Acid reflux commonly occurs when the lower esophageal sphincter (LES) does not work properly, and allows acid to seep upwards from the stomach to the esophagus. Although we know that a faulty LES is a common cause, we are not sure why it becomes faulty. One of many reasons could be that pressure in the stomach rises higher than the LES can withstand.
Here are some common causes of acid reflux:
* Pregnancy - more commonly found during the third trimester of a pregnancy. As the growing baby presses on the stomach, contents may back up into the esophagus. Doctors say antacids will not relieve acid reflux caused by pregnancy. Patients find that if they eat smaller meals but eat more meals per day, it helps. In the vast majority of cases the acid reflux will disappear soon after the baby is born.
* Large meals and eating habits - people who have large meals will usually find that their acid reflux will improve if they cut down portion sizes. Patients who kept a food diary, noting down everything they ate and linking certain foods to incidences of acid reflux, have experienced a reduction in acid reflux.
* Bending forward - this movement will not usually cause acid reflux unless there is another underlying trigger or problem.
* Hiatus hernia (hiatal hernia) - a condition where the upper part of the stomach protrudes into the chest through a small opening in the diaphragm. Hiatal hernias are commonly caused by severe coughing, vomiting, straining, sudden physical exertion, pregnancy, and obesity.
* Peptic ulcers and insufficient digestive enzymes - peptic ulcers and not enough digestive enzymes in the stomach may slow down the digestive process, causing an accumulation of gastric acids that back up into the esophagus.
* Asthma - experts still argue about which came first, the asthma or the acid reflux - did the asthma cause the acid reflux or did the acid reflux cause the asthma? Nobody has a definite answer to the relationship between asthma and acid reflux. Some say that the coughing and sneezing brought on by asthmatic attacks can cause changes in the chest which trigger acid reflux. Others blame asthma medications - they are taken to dilate the airways, but might also relax the esophageal sphincter.
Most asthma sufferers say that their asthma is worsened by acid reflux because the acid that seeps into the esophagus from the stomach stimulates the nerves along the neck into the chest, causing bronchial constriction and breathing problems.
* Smoking - research has shown that the saliva of smokers contain lower levels of bicarbonates, which neutralize acids. Cigarette smoking also reduces the production of saliva. Smoking also stimulates the production of stomach acid, weakens the esophageal sphincter, promotes the movement of bile salts from the intestine to the stomach (making the acids more harmful), and slows down digestion (making stomach pressure last longer because it takes more time to empty).
* Alcohol - patients have commented that quitting alcohol, or cutting down consumption significantly improved their symptoms.
What is the treatment for acid reflux?
The vast majority of people with acid reflux will get better if they make some changes to their diet. Some foods are safe for heartburn sufferers, while others are major triggers of it.
It would be easy to say that there is a reflux diet. Unfortunately, we all react differently to different foods.
Below is a list of foods/drinks that commonly cause irritation and/or heartburn:
* Black pepper
* Chili and chili powder
* Citrus fruit, pineapple
* Spicy food
* Tomatoes, tomato sauce, tomato juice, ketchup
Some patients with acid reflux say these gassy foods cause discomfort:
* Brussel Sprouts
* Fizzy drinks (sodas)
* Acid suppressant - these have been shown to be effective, such as histamine2-receptor antagonists (blockers). Histamines are good at reducing inflammation. An inflamed stomach produces more acid - blocking this extra production of acid helps prevent the acids from building up and seeping upwards.
* Propton pump inhibitors - these reduce the production of acid in the stomach. They act on cells in the stomach wall and produce stomach acids.
* Prokinetic agents - these promote the emptying of the stomach, stopping it from becoming overfull.
* Antiacids - commonly used to treat mild acid-related symptoms, such as heartburn or indigestion. They neutralize the acids in the stomach. These are not recommended for frequent heartburn for patients with GERD.