Digestive Health

Acid Reflux: Causes, Symptoms, and Diagnosis

When we swallow, a circular band of muscle around the bottom of esophagus relaxes and allows food and liquid to flow into the stomach. The sphincter then closes again. Acid reflux or gastrointestinal reflux disease (GERD) occurs due to a weakened sphincter. It results in stomach acid being frequently flown back inside the tube connecting the stomach and tube (esophagus). This can cause irritation in the inner lining of the stomach.

Some of the common symptoms of acid reflux include burning sensation in the chest (heartburn), chest pain, difficulty swallowing, lumpy sensation in the throat, chronic cough, laryngitis, asthma and disrupted sleep. While there are no fixed causes that trigger acid reflux, doctors have observed the following factors, which can worsen the symptoms:

1. Stomach abnormalities
Abnormalities such as hiatal hernia has been observed to be the most common acid reflux cause. Hiatal hernia occurs when the upper part of the stomach or lower esophageal sphincter (LES) moves above the diaphragm.

2. Pregnancy
Most pregnant women experience acid reflux due to imbalance in the hormones combined with the pressure from the growing fetus. The condition worsens during the third trimester. However, the symptoms usually go away after the delivery.

3. Smoking
It may contribute to acid reflux disease by damaging mucus membranes, impairing muscle reflexes in the throat, reducing LES muscle function, and increasing acid secretion.

4. Improper diet
Lying down right after having a large meal can trigger heartburn and symptoms of acid reflux such as trouble swallowing and dry cough. Other than this, some common foods that trigger acid reflux include alcohol, carbonated beverages, chocolate, fatty or fried food, highly processed foods

If not treated, acid reflux can lead to chronic inflammation in the esophagus and cause the following complications:

  • Esophageal ulcer
    It is an open sore in the esophagus which can bleed and can cause pain, making swallowing difficult.
  • Narrowing of the esophagus
    Also known as esophageal stricture, it damages the lower esophagus from stomach acid, leading to the formation of scar tissue. The scar tissue leads to narrowed food pathway, resulting in difficulty to swallow.
  • Barrett’s esophagus
    The damage from the acid can cause changes in the tissue lining of the lower esophagus. This can increase the risk of esophageal cancer.

The doctors will perform the following diagnostic tests to determine acid reflux, based on patient history, signs and symptoms:

  • Upper endoscopy
    The doctors insert a thin flexible tube down the patient’s throat. The endoscope is equipped with a light and camera for viewing and examining the stomach and esophagus. The endoscope helps in detecting inflammation of the esophagus and can also sample of tissues for biopsy.
  • Ambulatory acid (pH) probe test
    This test involves placing a small monitor in the esophagus to examine, when and how long stomach acid regurgitates. The monitor is connected to a small computer screen to look for symptoms of GERD. The monitor is a thin long flexible tube with a camera that examines the esophagus.
  • Esophageal manometry
    The test measures rhythmic muscle contractions in the esophagus when the patient swallows. It also measures if the power of the sphincter has weakened as it may lead to acid reflux or GERD.