Acid reflux or gastroesophageal reflux (not disease) occurs sporadically in a healthy person and has no long term consequences. As discussed under What is Acid Reflux, the alimentary tract has means of dealing with small amounts of stomach acid that occasionally enters the esophagus. However, in cases of persistent or recurrent acid reflux, the extent of the mucosal damage can lead to a complex of signs and symptoms, as well as other long term complications. This is a more severe and chronic form of acid reflux known as gastroesophageal reflux disease (GERD or GORD) and should be investigated and treated appropriately. Acute acid reflux however, is temporary and may pass with no treatment.
It is not uncommon for the terms acid reflux and GERD to be used interchangeably. Both refer to gastric contents rising up into the esophagus. However the causes, severity of symptoms, and treatment may differ and there is a host of even potentially life threatening complications associated with GERD.
There is no standardized definition for gastroesophageal reflux disease (GERD) / gastro-oesophageal reflux disease (GORD.) A broad definition for GERD is recurrent reflux that causes clinically significant symptoms, with or without esophagitis and is associated with a higher risk of complications like esophageal ulcers, Barrett’s esophagus or reflux-induced adenocarcinoma.
Causes of Acid Reflux
Most cases of acute acid reflux occurs due to increased volume of the stomach contents, slow gastric emptying or reduced tonicity of the lower esophageal sphincter (LES). This may occur as a result of :
- consuming carbonated beverages with food
- alcohol consumption
- exercising after eating
- hanging upside down (inversion) after eating
Other factors that contribute to excessive belching may also the odd episode of cause acid reflux.
In these situations, acid reflux may affect any person of any age. Often the odd episode of acid reflux occurs for no known reason. The situations above may exacerbate the symptoms of GERD. It is imperative not to pass off gastroesophageal reflux disease as acute attacks of acid reflux and settle for temporary OTC (over-the-counter) measures. With GERD, further investigation is needed as the cause of the reflux may be due to severe pathology and there are a host of complications that may arise.
Signs and Symptoms of Acid Reflux
The symptoms associated with acid reflux may go by unnoticed (asymptomatic) and due to the self limiting nature of acute reflux, it is not of concern. It is sometimes just passed off as indigestion. At other times, acute reflux may present with mild or severe symptoms.
- Heartburn (burning chest pain)
- Regurgitation (not vomiting)
- Water brash (sudden collection of a large volume of saliva in the mouth)
- Throat irritation (burning, itching, tickling, pain) which may elicit a cough
- Excessive belching
- Stomach bloating – sensation of fullness or pressure in the abdomen
It is not uncommon for some of these acid reflux symptoms to be mistaken for cardiac symptoms. Acute acid reflux is the most common reason for ER visits for chest pain. The differences are outlined in Cardiac vs Non-Cardiac Chest Pain.
Treatment of Acid Reflux
Antacids are usually sufficient to provide temporary symptomatic relief. The condition will pass on its own with nor further treatment required. Patients often report symptomatic relief by standing erect or sitting upright, walking or correcting the posture (in a person who slouches). Milk may provide symptomatic relief as it acts as an alkali however this should not be used as a means of counteracting acid reflux.
Other medication like acid suppressing drugs (proton pump inhibitors and H2-blockers) or drugs that speed up stomach emptying (prokinetic drugs) are not necessary. However, in GERD, these drugs are essential for the treatment and management of the conditions.