Acid Reflux

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Acid Reflux, commonly referred to as Gastroesophageal Reflux Disease or GERD, is a condition in which the liquid content of the stomach regurgitates (backs up or refluxes) into the esophagus. The liquid can inflame and damage the lining (cause, cause esophagitis) of the esophagus although visible signs of inflammation occur in a minority of patients.

The regurgitated liquid usually contains acid and pepsin that are produced by the stomach. (Pepsin is an enzyme that begins the digestion of proteins in the stomach.) The refluxed liquid also may contain bile that has backed-up into the stomach from the duodenum. (The duodenum is the first part of the small intestine that attaches to the stomach.) Acid is believed to be the most injurious component of the refluxed liquid. Pepsin and bile also may injure the esophagus, but their role in the production of esophageal inflammation and damage is not as clear as the role of acid.

Acid Reflux is a chronic condition. Once it begins, it usually is life-long. If there is injury to the lining of the esophagus (esophagitis), this also is a chronic condition.

A doctor can normally diagnose Acid Reflux from the symptoms alone. The most common symptoms of Acid Reflux are heartburn and regurgitation. Most people experience these symptoms occasionally, but some suffer from them more often. If they occur regularly on two or more days per week, or are troublesome enough to affect your daily life, you can be diagnosed as having Acid Reflux. However, in a few cases, doctor may arrange for further investigations to confirm a suspected diagnosis of Acid Reflux:

1. Endoscopy - During an endoscopy, a narrow, flexible tube with a light and camera at the end (fibre optic), is placed into the mouth and throat and then into the esophagus. This allows the doctor to see if there is any reddening (indicating inflammation) or erosions (shallow open sore) or ulcer (deeper lesion)on the esophageal wall. It is also possible to take a small sample (biopsy) of the esophageal wall to check for any histological abnormalities. The procedure may be uncomfortable but is not generally painful.
   
   
2. 24-hour pH testing - The amount of acid in the esophagus can be measured by passing a special tube, through the mouth, into the esophagus. The special tip of the tube can measure the acidity or pH over 24 hours.

Here are a few possible contributing causes of Acid Reflux:

1. Defective Lower Esophageal Sphincter - The most common acid reflux cause is an esophageal sphincter that does not function properly. The esophageal sphincter is a tough rim of muscle that surrounds the lower end of the esophagus. When food is eaten, the sphincter contracts strongly to push the food into the stomach, thus preventing stomach contents from backing up into the throat and mouth.

2. Hiatal Hernia - Hiatal hernia can impair the lower esophageal sphincter function. It is a condition where the upper part of the stomach moves up into the chest through a small opening in the diaphragm (the muscle that separate the stomach from the chest). Furthermore, it is usually caused by severe coughing, vomiting, straining or sudden physical exertion. Obesity or pregnancy may also increase the chance of hiatal hernia.

3. Pregnancy - Some pregnant women may experience acid reflux in their last few months of pregnancy. This is because the growing baby presses on the stomach, which can cause back up of stomach contents into the esophagus. Medication such as antacids will not relief acid reflux caused by pregnancy. The best solution is to eat less for every meal but eat more meals. The good news is, once the baby is born, such acid reflux condition will disappear.

4. Peptic ulcers and insufficient digestive enzymes - Peptic ulcers and an insufficiency of digestive enzymes in the stomach can also be the cause of acid reflux. This is because such conditions may slow down the digestion process in the stomach, resulting in a build up of stomach acids that back up into the esophagus.

5. Asthma - For those who believe asthma can cause acid reflux, the reasoning is because the coughing and sneezing related to asthmatic attacks can cause changes in the chest and trigger acid flux. It is also possible that certain asthmatic drugs (taken to dilate the airways) may relax the lower esophageal sphincter, which is a major cause of acid reflux.

6. Lifestyle Causes - Some lifestyle causes that directly contribute to acid reflux symptoms are smoking, overeating, stress and a diet that is high in salt and fatty foods. Lifestyle causes are usually preventable. For example, a person experiencing acid reflux symptoms after eating a large meal can prevent acid reflux by cutting down portion sizes.

Sources:
HealthCentral: http://www.healthcentral.com/acid-reflux/introduction-000085_2-145.html 
AcidRefluxCure: http://www.acidrefluxcure.net/cause/ 

The severity of heartburn does not necessarily indicate actual injury in the esophagus. For example, Barrett's esophagus, which causes precancerous changes in the esophagus, may trigger few symptoms, especially in elderly people. On the other hand, people can suffer severe heartburn without the presence of damage to the esophagus.

Dyspepsia. Up to half of Acid Reflux patients have dyspepsia, a syndrome consisting of the following:

People can have dyspepsia without having Acid Reflux.

Regurgitation. Regurgitation is the feeling of acid backing up in the throat. Sometimes acid regurgitates as far as the mouth and be experienced as a "wet burp." Uncommonly, it may come out forcefully as vomit.

Medications commonly used in the treatment of acid reflux include:

1. Acid suppressants, such as histamine2-receptor antagonists (blockers). Histamine is a chemical released in the body under different conditions, but particularly during inflammation. In the stomach it can release more acid, so blocking it reduces acid production.
   
   
2. Proton pump inhibitors, which reduce the production of acid in the stomach by acting on cells in the stomach wall that make acid and release it into the stomach.
   
   
3. Prokinetic agents, which promote emptying of the stomach so it does not overfill. They work by increasing the pressure of the lower esophageal sphincter (the muscular valve between the lower end of the stomach and the small bowel)
   
   
4. Antacids are over-the-counter medicines that are commonly used to treat mild acid-related symptoms, like heartburn or indigestion, and work by neutralising acid in the stomach. However, they are not usually recommended to treat the frequent heartburn suffered by people with Acid Reflux.