Acid Reflux and Chronic Heartburn, Causes, Symptoms, Treatment

What is acid reflux?

Acid reflux is a commonly used term to describe heartburn and indigestion but the process that occurs goes beyond a simple upset tummy. The passage of food that we eat or fluids that we drink is in one direction – it travels from the mouth, down the oesophagus (food pipe/gullet), into the stomach, then the small intestine, through the large intestine and the waste is passed out as stool. During its transit through the gut, food is broken down by mechanical and chemical digestion and nutrients are absorbed. Waste materials remain in the gut until it is evacuated.

Acid reflux occurs when the acidic stomach contents pass up from the stomach into the oesophagus. This backward flow (retrograde) damages the lining of the oesophagus which is not equipped to deal with acid. It causes a burning sensation that we refer to as heartburn and can lead to ulcers and other complications. Acid reflux is a condition that we all will suffer with at some time in life. It is usually temporary and will pass with little or no treatment. Antacids are commonly used to neutralise the acid in the oesophagus and soothe the oesophageal lining.

Causes of Acid Reflux and Chronic Heartburn

Acid reflux may occur after overeating, sleeping immediately after a large meal, exercising after eating or drinking excessive amounts of alcohol. In these cases the acid reflux is acute meaning that it will pass in a short while and not recur unless we repeat these habits that triggered it.

Many cases of acid reflux are chronic and is known as gastro-oesophageal reflux disease or GORD (in the United States it is known as GERD which stands for gastroesophageal reflux disease). Chronic acid reflux occurs for various other reasons but is also aggravated by the same factors as acute reflux – overeating, sleeping or exercising after meals or alcohol. In GORD, the lower esophageal sphincter (LES) which is valve that prevents stomach acid from entering the oesophagus fails to act properly.

This LES dysfunction arises when the valve cannot maintain a tight constriction and prevent the backward flow. The weakened valve therefore allows small amounts of stomach acid to spill into the oesophagus throughout most of the day, especially after eating. It may also occur with certain conditions like a hiatus hernia (also known as a hiatal hernia), sustained raised pressure within the abdomen (like with pregnancy or in obese people) or when other factors delay the stomach from emptying its contents into the small intestine. The heartburn in GORD is not felt all the time and some patients may not report any burning chest pain at all (silent reflux).

Signs and Symptoms

The main signs ans symptoms include :

  • Heartburn – burning chest pain worse after eating, when sleeping
  • Nausea
  • Regurgitation
  • Excessive saliva in the mouth (water brash)
  • Bloated feeling

In more severe cases, especially chronic case, a person may also experience other symptoms which could arise from the complications of long standing acid reflux. These include :

  • Sore throat, especially in the morning upon waking
  • Chest pain that is similar to a heart attack
  • Vomiting
  • Hoarse voice
  • Lump in the throat feeling
  • Cough
  • Risk of respiratory tract infections

Treatment of Acid Reflux and Chronic Heartburn

Acute acid reflux requires little treatment if any and passes on its own. Antacids are usually the treatment of choice for these episodes. With GORD, your doctor may also consider prescribing proton pump inhibitors (PPIs) or H2-receptor blockers, which are medication that help to reduce stomach acid secretion.

Another type of medication known as sucralfates will help line the esophagus and provide a barrier against the acid. Patients with delayed gastric emptying may also use prokinetic drugs to speed up the passage of food from the stomach into the duodenum (the first part of the small intestine).

Surgery may be necessary in severe cases that do not respond to medication. Anti-reflux surgery is done laparoscopically and is known as fundoplication. Here a portion of the stomach is wrapped around the lower end of the oesophagus to strengthen the lower esophageal sphincter (LES).