Stomach reflux is the regurgitation of the stomach contents into the esophagus. It is also known as acid reflux and gastroesophageal reflux. The regurgitated contents are a combination of stomach secretions (acid + digestive enzymes + water + mucus) and recently ingested food and drink. In the chronic setting, stomach reflux can cause a host of complications that are broadly encompassed under the term gastroesophageal reflux disease (GERD). Acute acid reflux is not usually associated with complications, the symptoms are short lived and often resolves without the need for medication or surgery.
Causes of Stomach Reflux
Every person experiences stomach reflux occasionally. In the acute setting, it is often related to :
- Excessive amounts of carbonated beverages
- Excessive belching
- Lying prone (flat) immediately after a large meal
- Caffeinated drinks like coffee, tea and cola
In chronic cases, stomach reflux or gastroesophageal reflux disease (GERD) is more likely linked to :
- LES (lower esophageal sphincter) dysfunction
- Hiatal hernia
- Impaired esophageal motility
- Delayed gastric emptying
- Intra-abdominal pressure – pregnancy, obesity
The factors implicated in acute acid reflux often aggravate gastroesophageal reflux disease but are not the main contributing factors or causes of GERD.
Signs and Symptoms of Stomach Reflux
Heartburn and regurgitation are the most prominent symptoms in stomach reflux. The rising gastric contents irritate the lining of the esophagus thereby eliciting a burning chest pain. The regurgitated contents may rise as high as the oropharynx and elicit the gag or cough reflex.
Waterbrash is the sudden secretion of large volumes of saliva as the acid enters the upper esophagus and mouth. It is a mechanism by which the body attempts to neutralize the stomach reflux as saliva is highly alkaline.
Nausea and vomiting may occur, especially in a case of chronic stomach reflux leading to esophagitis (inflammation of the esophageal lining) and esophageal ulcers.
Throat symptoms vary from mild irritation to a morning sore throat or even a chronic sore throat that persists throughout the day and night. The latter is more likely to occur in cases of chronic stomach reflux (GERD).
Additional gastrointestinal symptoms may include :
- Changes in appetite
- Stomach bloating
- Abdominal discomfort varying from a stomach ache to abdominal pain
- Excessive belching
Chronic stomach reflux (GERD) may lead to various complications including esophageal ulcers, Barrett’s esophagus, esophageal spasms, esophageal strictures and reflux-induced adenocarcinoma. The signs and symptoms of these conditions may also be present.
Treatment of Stomach Reflux
The treatment option depends on the severity of the condition and contributing factor(s). In acute acid reflux, antacids may provide symptomatic relief and no other therapeutic measures may be necessary since the condition is self limiting. Conservative measures like sitting upright and walking may help with preventing stomach reflux or promote gastric emptying and gut motility.
In chronic cases, a more aggressive therapeutic approach is necessary to provide symptomatic relief and reduce the risk of complications.
- Neutralizes stomach acid.
- Offers temporary relief.
- Acid Suppressing Drugs
- Proton pump inhibitors like omeprazole, lansoprazole and pantoprazole.
- H2-blockers like cimetidine and ranitidine.
- These drugs reduce the amount of stomach acid and can be used to prevent stomach reflux.
- Ideal for long term management of stomach reflux.
- Prokinetic Drugs
- Speeds up the passage of food through the gut by promoting gastric emptying and gut motility.
- Includes drugs like metoclopramide and domperidone.
Surgical intervention is not routinely conducted for the treatment and management of chronic stomach reflux. It is considered for patients suffering with severe stomach reflux or cases which are not responding to medication. This surgery is known as laparoscopic anti-reflux surgery and provides symptomatic relief (particularly of heartburn and regurgitation) in most patients. The risk of complications like impairment of the vomiting mechanism and abdominal bloating (“gas bloat” syndrome) is reported in a minority of cases.