hcl] is released by the walls of the stomach. Part of this acid content of the stomach flows up into the esophagus, into the gullet, which moves food down from the mouth. Despite the name, heartburn has nothing to do with the heart. Hydrochloric acid, is a strong acid that helps break down food and protect against pathogens such as bacteria.
Before prescribing medications, many Physicians recommend that patients try to change their lifestyles to keep acid reflux in check. Avoiding spicy or acidic foods, quitting smoking, minimizing caffeine and alcohol and losing weight are some of the changes recommended by the American College of Gastroenterology.
The lining of the stomach is specially adapted to protect it from the powerful acid, but the esophagus is not protected. There is a ring of muscle, the gastroesophageal sphincter, normally acts as a valve that lets food into the stomach but not back up into the esophagus. When this valve fails, and stomach contents are regurgitated into the esophagus back up, the symptoms of acid reflux are felt, such as heartburn.
GERD affects people of all ages, sometimes for unknown reasons. Though very often, it is due to a lifestyle factor, but as per medical experts, it can also be due to causes that cannot always be prevented.
One cause that is not preventable is a hiatal (or hiatus) hernia also. A hole in the diaphragm allows the upper part of the stomach to enter the chest cavity, sometimes leading to GERD.
Other risk factors are:
• Obesity, smoking (active or passive), very low levels of physical exercise[ sedentary life style].Medications, including drugs for asthma, calcium-channel blockers, antihistamines, painkillers, sedatives, and antidepressants also create acidity as an adverse effect. Pregnancy can also cause acid reflux due to extra pressure being placed on the internal organs in women in some cases.
Some major symptoms of GERD include:
• chest or upper abdominal pain
• dry, persistent cough
• bad breath.
• throat problems, such as soreness, hoarseness, or laryngitis (voice box inflammation
• dental erosion
Risks and complications:
Without treatment, GERD can lead to serious complications in the long term, including an increased risk of cancer.
Persistent exposure to stomach acid can damage the esophagus, leading to:
the lining of the esophagus is inflamed, causing irritation, bleeding, and ulceration in some cases
damage caused by the stomach acid leads to scar development and difficulties in swallowing, with food getting stuck as it travels down the esophagus
• Barrett’s esophagus:
a serious complication where repeated exposure to stomach acid causes changes in the cells and tissues lining the esophagus with potential to develop into cancer cells
Both esophagitis and Barrett’s esophagus are associated with a higher risk of cancer.
Acid Reflex in infants:
Most infants “spit up” milk as part of their daily activities. The action of spitting up milk is known as reflux or gastroesophageal reflux. Reflux is perfectly normal, common in infants, and is rarely serious.
30 to 50 % of women experience heartburn during pregnancy, even if they did not have it before. Lifestyle modifications are recommended during pregnancy, such as not eating too late at night and consuming small meals. Any woman who is experiencing severe reflux during pregnancy should speak to her doctor about treatment options.
Overweight or Obesity:
Added weight increases the pressure between the stomach and esophagus, forcing stomach acid back up. It’s purely mechanical that way. Over 35% people are overweight in North America. That’s probably one of the most important factors.
Not eating before bed helps as does raising the head of the bed on blocks by 2 to 3 inches,” said Dr. Randy Wexler, an assistant professor of family medicine at Ohio State University. “If somebody has problems less than two times per week or in certain situations, over-thecounter antacids like Tums are fine,” but more chronic or severe acid reflux may call for other drugs, such as H2 blockers like Zantac or proton pump inhibitors like Nexium and Prilosec.
Obesity is a familiar problem for North Americans, and doctors say it’s not hard to imagine that the obesity epidemic has caused a similar surge in acid reflux in the area.
Diet plays a big role:
Dietary choices may be as effective as using medicines- allopathic or herbal. Choice of Food and dietary habits that have been linked to acidity problem are:
• a diet low in dietary fiber- consume at least 30 gm fiber in your daily diet
• eating large meals
• consuming chocolate, carbonated drinks, and acidic juices
• a high intake of table salt
• lying down within 2 to 3 hours of eating a meal. Stay up at least 40 minutes after eating your meal and drink water after 30 minutes of meal finish time.
