Acid reflux, also called gastroesophageal reflux (GER), occurs when stomach acid or food flows back into the esophagus. This happens when the lower esophageal sphincter (LES) relaxes or becomes weak, causing symptoms like a burning sensation in the throat or chest (heartburn), a bitter taste in your mouth, burping, nausea, and bloating. Many people get occasional acid reflux after eating a large meal or lying down too soon after eating.
Almost everyone experiences acid reflux occasionally, but it may be gastroesophageal reflux disease (GERD) if you have acid reflux more frequently. About 20% of the US population has GERD. Treatment for acid reflux usually involves lifestyle changes and medications.
Types
There are two main types of acid reflux: gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD). The key difference between GER and GERD is the severity and frequency of symptoms.
Gastroesophageal Reflux (GER)
Gastroesophageal reflux (GER) happens when the lower esophageal sphincter (LES) relaxes and allows stomach contents to flow back into the esophagus, causing symptoms such as burning in the chest and throat, regurgitation, and burping. GER is common and is often caused by eating spicy or fatty foods, drinking carbonated beverages or fruit juices, and certain medical conditions and medications. GER is also called heartburn, reflux, acid reflux, and acid indigestion.
Gastroesophageal Reflux Disease (GERD)
Gastroesophageal reflux disease (GERD) is a chronic form of acid reflux that happens when GER symptoms persist and cause damage to the esophagus. In addition to the typical symptoms of GER, people with GERD may experience symptoms like difficulty swallowing, chest pain, chronic cough, and throat irritation. GERD can lead to complications if left untreated.
Acid Reflux Symptoms
Symptoms of acid reflux vary from person to person. Some people may have no symptoms, and others may have common symptoms of acid reflux, including:
A burning sensation in the chest or throat that may worsen after eating, lying down, or bending over
A bitter or sour taste in the mouth caused by stomach contents flowing back up into the throat or mouth (regurgitation)
Burping
Bad breath
Feeling like a lump is in your throat
Sore throat
Hiccups
Abdominal bloating
Nausea
Dry cough
What Causes Acid Reflux?
Acid reflux occurs when the lower esophageal sphincter (LES)—a bundle of muscle at the bottom of the esophagus—relaxes when it shouldn't or becomes weak, allowing stomach contents (acid and food) to flow back into the esophagus. Several factors may cause or contribute to a weakened LES and acid reflux, including:
Obesity: Excess body weight can increase pressure on the stomach, forcing acid to flow back into the esophagus.
Hiatal hernia: A condition in which part of the stomach bulges through an opening in the diaphragm into the chest, weakening the LES and leading to acid reflux.
Pregnancy: Hormonal changes and increased pressure on the stomach from a growing baby can cause acid reflux during pregnancy.
Risk Factors
Certain risk factors can increase the likelihood of acid reflux, including:
Smoking
Consuming large meals
Lying down or engaging in exercise after eating
Eating certain trigger foods, such as spicy or acidic foods
Certain medications, such as beta-blockers for heart disease or high blood pressure, sedatives for anxiety, antihistamines, and tricyclic antidepressants
Stress
Anxiety
Poor sleep habits
Diagnosis
Acid reflux is usually easy to diagnose based on your symptoms. If you have occasional acid reflux, you may be able to identify symptoms and use over-the-counter medications to alleviate symptoms.
A healthcare provider can diagnose acid reflux based on your symptoms, medical history, and a physical examination. Occasional acid reflux usually does not require tests to diagnose, but if it happens more than a couple of times a week or if you have symptoms that suggest complications of GERD, your healthcare provider may recommend testing. These tests can include:
Upper gastrointestinal endoscopy: A flexible tube with a camera is passed down the throat and into the esophagus and stomach to examine the tissues for signs of damage.
Esophageal pH monitoring: A small capsule or catheter is inserted through the nose or mouth to measure the amount of acid reflux in the esophagus over a certain period (e.g., 24 hours).
Barium swallow: Also known as an esophagogram, a barium swallow test involves swallowing a chalky-tasting liquid containing barium sulfate. It is a radiographic contrast agent, meaning it shows up on X-rays and can help identify any abnormalities or damage to the esophagus, throat, and stomach.
