Acid reflux is diagnosed when highly acidic gastric contents reflux back up into the esophagus. We all on the odd occasion suffer acid reflux especially when we over indulge.
The lower esophageal sphincter (LES) is the barrier than remains closed and stops reflux from developing. If the LES relaxes, then reflux can occur. Reflux becomes a problem when it is recurrent.
Unlike the stomach, the esophageal lining does not cope well with persistent acid. Not only will it result in symptoms such as heartburn but long term contact with acid can cause ulceration, bleeding, strictures and respiratory problems.
Acid suppression treatment with drugs such as ranitidine and Omeprazole are so very effective and with these drugs readily available over the counter, it is so easy for a sufferer to go for the drug treatment option. This may be appropriate if acid reflux in caused by true LES incompetence but this diagnosis should be made by your gastro-enterologist. There may be things you can do to improve acid reflux. So before taking OTC medication find out what you can do for yourself.
There are various factors that affect the LES and these could be adequately addressed by lifestyle modification. Sometimes just a simple change in lifestyle can make a significant difference. For you to make the changes, it is important that you are aware of the various factors that either trigger acid reflux or make it worse.
There are things that increase the intra-abdominal pressure and thereby put pressure on the LES. Some affect the tone of the LES and some affect contraction of intestinal muscles leading to poor clearance of the esophagus and delay in gastric emptying allowing more opportunity for reflux.
A Weighty Problem
Obesity is the biggest cause of acid reflux today. If you happen to be apple shaped then the extra weight will settle around the waist. This extra weight presses on the abdomen and increases abdominal pressure. This forces the stomach up against the diaphragm and can distort the LES. Food can then be forced up into the esophagus.
Losing weight will make a difference. Some sufferers have significant improvement of their symptoms with only a small weight loss. Wearing tight fitting clothes also increase intra-abdominal pressure. Acid reflux sufferers should wear loose clothes.
Smoking can make acid reflux worse. Nicotine relaxes the lower esophageal sphincter. In addition nicotine deposited at the back of the throat can be corrosive to the esophageal lining. If you have acid reflux and you smoke, then this is another reason to add to the long list of why you should give up.
Certain foods can have a direct effect on acid reflux. Fatty foods will stay longer in the stomach. Delayed gastric emptying increases the opportunity for reflux. Similarly large meals will slow down gastric emptying and distend the stomach. A distended stomach filled with food will put unnecessary pressure on the LES.
You can make matters worse if you wash the meal down with more than a few glasses of red wine. I am not a killjoy but alcohol stimulates increased acid production in the stomach and relaxes the tone of the LES. This is not a good combination. Drink alcohol sensibly or not at all.
Cow’s milk intolerance or allergy can cause esophagitis. This is called Allergic Eosinophilic Esophagitis. In this case avoiding cow’s milk protein (Lactose) solves the problem.
Other foods that can cause problems in acid reflux include tomatoes, citrus fruits, garlic, chilli and certain spices. Caffeine can affect the LES. Avoid or use carefully tea and coffee. Some IBS sufferers use peppermint as treatment. This herb can affect the LES and can cause heartburn. If you have heartburn with peppermint, consider stopping.
Taking smaller meals more frequently will reduce acid reflux because the stomach will not be full. On average, food stays in the stomach about three hours. It makes sense, therefore, to avoid eating up to three hours before going to bed and that includes a nightcap. Similarly do not lie down soon after a meal.
Some drugs affect the LES. These include the Tricyclic antidepressants (i.e. amitriptylline), bronchodilators (Theophylline) and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Tranquillisers and sedatives relax muscles and in the gut can slow down peristaltic contractions of the esophagus. This will increase clearance time in the esophagus. If the drugs you are taking are causing acid reflux then discuss with your doctor.
A Scandinavian study showed that women on HRT are more likely to develop acid reflux. The high level of female hormones, estrogen and progesterone, relax smooth muscles and increase the risk of acid reflux. It is estimated that up to 80% of pregnant women have acid reflux. This is due to the rising level of the female hormones and the weight gain.
If you have acid reflux and you are on treatment, opt for liquid medication. It goes down easier. Some tablet such as tetracycline can be corrosive to the esophagus. Tablets and capsules can also stick in the esophagus.
If you have to take medication always wash it down with a glass of water. Avoid taking medication lying down. Patients with acid reflux should take medication sitting up or standing and avoid lying down soon after.
If you have nocturnal heartburn then raising the head of the bed will reduce this. It will also reduce sensitisation in patients with day time reflux. Adding extra pillows has been shown to be ineffective. Best position to sleep is on the left side. In this position, the stomach is lower than the esophagus.
So if you have acid reflux symptoms, it is likely that it is due the factors you can control rather than true LES incompetence. Remember that to treat acid reflux, you need 24 hours acid suppression and not just the nocturnal dose. So instead of taking continuous medication, is it not better to address your lifestyle and make modification? Who knows, it may be all you need.