Lifestyle matters in a big way:
Losing weight and stopping smoking will remove two lifestyle risk factors associated with acid reflux.
Lifestyle measures that may help include:
• improving posture, for instance, sitting up straighter
• wearing loose clothing
• losing weight if BMI is over 25 i.e. overweight or obese
• avoiding increased pressure on your abdomen, such as from tight belts or doing sit-up exercises
• by stopping smoking
Remedial measures / drug treatments are the most common therapy and are available on prescription and over the counter (OTC). The main treatment medicine options for people who repeatedly experience acidity or acid reflux in GERD are either Proton Pump Inhibitors[ PPIs ] or H2 blockers.
PPIs and H2 blockers decrease acid production and reduce the potential for damage caused by acid reflux. These medications are generally safe and effective, but like any prescription drug, they are not appropriate for all people with reflux disease and can cause side effects.
PPIs include Omeprazole, Rabeprazole, and Esomeprazole. H2 blockers, include cimetidine, ranitidine, and famotidine. Go for Modified release[MR version] as it works for 24 hrs. whereas regular one works for 8 to 12 hrs. PPIs and H2 blockers decrease acid production and reduce the potential for damage caused by acid reflux. These medications are generally safe and effective, but like any prescription drug, they are not appropriate for all people with reflux disease and can cause side effects.
Over the Counter [OTC] remedies for acid reflux:
For people who experience heartburn or indigestion infrequently, perhaps in association with occasional food and drink triggers, OTC treatments are available to reduce the acidity of the stomach contents.
These liquid and tablet formulations are called antacids, and there are scores of brands available, all with similar effectiveness. They may not work for everyone, and any need for regular use should be discussed with your respective Physician.
Always remember that antacids provide rapid but short-term relief by reducing the acidity of the stomach contents. They contain chemical compounds such as calcium carbonate, sodium bicarbonate, aluminum, and magnesium hydroxide. They can also inhibit nutrient absorption, may lead to deficiencies of vitamins over a time.
Alginate drugs such as Gaviscon
Gaviscon is probably the best-known heartburn therapy. It has a different mode of action than antacid drugs. Alginate drugs such as Gaviscon differ in composition, but they usually contain an antacid named alginic acid.
The alginic acid works by creating a mechanical barrier against the stomach acid, forming a foamy gel that sits at the top of the gastric pool itself.
Any reflux is then relatively harmless as it consists of alginic acid and not damaging stomach acid. The active ingredient—alginate—is found naturally in brown algae. Alginate drugs, including Gaviscon, for instance, may cause problems absorbing nutrients. This can lead to malnutrition.
If GERD is severe and unresponsive to medical treatment, a surgical intervention known as fundoplication may be needed.
For many, a military rich diet- spicy and fried one in particular- alcohol in abundance, weight gain and stress in succession may lead to one thing: heartburn. But new research finds that an increasing number of people struggle with the burning and pressure of surging stomach acid all year long. In one year in USA total number of prescriptions written for a 36o million people is
A new study reports that the number of people who frequently experience symptoms of heartburn, also called acid reflux, has almost doubled in the last 10 years. Acid reflux can mean more than just discomfort — too much surging stomach acid can create a web of wounds in the esophagus, causing food to get stuck on its way down. Research also has connected acid reflux with an increased risk of esophageal cancer, particularly if it is chronic and left untreated.
Women seemed to be more affected by the disease than men, and acid reflux became more common in people of both sexes as they progress toward middle age.
In 2006, a study from the Mayo Clinic found that 5 percent of people with acid reflux developed Barrett’s esophagus, a condition that may be a precursor of esophageal cancer.
Prof. Surinder Kochhar (Shaun)
LPN, FCN, M.Com, CAIIB, DIM A freelance writer with 36 Years Exp. A Health Coach of University of Victoria