Esophageal manometry: A thin, flexible tube is passed through the nose or mouth and into the esophagus to measure the strength and coordination of the muscles involved in swallowing.
Treatments for Acid Reflux
Treatment for acid reflux usually includes lifestyle modifications and medications to manage symptoms and prevent complications. If you have occasional acid reflux, healthy lifestyle habits and over-the-counter medicines may be sufficient to manage symptoms. For more frequent or severe acid reflux, your healthcare provider may recommend prescription medications.
Lifestyle Modifications
Acid reflux can often be managed through lifestyle modifications, including:
Avoid eating foods that trigger symptoms, including spicy, acidic, and fatty foods (e.g., citrus, peppermint, tomatoes or tomato sauce, fried foods, coffee)
Eat smaller, more frequent meals rather than large ones
Lose weight if you carry excess body weight
Avoid laying down 2-3 hours after eating
Elevate your upper body and head by 6-8 inches when sleeping (e.g., stack blocks or books under the legs of the head of your bed)
Quit smoking and avoid secondhand smoke exposure
Medications
Many over-the-counter (OTC) medications may help relieve symptoms of acid reflux, including antacids, H2-receptor blockers, and proton pump inhibitors. These medicines can have side effects and may interact with other medications, so talk to your healthcare provider before starting any new drug for acid reflux.
Antacids: These medicines neutralize stomach acid and quickly relieve mild to moderate acid reflux symptoms. Some examples of OTC antacids include Tums, Rolaids, and Maalox.
H2-receptor blockers: These drugs reduce the amount of acid the stomach produces, which can help relieve acid reflux symptoms. H2 blockers may take longer than antacids, but their effects last longer. Examples include Tagamet (cimetidine) and Pepcid (famotidine).
Proton pump inhibitors (PPIs): These medications block the enzyme in the stomach that produces acid, which can help reduce acid reflux symptoms. PPIs are typically taken once a day and are often more effective than H2 blockers for controlling acid reflux symptoms. Examples include Prilosec (omeprazole), Nexium (esomeprazole), and Prevacid (lansoprazole).
If these medicines don't effectively manage your symptoms, your healthcare provider may prescribe other medications to help control acid reflux.
Prevention
Lifestyle modifications can help prevent or reduce the frequency of acid reflux:
Maintain a healthy weight
Avoid trigger foods (e.g., spicy, fatty, or acidic foods)
Eat smaller meals throughout the day
Wait 2-3 hours after eating before lying down
Elevate the head of your bed by 6-8 inches
Quit smoking or avoid secondhand smoke
Limit alcohol and caffeine
Complications
Occasional acid reflux is normal and does not lead to complications. However, untreated, long-lasting acid reflux (GERD) can damage the esophagus and cause serious complications such as:
Esophagitis: Inflammation of the esophagus can occur when stomach acid frequently flows back into the esophagus, leading to ulcers and bleeding in the esophageal lining.
Barrett's esophagus: A condition in which esophageal tissue is replaced with tissue similar to the lining of your intestines, increasing the risk of esophageal cancer.
Esophageal stricture: Narrowing of the esophagus due to damage and scarring from repeated exposure to stomach acid can make swallowing difficult.
Some people with GERD may experience complications in other areas of the body, such as:
Respiratory problems, including chronic cough and asthma
Erosion of tooth enamel
Laryngitis (loss of voice) or hoarseness
Here's Everything You Need to Know About the Complications of GERD
Living With Acid Reflux
Occasional acid reflux is normal, and most people can control symptoms with over-the-counter medicines, such as antacids. Eating smaller meals, maintaining a healthy body weight, and avoiding trigger foods (e.g., acidic or fatty foods), can help prevent acid reflux.
Frequent acid reflux is a sign of gastrointestinal esophageal reflux disease (GERD), which is more serious and requires medical attention for a diagnosis, treatment plan, and monitoring for potential complications. Most people with GERD can control symptoms and prevent complications with appropriate treatment.