Acid reflux is the abnormal backflow of gastric acid into the esophagus causing inflammation and the typical heartburn sensation. This regurgitation of acid (and sometimes bile) causes irritation of the esophagus and if transient may be controlled with diet and over the counter antacids. However if it becomes persistent (GERD – Gastro Esophageal Reflux Disease) it may lead to more serious conditions such as ulcers causing persistent burning sensation or pain on swallowing; scarring with narrowing of the esophagus causing difficulty swallowing; and even chronic changes in the lining of the esophagus (Barrett’s Esophagus) that can lead to esophageal cancer.
This regurgitation of acid is caused by a malfunctioning mechanical barrier at the junction of the esophagus with the stomach. Anatomical problems such as hiatal hernia, medications affecting the muscle such as bronchodilators used in asthma, conditions that increase abdominal pressure such as pregnancy or obesity will predispose to acid reflux.
Although the typical reflux symptom is heartburn others include chest pain that if severe enough may simulate a heart attack; difficulty swallowing; or even respiratory symptoms such as hoarseness, chronic cough, laryngitis, and asthma.
Symptoms of acid reflux may be controlled avoiding predisposing factors such as weight gain, smoking, or eating large meals. Medications that affect the muscular barrier should also be avoided as well as ingesting caffeine products, fatty foods, alcohol, and acidic juices. Elevation of the head of the bed helps to prevent acid reflux at night. Over the counter medications such as antacids can also be used. Patients with a hiatal hernia may benefit from laparoscopic surgery to repair the hernia and reestablish the mechanical barrier to prevent acid reflux.
When acid reflux is persistent or chronic an endoscopy (looking inside the esophagus with a flexible lighted camera) is recommended to evaluate the severity of the disease as well as to look for the presence of Barrett’s esophagus, condition caused by chronic heartburn and important to find as it predisposes to esophageal cancer. These patients may need long term treatment with a stronger acid reducer (prescribed) and periodic endoscopies to look for changes before the development of cancer. Barrett’s esophagus can be cauterized if there is evidence of precancerous changes (dysplasia).
Endoscopy evaluation is recommended in persistent or chronic acid reflux, or if “alarm symptoms” are presents such as weight loss, difficulty swallowing, passage of black stools (bleeding), and anemia. South Texas Gastroenterology Associates consists of six board certified gastroenterologists trained in endoscopy as well as the evaluation and management of GERD and all other gastrointestinal disorders.