Acid Reflux
Stomach acid flowing back into the food pipe, causing heartburn
Quick Facts
- Type: Digestive condition
- Main symptom: Heartburn
- Common triggers: Large or fatty meals, lying down
- When chronic: May be called GERD
Overview
Acid reflux occurs when stomach acid flows backward up into the esophagus, the tube that carries food from the mouth to the stomach. A ring of muscle at the bottom of the esophagus normally acts as a one-way valve, but when it relaxes or weakens, acid can escape upward and irritate the lining, producing the burning feeling known as heartburn.
Occasional acid reflux is very common and is usually nothing to worry about. When reflux happens frequently, becomes persistent, or causes complications, it is called gastroesophageal reflux disease, or GERD. Most people can manage reflux with simple lifestyle changes and over-the-counter remedies, though some need ongoing treatment.
Reflux tends to be worse after large meals, when lying down, or when bending over, because these situations make it easier for acid to flow upward. Understanding your personal triggers and the situations that bring on symptoms is often the first step toward controlling them and deciding whether stronger treatment is needed.
Symptoms
The hallmark of acid reflux is heartburn, a burning discomfort behind the breastbone. Other symptoms can include:
- A burning sensation in the chest, often after eating or when lying down
- A sour or bitter taste in the mouth (regurgitation)
- A sensation of food or liquid coming back up
- Difficulty or discomfort swallowing
- A persistent dry cough, hoarseness, or sore throat
- A feeling of a lump in the throat
Importantly, chest pain can also be a sign of a heart problem. Chest pain with shortness of breath, sweating, or pain spreading to the arm or jaw should be treated as a possible emergency rather than assumed to be reflux.
Causes
Acid reflux happens when the lower esophageal sphincter relaxes at the wrong time or is weakened, allowing stomach contents to flow back up. Common contributors include:
- Large or high-fat meals, and eating close to bedtime
- Being overweight, which increases pressure on the stomach
- A hiatal hernia, where part of the stomach pushes up through the diaphragm
- Pregnancy
- Certain foods and drinks such as coffee, alcohol, chocolate, citrus, and spicy or fatty foods
- Smoking and some medications
Risk Factors
- Being overweight or obese
- Pregnancy
- Smoking
- A hiatal hernia
- Eating large meals, lying down after eating, or late-night eating
- Frequent consumption of trigger foods, alcohol, or caffeine
Diagnosis
Acid reflux is often diagnosed from the typical symptoms and the response to treatment. Further tests are used when symptoms are severe, persistent, or have warning features:
- Symptom review and trial of treatment: Improvement with acid-reducing medication supports the diagnosis.
- Upper endoscopy: A thin camera examines the esophagus and stomach, especially if there are alarm symptoms.
- pH monitoring: Measures acid in the esophagus over time to confirm reflux.
- Other tests: Such as esophageal manometry to assess muscle function.
Treatment
Treatment combines lifestyle changes with medication when needed.
- Lifestyle measures: Eating smaller meals, avoiding trigger foods, not lying down for two to three hours after eating, raising the head of the bed, losing excess weight, and not smoking.
- Antacids: Provide quick, short-term relief by neutralizing acid.
- H2 blockers: Reduce acid production and last longer than antacids.
- Proton pump inhibitors (PPIs): Such as omeprazole, the strongest acid reducers, used for frequent or severe reflux.
- Surgery: Occasionally considered for severe GERD that does not respond to medication.
Many people find that combining a few lifestyle adjustments with an over-the-counter or prescription acid reducer keeps symptoms well under control.
Prevention and Self-Care
- Eat smaller, more frequent meals and avoid eating within a few hours of bedtime
- Identify and limit your personal trigger foods and drinks
- Maintain a healthy weight and stay upright after meals
- Raise the head of your bed if nighttime symptoms are a problem
- Avoid smoking and limit alcohol
When to See a Doctor
See a doctor if heartburn occurs more than twice a week, does not improve with over-the-counter remedies, or is accompanied by difficulty swallowing, unintended weight loss, persistent vomiting, or signs of bleeding such as black stools or vomiting blood.
Call emergency services for chest pain that comes with shortness of breath, sweating, nausea, or pain spreading to the arm, neck, or jaw, as these may be signs of a heart attack rather than reflux.
Frequently Asked Questions
What is the difference between acid reflux and GERD?
Acid reflux is the backflow of stomach acid into the esophagus, and occasional reflux is normal. When reflux happens frequently, is persistent, or causes complications, it is called GERD, the chronic form of the condition that usually needs ongoing management.
How can I tell reflux chest pain from a heart problem?
Reflux pain is typically a burning sensation behind the breastbone, often after meals or when lying down. Chest pain that comes with shortness of breath, sweating, nausea, or pain spreading to the arm, neck, or jaw could be a heart attack and should be treated as an emergency.
What foods trigger acid reflux?
Common triggers include fatty or fried foods, large meals, coffee, alcohol, chocolate, citrus, tomato-based foods, and spicy dishes. Triggers vary between people, so keeping track of what worsens your symptoms helps you avoid them.
Can lifestyle changes really help reflux?
Yes. Eating smaller meals, avoiding late-night eating, losing excess weight, raising the head of the bed, and not smoking can substantially reduce reflux. Many people improve with these steps alone or combined with over-the-counter remedies.
When should I see a doctor about reflux?
See a doctor if heartburn occurs more than twice a week, does not respond to over-the-counter treatment, or comes with trouble swallowing, weight loss, persistent vomiting, or signs of bleeding such as black stools. These can point to GERD or another condition needing evaluation.
References
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Acid Reflux (GER & GERD).
- Mayo Clinic. Gastroesophageal reflux disease (GERD).
- MedlinePlus, U.S. National Library of Medicine. GERD.
- American College of Gastroenterology. Acid Reflux.