Acute attacks of acid reflux occur periodically in life and is often associated with overeating, alcohol excess, exercising or lying flat after a large meal. These acute attacks are severe in that the symptoms are intense but subside with little or no treatment.
In chronic cases of acid reflux, known as gastroesophageal reflux disease or GERD, the symptoms are present almost daily or even throughout the day. It is often not as severe as the acute attacks since a person adapts to the sensations (heartburn, nausea, bloating) and the damage to the esophageal lining means that the sensory perception is hampered. With GERD, the cause often lies with an LES dysfunction but may also be due to a hiatal hernia, intra-abdominal pressure or delayed gastric emptying. Acute exacerbations in GERD can however be quite severe and debilitating.
Severe acid reflux is often defined by the intensity of symptoms or severity of complications.
- Intensity of symptoms
- Heartburn – burning chest pain
- Stomach bloating – sensation of fullness or pressure
- The symptoms of severe acid reflux can be so intense that it is often mistaken for a heart attack.
- Severity of complications
Severe acid reflux is usually a combination of multiple factors rather than a single factor as is seen with acute reflux or GERD. The more severe episodes are seen with both these short and long term factors.
- Overeating is one of the most common causes of severe acid reflux. This is often seen in the festive or social settings. It may also be seen with alcohol or drug intoxication where self-control and the feeling of satiety is impaired.
- Alcohol affects the tonicity of the lower esophageal sphincter (LES) and excessive consumption can be followed by severe acid reflux.
- Cigarette smoking has also been implicated in severe cases of acid reflux as it increases gastric acid secretion. Bouts of excessive smoking may be followed by chest pain which could possibly be a result of acid reflux (heartburn).
- Obesity and pregnancy increase the intra-abdominal pressure, hamper gastric emptying, disrupt LES functioning and affect the pressure gradient between the chest and abdominal cavity. All these factors can result in severe acid reflux.
- Gastric outlet obstruction as is seen with pyloric stenosis, stomach polyp or tumors which hampers the emptying of the stomach and results in frequent regurgitation.